Faulty Assumptions Associated With the Use of Restraints With Children

Mtrhr, Wanda K.; Anderson, Jeffrey

doi:10.1111/j.1744-6171.2001.tb00305.x

Cited by 14 publications

(2 citation statements)

References 45 publications

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“…To our knowledge, no quantitative studies until the present have examined the extent to which weight restoration is facilitated by the use of physical restraint, that is, the use of physical force to restrict or control the patient. In the literature, the general view is that interventions involving physical restraint have no inherent therapeutic effects in the treatment of children and adolescents [5] and may be associated with negative psychological outcomes [6,7]. However, the literature has largely concerned itself with physical restraint to manage patient aggression [8,9], and therefore may not generalize to physical restraint utilized to administer nutrition in ED.…”

Section: Introductionmentioning

confidence: 99%

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

2020

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Background: Studies of the use and effects of physical restraint in anorexia nervosa (AN) treatment are lacking. The purpose of this study was to describe the frequency of physical restraint in a specialized program for adolescents with AN, and to examine if meal-related physical restraint (forced nasogastric tube-feeding) was related to 5-year outcome. Method: Thirty-eight (66% of 58) patients with AN (mean age 15.9, SD = 1.9) admitted to a regional, specialized adolescent eating disorders (ED) inpatient unit. Patient data, including restraint episodes, were obtained from hospital records, and outcome was assessed at a 5-year follow-up. Results: A total of 201 restraint episodes occurred over 5513 days of inpatient treatment, including 109 meal-related episodes and 56 episodes to avoid self-harm. Twelve (32%) patients experienced at least one restraint episode during the admission, of which eight (21%) experienced meal-related restraint. Four patients represented 91% of all restraint episodes, experiencing 10 or more episodes during admission. Meal-related restraint was significantly associated with a higher rate of persisting ED diagnosis, but not with weight gain during admission, EDE-Q global score or BMI at follow-up. Conclusions: Restraint episodes occurred rather infrequently. A small number of patients (n = 4) accounted for a high proportion of episodes (91%). More knowledge is important to reduce the need for restraint in treatment for AN.

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Section: Introductionmentioning

confidence: 99%

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

2020

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“…However, the application of these restrictive interventions is fraught with challenges. For example, critics have cited the lack of evidence for long-term benefits, potential physical injury, and psychological harm resulting from seclusion and restraint, along with the absence of a sound and empirically based theory underpinning the application of these techniques (e.g., Measham, 1995; Mohr & Anderson, 2001; Mohr, Mahon, & Noone, 1998). …”

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confidence: 99%

Prediction of restraints among youth in a psychiatric hospital: application of translational action research

2011

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This study extends a translational action research program by applying a theoretically based measure of risk in predicting incidents of restraint among children and adolescents in a secure psychiatric hospital. Youth inpatients (N=149, ages 5-17) were assessed at intake for the presence of selected individual and contextual risk factors, and their involvement in critical incidents was tracked (i.e., number of episodes in which restraint was applied) for the remainder of their hospitalization. Models including history of aggression or history of previous placements as well as a combined model including several individual and contextual factors significantly predicted the likelihood of a youth becoming involved in at least one restraint. Unique predictors of restraint involvement included history of aggression against adults and history of previous psychiatric hospitalizations. None of the variables assessed predicted the extent of a youth’s restraint involvement. The implications of these findings are discussed with respect to future research and empirically informed practice with high-risk youth.

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Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint

Huckshorn

2005

Adm Policy Ment Health

103

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: The members of the National Association of State Mental Health Program Directors (NASMHPD) believe that seclusion and restraint, including "chemical restraints," are safety interventions of last resort and are not treatment interventions. Seclusion and restraint should never be used for the purposes of discipline, coercion, or staff convenience, or as a replacement for adequate levels of staff or active treatment. The use of seclusion and restraint creates significant risks for people with psychiatric disabilities. These risks include serious injury or death, retraumatization of people who have a history of trauma, and loss of dignity and other psychological harm. In light of these potential serious consequences, seclusion and restraint should be used only when there exists an imminent risk of danger to the individual or others and no other safe and effective intervention is possible. (Endorsed by the State Mental Health Directors, July 13, 1999). (NASMHPD 1999, NASMHPD Position Statement on Seclusion and Restraint. Alexandria, VA: National Technical Assistance Center for State Mental Health Planning.).

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Faulty Assumptions Associated With the Use of Restraints With Children

Abstract: Alternatives to restraints must be investigated and developed to replace the current reactive, crisis-management orientation of practice.

Cited by 14 publications

References 45 publications

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

Prediction of restraints among youth in a psychiatric hospital: application of translational action research

Re-Designing State Mental Health Policy to Prevent the Use of Seclusion and Restraint

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