Documenting Restraint: Minimizing Trauma

Zaheer, Juveria

doi:10.1007/978-3-030-83692-4_5

Cited by 4 publications

(1 citation statement)

References 26 publications

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“…9 10 Further, common practices used to manage patient aggression, including chemical and physical restraints and seclusion, are coercive practices that can be (re)traumatising. [11][12][13] These practices negatively impact the patient experience of care, [13][14][15][16][17] reduce the willingness of patients to disclose sensitive information 18 19 and may increase patient aggression overall. 20 As a result, most psychiatric settings aim to identify early warning signs of aggression, such as agitation, to facilitate timely and noncoercive interventions.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

Predictive care: a protocol for a computational ethnographic approach to building fair models of inpatient violence in emergency psychiatry

et al. 2023

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IntroductionManaging violence or aggression is an ongoing challenge in emergency psychiatry. Many patients identified as being at risk do not go on to become violent or aggressive. Efforts to automate the assessment of risk involve training machine learning (ML) models on data from electronic health records (EHRs) to predict these behaviours. However, no studies to date have examined which patient groups may be over-represented in false positive predictions, despite evidence of social and clinical biases that may lead to higher perceptions of risk in patients defined by intersecting features (eg, race, gender). Because risk assessment can impact psychiatric care (eg, via coercive measures, such as restraints), it is unclear which patients might be underserved or harmed by the application of ML.Methods and analysisWe pilot a computational ethnography to study how the integration of ML into risk assessment might impact acute psychiatric care, with a focus on how EHR data is compiled and used to predict a risk of violence or aggression. Our objectives include: (1) evaluating an ML model trained on psychiatric EHRs to predict violent or aggressive incidents for intersectional bias; and (2) completing participant observation and qualitative interviews in an emergency psychiatric setting to explore how social, clinical and structural biases are encoded in the training data. Our overall aim is to study the impact of ML applications in acute psychiatry on marginalised and underserved patient groups.Ethics and disseminationThe project was approved by the research ethics board at The Centre for Addiction and Mental Health (053/2021). Study findings will be presented in peer-reviewed journals, conferences and shared with service users and providers.

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