An audit of physical restraint and seclusion in five psychogeriatric admission wards in Victoria, Australia

O'Connor, Daniel William; Horgan, Lucy; Cheung, Alice; Fisher, Dawn; George, Kuruvilla; Stafrace, Simon

doi:10.1002/gps.1154

Cited by 11 publications

(15 citation statements)

References 6 publications

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“…Comparisons with previously published results remain difficult, due to lack of uniformity in reporting (Bowers 2000) and heterogeneity of settings. However, from the work that is available, the rates of restraint for all wards in this study are lower than previous studies (DeSantis et al 1997;O'Connor et al 2004).…”

Section: Discussioncontrasting

confidence: 69%

“…O'Connor et al . () found that restraint use and types of restraint implemented differed substantially across five acute care psychiatric wards for older persons in the same region of Melbourne, Australia. DeSantis et al .…”

Section: Introductionmentioning

confidence: 99%

“…Engberg et al 2008) settings have been investigated, there has been limited examination of the use of containment practices with older persons in psychiatric settings. In a Swedish study of different older persons' care settings, the highest rate of restraint for a 1-week period was for a psychogeriatric clinic (Karlsson et al 1996). O'Connor et al (2004 found that restraint use and types of restraint implemented differed substantially across five acute care psychiatric wards for older persons in the same region of Melbourne, Australia.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Restraint use in acute and extended mental health services for older persons

Gerace

Mosel

Oster

et al. 2012

Int J Mental Health Nurs

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Section: Discussioncontrasting

confidence: 69%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Restraint use in acute and extended mental health services for older persons

Gerace

Mosel

Oster

et al. 2012

Int J Mental Health Nurs

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show abstract

“…However, there has been little investigation of the use of these containment practices with elderly persons in old age psychiatry inpatient settings, and the rate and type of restraint use can vary, even within neighbouring units [30]. Furthermore, Cochrane reviews of restraint and seclusion [31] and containment practises [32] have concluded that non-pharmacological approaches to restraint and seclusion are not supported by evidence from controlled studies.…”

Section: Introductionmentioning

confidence: 99%

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

McCann

Baird²,

Muir‐Cochrane

2014

BMC Psychiatry

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BackgroundIn psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings.MethodsA convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings.ResultsEighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued.ConclusionsAggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour.

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“…Usage varies widely between and within organizations (O'Connor et al . , Gerace et al . ) and globally (ranging from 12% to 47%) (Evans et al .…”

Section: Introductionmentioning

confidence: 99%

Nurses' experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: a qualitative study

Muir‐Cochrane

Baird²,

McCann

2014

Psychiatric Ment Health Nurs

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Accessible summary• While the decision to use restraint and seclusion was not taken lightly, nurse participants felt that there were no effective alternatives to the use of these measures.• Adverse interpersonal, physical and practice environments contributed to the onset of aggression in old age psychiatry inpatient settings.• Policies to reduce or eliminate the use of restraint and seclusion need to take account of wide-ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices. AbstractRestraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices.

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An audit of physical restraint and seclusion in five psychogeriatric admission wards in Victoria, Australia

Cited by 11 publications

References 6 publications

Restraint use in acute and extended mental health services for older persons

Restraint use in acute and extended mental health services for older persons

Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

Nurses' experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: a qualitative study

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