Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff

Vedana, Kelly Graziani Giacchero; Silva, Danielle Maria da; Ventura, Carla Aparecida Arena; Giacon, Bianca Cristina Ciccone; Zanetti, Ana Carolina Guidorizzi; Miasso, Adriana Inocenti; Borges, Tatiana Longo

doi:10.1016/j.apnu.2017.11.027

Cited by 36 publications

(93 citation statements)

References 20 publications

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“…However, the use of restraint is at odds with the global movement for a cessation of its use [35,36]. The use of restraint can result in physical injuries [4,15] and emotional distress for staff and patients [14]. Its use may also impact on the effective delivery of person-centred care as it is a coercive strategy [34] that has the potential to negatively impact the important therapeutic relationship between staff and patients.…”

Section: Discussionmentioning

confidence: 99%

“…The best practice recommendation for mild-moderate agitation is for the ' rst choice' use of non-pharmacological interventions such as verbal de-escalation or engaging the patient in diversionary activities [1,13]. Best practice also recommends the avoidance of invasive measures such as physical or mechanical restraint and environmental seclusion of the patient due to their potential to result in physical injuries [13] and psychological distress [14,15] to staff and patients and to negatively impact the therapeutic relationship between the two [4]. In circumstances where de-escalation or diversionary strategies are ineffective or inappropriate, the best practice pharmacological treatment of agitation is to use medications that are safe, easy and quick to administer; have rapid impact, and do not overly sedate the patient [4].…”

Section: Introductionmentioning

confidence: 99%

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Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Tucker¹,

Whitehead

Palamara

et al. 2020

Preprint

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Background: Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. Methods: This study used a qualitative cross-sectional descriptive methodology. Semi-structured focus group interviews were conducted with twenty-one nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. Results: Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care.Conclusion: The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Tucker¹,

Whitehead

Palamara

et al. 2020

Preprint

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“…Studies performed in the psychiatric hospitals of two Brazilian cities estimated that physical restraint was used in 13%-36% of admissions and that it was more common in the patients presenting with agitation/aggressive behavior (Vedana et al, 2018).…”

Section: Prevalencementioning

confidence: 99%

“…Regarding the restraint measures, The Brazilian Federal Care Council states that nurse assistants can only use mechanical restraints under the direct supervision of nurses, except in emergency situations. Maintenance control is also needed by the doctors (Vedana et al, 2018).…”

Section: Parts Involvedmentioning

confidence: 99%

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Minimizing the Use of Restraint in Patients with Mental Disorders at a Mental Hospital: A Systematic Review

Syamsudin

Fiddaroini

Heru

2020

J. Ners

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Background: Restraint in the psychiatric unit is a common practice but it is very controversial and it has undergone a poor evaluation according to methodological investigations. Using restraint is a common problem and has a significant impact on patients, families and health care staff. Therefore, this systematic review will discuss the important reasons as to why restraint should be reduced. It will also explain several alternative treatments for aggressive patients in mental hospitals.Method: The database searches were used to identify potential articles: Scopus and Proquest were the focus. The search was limited to those published in the range of the last 5 years from 2013 to 2018. The keywords that were used were ‘restraint in the hospital’, ‘restraint reduction’, ‘the elimination of restraint’ and ‘physical restraint’.Result: Only 15 articles met the inclusion criteria. The results suggest that restraint is considered to be a violation of human rights and that it traumatizes the patients. It is inhuman and degrading. Besides this, restraint can result in physical complications in the form of lacerations, asphyxia, thrombosis and death. Restraint is permitted when other methods fail and in emergency conditions.Conclusion: Some of the ways to reduce the use of restraint are by constant monitoring and through the control of individual behavior, including verbal management and attitudes, reducing the environmental risks, and administering drugs. Some of the efforts to avoid restraint are the "Positive and Safe in Calderstones" program, sensory modulation and peer advice and support.

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Force and Compassion in Health Care

2021

AMA Journal of Ethics

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Physical and mechanical restraint in psychiatric units: Perceptions and experiences of nursing staff

Cited by 36 publications

References 20 publications

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Recognition and Management of Agitation in Acute Mental Health Services: A Qualitative Evaluation of Staff Perceptions

Minimizing the Use of Restraint in Patients with Mental Disorders at a Mental Hospital: A Systematic Review

Force and Compassion in Health Care

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