A Synthesis of What We Know About the Use of Physical Restraints and Seclusion with Patients in Psychiatric and Acute Care Settings

Abstract

Purpose (1) This article synthesizes research findings on the use of restraint and seclusion with patients in psychiatric and acute care settings. Conclusions (2) The little that is known about restraint/seclusion use with these populations is inconsistent. Attitudes and perceptions of patients, family, and staff differ. However, all patients had very negative feelings about both, whether they were restrained/secluded or observed by others who were not restrained. The reasons for restraint/seclusion use vary with no accurate use rate for either. What precipitates the use of restraint/seclusion also varies but professionals claim they are necessary to prevent/treat violent or unruly behavior. Some believe seclusion/restraint is effective but there is no empirical evidence to support this belief. Many less restrictive alternatives have been tested with varying outcomes. Several educational programs to help staff learn about different ways to handle violent/confused patients have been successful. Implications (3) Until more is known about restraint/seclusion use from prospective controlled research, the goal to use least restrictive methods must be pursued. More staff educational programs must be offered and the evaluation of alternatives to restraint/seclusion pursued. When seclusion/restraint is necessary it should be used less arbitrarily, less frequently, and with less trauma.

An Instrument to Measure Mental Health Professionals’ Beliefs and Attitudes Towards Service Users’ Rights

“…We would like to highlight that more than half of our sample believed that mechanical restraints are sometimes necessary and that one should be involuntarily hospitalised even if they do not pose a threat to others. This is in contrast to the evidence that shows a worse prognosis [60], iatrogenia [61,62], and even death [63] caused to people subjected to such coercive measures. Conversely, restraint reduction has been shown to be feasible [64] and to reduce the risk of injury and medical leave among nursing staff [65].…”

An Instrument to Measure Mental Health Professionals’ Beliefs and Attitudes towards Service Users’ Rights

“…We would like to highlight that more than half of our sample believed that mechanical restraints are sometimes necessary and that one should be involuntarily hospitalised even if they do not pose a threat to others. This is in contrast to the evidence that shows a worse prognosis [60], iatrogenesis [61,62], and even death [63] for people subjected to such coercive measures. Conversely, restraint reduction has been shown to be feasible [64] and to reduce the risk of injury and medical leave among nursing staff [65].…”

The Conceptualization of Physical Restraint as a Nursing-Sensitive Adverse Outcome in Acute Care Psychiatric Treatment Settings

“…This intervention failed to significantly decrease aggressive incidents among the experimental group; however, the severity of aggressive incidents was less than that in the control group. Despite numerous attempts to minimize aggression and the use of physical restraint in psychiatric hospitals, there are no conclusive findings about the most effective method (Bower, McCullough, & Timmons, 2003). Although interventions are mediated by the organization to influence client outcomes, the exact mechanism of this bidirectional relationship is not known.…”