Reducing the Use of Restrictive Procedures in a Residential Facility

Davidson, Neal A.; Hemingway, Michael J.; Wysocki, Tim

doi:10.1176/ps.35.2.164

Cited by 21 publications

(23 citation statements)

References 9 publications

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“…In hospitals, restraints are used for five patient problems. Restraints are used in the psychiatric units for the management of self-injurious and socially unacceptable behavior, or when the patient is considered a threat to personal safety of staff or other patients (Appelbaum & Roth, 1984;Davidson, Hemingway, & Wysocki, 1984;Guirguis & Durost, 1978;Sreenivasan, 1983). The second situation, most common with the pediatric patient or when the patient is gravely ill, is use of restraints that prevent the patient from inadvertently or intentionally interfering with treatment devices, such as intravenous lines, catheters or monitors (Robbins et al, 1987).…”

Section: Literature Reviewmentioning

confidence: 99%

Releasing restraints: Providing safe care for the elderly

Morse

McHutchion

1991

Research in Nursing & Health

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To examine the behavioral effects of releasing restraints and the feasibility of caring for patients considered at risk if unrestrained, two patients were continuously videotaped using surveillance cameras for 1 week with and 1 week without restraints. The videotapes were coded and analyzed using nonparametric and parametric statistics. In Patient #1, motor behavioral changes with a decrease of restless behaviors, as well as changes in sleeping position, were observed. There were no changes in verbal behavior. For Patient #2, no changes in motor or verbal behavior were observed. Nursing care showed a non-significant decrease in nursing care time and an increase in the number of nursing contacts. The implications of the findings and the use of videotapes as a method for collecting observational data in the clinical area are discussed.

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Section: Literature Reviewmentioning

confidence: 99%

Releasing restraints: Providing safe care for the elderly

Morse

McHutchion

1991

Research in Nursing & Health

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“…Little prospective data exists on the use of mechanical restraints among patients admitted to medical or surgical wards. Most published data on physical restraints focus on a cohort of patients on acute or chronic psychiatric inpatient services 1–7 . In the single study of a general hospital's medical and surgical wards, 18 episodes of involuntary treatment were reported including 17 interventions involving chemical or mechanical restraints 8 .…”

mentioning

confidence: 99%

Binding the Elderly: A Prospective Study of the Use of Mechanical Restraints in an Acute Care Hospital

Robbins

Boyko

Lane

et al. 1987

J American Geriatrics Society

146

118

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Little information exists on the use of mechanical restraints among nonpsychiatric inpatients. This prospective study evaluates their use among consecutive medical and surgical admissions to an acute care hospital. Daily direct observation of patients and hospital record review provided data on potential predictors of restraint, reasons for their application, complications, and outcome. Cox regression analysis was used to calculate relative risk of restraint while adjusting for duration of hospitalization as well as other variables. Restraints were applied to 37 (17%) of the 222 study patients. Restrained patients were eight times more likely to die during hospitalization (24% v 3%; P less than 0.01). Abnormal mental status exam, diagnosis of dementia, surgery, and presence of monitoring and support devices (eg, intravenous lines) were statistically significant independent predictors of restraint. Mechanical restraint is a common occurrence among nonpsychiatric inpatients particularly those with impaired mentation, requirement for surgery, or intensive medical intervention. Identification of medical and surgical patients at risk for restraint may reduce the use of these devices by concentrating surveillance and prevention on this group.

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“…Fisher (2003) reports that this shift has been fueled by a number of factors including new regulations and accreditation standards (HCFA, 2000); media coverage of recipient's death while in restraint (Weiss, 1998); and a growing acceptance by mental health providers of the negative effects of these procedures for both clients and staff (Blanch & Parrish, 1990;Fisher, 1994). As a result, a dramatic reduction in both the frequency and duration of restraints has occurred in numerous mental health settings (Davidson, Hemingway, & Wysocki, 1984;Donat, 1998;Fisher, 2003;Kalogjera, Bedi, Watson, & Meyer, 1989;Singh et al, 1999). As such, program elements that have successfully reduced the use of restraints have been emphasized in the literature and have been found to include administrative endorsement, client participation, culture change, training, data analysis, and individualized treatment (Fisher, 2003).…”

Section: Abstract Restraints Reduction Of Restraints Residential Famentioning

confidence: 99%