Effectiveness and safety of restraint and breakaway techniques in a psychiatric intensive care unit

Abstract

Restraint procedures, as taught in Control and Restraint training, appear to be an effective and reasonably safe means of manually controlling a violent client in psychiatric intensive care settings.

Manual restraint of adult psychiatric inpatients: a literature review

“…Incidence rates varied greatly among studies using violent or aggressive incident reports as the basis for analysis, with some studies in forensic settings reporting very high levels of restraint. The proportion of incidents resulting in restraint varied from 4% (Cheung et al 1997), 12% (Torpy & Hall 1993), 23% (Parkes 2003, Southcott & Howard 2007, 26% (Tobin et al 1991), 36% (Kennedy et al 1995, Duff et al 1996, 37% (Smith & Humphreys 1997), 38% (Shepherd & Lavender 1999), 57% (Dowson et al 1999) to 67% in a medium secure unit (Gudjonsson et al 2000) and 76% in a Special Hospital for dangerous offenders (Larkin et al 1988).…”

“…Manual restraint carries a risk of injury for all those involved and in some circumstances can provoke aggressive behaviour (Powell et al 1994), but injuries are generally more common among staff than patients. The proportion of restraint episodes resulting in staff injuries ranged from 12% (Southcott & Howard 2007), 17% (Riley et al 2006, Lancaster et al 2008, 19% (Parkes 1996, Leggett & Silvester 2003, Parkes 2003 to 40% (Dowson et al 1999). In contrast, restraint episodes leading to patient injuries ranged from 5% (Southcott & Howard 2007), 6% (Riley et al 2006, Lancaster et al 2008, 7% (Dowson et al 1999), 10% (Parkes 1996) to 18% (Leggett & Silvester 2003).…”

“…The proportion of restraint episodes resulting in staff injuries ranged from 12% (Southcott & Howard 2007), 17% (Riley et al 2006, Lancaster et al 2008, 19% (Parkes 1996, Leggett & Silvester 2003, Parkes 2003 to 40% (Dowson et al 1999). In contrast, restraint episodes leading to patient injuries ranged from 5% (Southcott & Howard 2007), 6% (Riley et al 2006, Lancaster et al 2008, 7% (Dowson et al 1999), 10% (Parkes 1996) to 18% (Leggett & Silvester 2003). A survey of nurses also reported more injuries among staff and that injuries sustained by staff were generally more serious than those of patients (Lee et al 2003).…”

Breakaways in specialist secure psychiatry

“…One-third of respondents reported assault and one quarter reported use of a breakaway technique in the past year. Breakaways were used frequently compared with reports of psychiatric care staff employed in acute (11%; Wright et al 2005), medium secure (0%; Rogers et al 2006) and psychiatric intensive care (13%; Southcott & Howard 2007) settings. This may reflect study variations in the definition of breakaways and the timescales involved.…”

A qualitative investigation into nurses' perceptions of factors influencing staff injuries sustained during physical interventions employed in response to service user violence within one secure learning disability service

“…Physical interventions carry a risk of injury for all those involved and in some circumstances can provoke aggressive behaviour (Powell et al 1994), but injuries are generally more common among staff than service users. The proportion of physical intervention episodes in mental health settings resulting in staff injuries vary from 12% (Southcott & Howard 2007) to as high as 40% (Dowson et al 1999), whilst intervention episodes resulting in service user injuries ranged from 5-7% (Southcott et al 2002) to 18% (Leggett & Silvester 2003). A survey of nurses also reported more injuries among staff and that their injuries were generally more serious than those of service users (Lee et al 2003).…”