Restraint use in acute and extended mental health services for older persons

Gerace, Adam; Mosel, Krista A; Oster, Candice; Muir‐Cochrane, Eimear

doi:10.1111/j.1447-0349.2012.00872.x

Cited by 19 publications

(15 citation statements)

References 57 publications

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“…In the case of services for aged persons, attention must be paid to restraint use, as this has been identified as a more common strategy (Gerace et al . ).…”

Section: Discussionmentioning

confidence: 97%

“…Therefore, future research should focus on the development of a more proximal measure of conflict and containment to provide objective feedback on the outcomes of using the Safewards model and interventions. In the case of services for aged persons, attention must be paid to restraint use, as this has been identified as a more common strategy (Gerace et al 2013).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Fletcher

Spittal

Brophy

et al. 2017

Int J Mental Health Nurs

148

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Restrictive practices are used in response to conflict and aggression in psychiatric inpatient settings. Reducing such practices is the focus internationally of policy and legislative change, many initiatives, and a growing body of research. Safewards is a model and a set of 10 interventions designed to reduce conflict and containment in inpatient services. In the current study, we aimed to assess the impact of implementing Safewards on seclusion in Victorian inpatient mental health services in Australia. The study used a before-and-after design, with a comparison group matched for service type. Thirteen wards opted into a 12-week trial to implement Safewards and 1-year follow up. The comparison group was all other wards (n = 31) with seclusion facilities in the jurisdiction, matched to service type. Mandatorily-reported seclusion event data for all 44 wards over a 15-month period were analysed using negative binomial regression. Adherence to Safewards was measured via fidelity checklists at four time points: twice during the trial, post-trial, and at 1-year follow up. Seclusion rates were reduced by 36% in Safewards trial wards by the 12-month follow-up period (incidence rate ratios (IRR) = 0.64,) but in the comparison wards seclusion rates did not differ from baseline to post-trial (IRR = 1.17) or to follow-up period (IRR = 1.35). Fidelity analysis revealed a trajectory of increased use of Safewards interventions after the trial phase to follow up. The findings suggest that Safewards is appropriate for practice change in Victorian inpatient mental health services more broadly than adult acute wards, and is effective in reducing the use of seclusion.

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“…In the case of services for aged persons, attention must be paid to restraint use, as this has been identified as a more common strategy (Gerace et al . ).…”

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Fletcher

Spittal

Brophy

et al. 2017

Int J Mental Health Nurs

148

View full text Add to dashboard Cite

show abstract

“…Restraint (restricting patients' freedom of movement by physical, mechanical, chemical and/or emotional means; National Mental Health Consumer Carer Forum 2009) and seclusion (confining patients alone in rooms with locked doors and windows; Parliament of Victoria 1986) may be used to address aggression (Bowers et al 2004) but can have deleterious effects on patients. Both measures are commonly used interventions for elderly patients in hospital (Sullivan-Marx 2001), nursing homes (Engberg et al 2008) and psychiatric settings (O'Connor et al 2004, Gerace et al 2013. Usage varies widely between and within organizations (O'Connor et al 2004, Gerace et al 2013) and globally (ranging from 12% to 47%) (Evans et al 2003).…”

Section: Introductionmentioning

confidence: 99%

“…Both measures are commonly used interventions for elderly patients in hospital (Sullivan-Marx 2001), nursing homes (Engberg et al 2008) and psychiatric settings (O'Connor et al 2004, Gerace et al 2013. Usage varies widely between and within organizations (O'Connor et al 2004, Gerace et al 2013) and globally (ranging from 12% to 47%) (Evans et al 2003). There is growing concern these measures are ineffective and have adverse effects on patients (Mohr et al 2003, National Mental Health Working Group 2005, and, according to Cochrane Reviews, their use is not evidence based (Mohler et al 2011, Muralidharan & Fenton 2012, Sailas & Fenton 2012.…”

Section: Introductionmentioning

confidence: 99%

Nurses' experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: a qualitative study

Muir‐Cochrane

Baird²,

McCann

2014

Psychiatric Ment Health Nurs

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This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Accessible summary• While the decision to use restraint and seclusion was not taken lightly, nurse participants felt that there were no effective alternatives to the use of these measures.• Adverse interpersonal, physical and practice environments contributed to the onset of aggression in old age psychiatry inpatient settings.• Policies to reduce or eliminate the use of restraint and seclusion need to take account of wide-ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices. AbstractRestraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices.

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“…Unsurprisingly, behavioural and psychological difficulties are common in people with dementia (Cummings et al 2015). Mechanical and physical restraint techniques are employed in approximately 13% of older people admitted onto acute mental health wards (Gerace et al 2013). The confusion, agitation, and aggressive behaviours that these individuals might express can be challenging and distressing for all types of carers, both formal and informal, especially family members (Van Vracem et al 2016).…”

Section: Introductionmentioning

confidence: 99%

Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults

Smith

Clark

Dodd

et al. 2017

Int J Mental Health Nurs

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Hospital adverse events, such as falls, violence and aggression, security, self-harm, and suicide, are difficult to manage in older people with dementia. The purpose of the present study was to determine whether protected engagement time (PET) resulted in lower adverse events and incidents compared to comparable non-PET wards for people admitted to inpatient older people's mental health wards. Ten inpatient wards for older people were included. Five followed a PET-management pathway, while five continued usual care. All adverse events and incidents were recorded in routine hospital records over 72 weeks. Data were gathered from these records and analysed as rate per person per week to assess differences in frequency and type of adverse events between wards. A total of 4130 adverse events were recorded. In the PET wards, a mean of 0.38 adverse events occurred per person per week compared to 0.40 in non-PET wards. No statistically-significant differences were found between PET and non-PET wards for adverse events (P = 0.93), or for adverse events of any particular type (P ≥ 0.15). Therefore, there is no evidence to suggest that PET has any impact on adverse events in older people's mental health wards. Further investigation with a larger cohort is warranted, using a definitive, phase 3, clinical trial.

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Restraint use in acute and extended mental health services for older persons

Abstract: Restraint of older persons in inpatient and

Cited by 19 publications

References 57 publications

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and fidelity measurement

Nurses' experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: a qualitative study

Feasibility study suggests no impact from protected engagement time on adverse events in mental health wards for older adults

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