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Objective: Dementia affects more than 55 million people worldwide. Use of restraints for hospitalized older adults with dementia is a social issue that should be addressed systematically and should not depend on the characteristics of nurses. This study reviewed the literature on organizational factors associated with reducing use of restraints in older adults with dementia admitted to acute care hospitals. Methods: A scoping review was performed. Three databases were searched for papers that met our eligibility criteria. Factors related to restraint reduction were extracted, and results were deduced. Through inductive analysis, subthemes were categorized according to similarities and differences, which were then integrated into broader themes. Results: Sixteen studies were eligible for inclusion. The prevalence of restraints ranged from 5.1% to 80.0% depending on how the meaning of restraint was interpreted. The most common indications for restraints were history of falls and fall risk. Interdisciplinary screening for restraints was associated with reduced prevalence of restraints, with a 0.18‐fold (confidence interval [CI]: 0.12–0.24) reduction through use of a restraint decision flowchart and a 0.76‐fold (CI: 0.63–0.92) reduction through consultation with a psychiatrist. Interdisciplinary members included nurses, physicians, clinical psychologists, pharmacists, respiratory therapists, and therapists. Conclusions: Research is needed to introduce and develop an interdisciplinary restraint decision‐making system and to test its effectiveness. Important factors in implementing alternatives to restraints are the harmful effects of restraints, expertise in dementia, regular education on alternative methods, an inpatient environment that ensures patient safety, and the development of human resources. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary. Aims: The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors. Study Design: A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann–Whitney U test and Pearson‐χ2 test were used to analyse the data. Results: During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p <.05), lower GCS scores (p <.05) and higher INR values (p <.05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692–34.734, OR = 7.667, p =.032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062–11.599, OR = 3.510, p =.032). Conclusions: Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values. Relevance to Clinical Practice: Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications. [ABSTRACT FROM AUTHOR]

Background: Physical restraint of patients in intensive care units (ICUs) has an estimated prevalence of 50%. Many medical centres do not have specific protocols for physical restraint, and the decision of whether to physically restrain a patient is up to the nursing staff. Disadvantages of physical restraint include injuries, exacerbation of agitation and an increased risk of developing post‐traumatic stress disorder (PTSD). Aim: To report prevalence and outcomes in terms of morbidity and mortality of physical restraint in general ICU patients in an 800‐bed secondary medical centre. Study Design: This retrospective study included 647 patients admitted to a general ICU in an 800‐bed secondary medical centre in Kfar Saba, Israel, between January and December 2020. Data included demographics, medical history, length of stay, need for mechanical ventilation, number of ventilation days, 28‐day mortality, reason for admission, agitation rate assessed by Richmond Agitation and Sedation Scale (RASS) score, need for physical restraint and need for anti‐psychotics. Results: Among the patients, 40% (256 of 647) required physical restraint. Older adult patients had a greater likelihood of being physically restrained along with those admitted because of sepsis or acute respiratory failure. Among the study sample, 11% (71 of 647) required anti‐psychotics. Patients who were restrained had longer duration of ventilation (5.9 ± 8.2 vs. 0.36 ± 1.4 days; p <.001) and higher 28‐day mortality (0.26 ± 0.45 vs. 0.07 ± 0.25, Z = 6.86, p <.001). There was no difference in medical history, except for chronic drug abuse, which was more frequent in the restraint group (18 [6.9%] vs. 11 [2.8%], respectively; p =.019), as well as the use of anti‐psychotic medications (24 [9.3%] vs. 19 [4.8%], respectively; p =.034) and anti‐depressants (55 [21.2%] vs. 59 [14.8%], respectively; p =.042). The restraint group had higher disease severity scores, as reflected in requirements for vasopressor support (174 [67.2%] vs. 69 [17.3%], respectively; p <.001) and need for dialysis (39 [15.1%] vs. 19 [4.8%], respectively; p <.001); higher frequency of in‐hospital anti‐psychotic treatment (60 [23.2%] vs. 11 [2.8%], respectively; p <.001); a greater tendency for agitation events and more severe agitation scores (episodes of RASS above zero [1.7 ± 4.0 vs. 0.04 ± 0.27, respectively; p <.001] and maximum RASS score [0.19 ± 1.6 vs. 0.01 ± 0.54, respectively; p <.001]). Overall, advanced age, number of ventilation days and need for dialysis were associated with increased 28‐day mortality. In the restraint group, advanced age, chronic use of diuretics and the use of dialysis during ICU admission were associated with increased mortality risk. Conclusions: Restrained patients tended to have higher morbidity and mortality during ICU and hospital stays, as well as a greater tendency for agitation events and more severe agitation scores, with an increased need for in‐hospital anti‐psychotic treatment. These findings regarding patient characteristics might be used to formulate treatment plans to reduce the rate of physical restraint in the ICU. Relevance to Clinical Practice: Because restrained ICU patients tend to have higher morbidity and mortality, treatment plans should be formulated to reduce the rate of physical restraint in the ICU. Clinical trial registration: NCT04771793. [ABSTRACT FROM AUTHOR]

Background: Nurses in neurointensive care units (NCUs) commonly use physical restraint (PR) to prevent adverse events like unplanned removal of devices (URDs) or falls. However, PR use should be based on evidenced decisions as it has drawbacks. Unfortunately, there is a lack of research‐based PR protocol to support decision‐making for nurses, especially for neurocritical patients. Aim: This study developed a restraint decision tree for neurocritical patients (RDT‐N) to assist nurses in making PR decisions. We assessed its effectiveness in reducing PR use and adverse events. Study Design: This study employed a baseline and post‐intervention test design at a NCU with 19 beds and 45 nurses in a tertiary hospital in a metropolitan city in South Korea. Two‐hundred and thirty‐seven adult patients were admitted during the study period. During the intervention, nurses were trained on the RDT‐N. PR use and adverse events between the baseline and post‐intervention periods were compared. Results: Post‐intervention, total number of restrained patients decreased (20.7%–16.3%; χ2 = 7.68, p =.006), and the average number of PR applied per restrained patient decreased (2.42–1.71; t = 5.74, p <.001). The most frequently used PR type changed from extremity cuff to mitten (χ2 = 397.62, p <.001). No falls occurred during the study periods. On the other hand, URDs at baseline were 18.67 cases per 1000 patient days in the high‐risk group and 5.78 cases per 1000 patient days in the moderate‐risk group; however, no URD cases were reported post‐intervention. Conclusions: The RDT‐N effectively reduced PR use and adverse events. Its application can enhance patient‐centred care based on individual condition and potential risks in NCUs. Relevance to Clinical Practice: Nurses can use the RDT‐N to assess the need for PR in caring for neurocritical patients, reducing PR use and adverse events. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is frequently used in intensive care units to prevent patients' life‐threatening removal of indwelling devices. In France, their use is poorly studied. Therefore, to evaluate the need for physical restraint, we have designed and implemented a decision support tool. Aims: Besides describing the prevalence of physical restraint use, this study aimed to assess whether the implementation of a nursing decision support tool had an impact on restraint use and to identify the factors associated with this use. Study Design: A large observational, multicentre study with a repeated one‐day point prevalence design was conducted. All adult patients hospitalized in intensive care units were eligible for this study. Two study periods were planned: before (control period) and after (intervention period) the deployment of the decision support tool and staff training. A multilevel model was performed to consider the centre effect. Results: During the control period, 786 patients were included, and 510 were in the intervention period. The prevalence of physical restraint was 28% (95% CI: 25.1%–31.4%) and 25% (95% CI: 21.5%–29.1%) respectively (χ2 = 1.35; p =.24). Restraint was applied by the nurse and/or nurse assistant in 96% of cases in both periods, mainly to wrists (89% vs. 83%, p =.14). The patient‐to‐nurse ratio was significantly lower in the intervention period (1:3.0 ± 1 vs. 1:2.7 ± 0.7, p <.001). In multivariable analysis, mechanical ventilation was associated with physical restraint (aOR [95% CI] = 6.0 [3.5–10.2]). Conclusion: The prevalence of physical restraint use in France was lower than expected. In our study, the decision support tool did not substantially impact physical restraint use. Hence, the decision support tool would deserve to be assessed in a randomized controlled trial. Relevance to Clinical Practice: The decision to physically restrain a patient could be protocolised and managed by critical care nurses. A regular evaluation of the level of sedation could allow the most deeply sedated patients to be exempted from physical restraint. [ABSTRACT FROM AUTHOR]

Mechanical restraint is a commonly used restrictive practice worldwide, although reducing its use is an international priority. Interventions to reduce mechanical restraint are needed if reducing mechanical restraint is to succeed. Therefore, this systematic review aimed to examine evaluated evidence‐based interventions that seek to reduce the incidence of and/or time in mechanical restraint in adult mental health inpatient settings. The JBI framework was used to guide this systematic review. The search strategy included peer‐reviewed primary research literature published between 1999 and 2023. Two authors independently conducted the systematic search, selection process and data extraction process. Forty‐one studies were included in this review. Using content analysis, we grouped interventions into four categories: (I) calm‐down methods, (II) staff resources, (III) legal and policy changes and (IV) changing staff culture. Interventions to reduce mechanical restraint in adult mental health inpatient settings have shown some promise. Evidence suggests that a range of interventions can reduce the incidence of and/or time in mechanical restraint. However, controlled trials were lacking and consensus was lacking across studies. Furthermore, specific findings varied widely, and reporting was inconsistent, hampering the development of interventions for this issue. Further research is needed to strengthen the evidence base for reducing mechanical restraint in mental health inpatient settings. [ABSTRACT FROM AUTHOR]

Reducing and eliminating seclusion and restraint in inpatient settings has been a key area of focus in mental health policy and research for many years. To address this issue, numerous programmes aimed at minimising the use of these practices have been developed over the past two decades, with varying degrees of success. This article reports on research focused on the implementation of a localised, multilevel complex intervention that targeted both organisational and individual factors related to the use of seclusion and restraint. The researchers followed the impact of the intervention by interviewing medical, nursing and allied health staff who worked within the service (N = 12) and analysing the rates of seclusion and restraint over an 18‐month period. Post‐adoption, participants identified that there were clear changes in practice culture. Seclusion clearly became a practice of last resort and other options became prominent in staff's practice. Participants identified that there was a sense of shared purpose across the multidisciplinary team. The clinical environment was viewed as being more therapeutic for service users and less frightening for staff. There was a significant difference in the total number of seclusion events between pre‐ (Mean = 6.22, SD = 5.82) and post‐implementation (Mean = 2.55, SD = 2.44, p = 0.002, d = 0.94), demonstrating a significantly lower number of seclusions was observed after the intervention. Similarly, a significant difference in restraint events between pre‐ (Mean = 5.50, SD = 3.77) and post‐implementations (Mean = 3.38, SD = 3.21, p = 0.037, d = 0.62) was observed. [ABSTRACT FROM AUTHOR]

Objective: Approximately 10% of emergency medical services (EMS) encounters in the United States are behavioral health related, but pediatric behavioral health EMS encounters have not been well characterized. We sought to describe demographic, clinical, and EMS system characteristics of pediatric behavioral health EMS encounters across the United States and to evaluate factors associated with sedative medication administration and physical restraint use during these encounters. Methods: We conducted a retrospective cross‐sectional study of pediatric (<18 years old) behavioral health EMS encounters from 2019 to 2020 using the National Emergency Medical Services Information System. Behavioral health encounters were defined using primary or secondary impression codes. We used multivariable logistic regression to identify factors associated with sedative medication administration and physical restraint use. Results: Of 2,740,271 pediatric EMS encounters, 309,442 (11.3%) were for behavioral health. Of pediatric behavioral health EMS encounters, 85.2% of patients were 12–17 years old, 57.3% of patients were female, and 86.6% of encounters occurred in urban areas. Sedative medications and physical restraints were used in 2.2% and 3.0% of pediatric behavioral health EMS encounters, respectively. Sedative medication use was associated with the presence of developmental, communication, or physical disabilities relative to their absence (adjusted odds ratio [aOR] 3.38, 95% confidence interval [CI] 2.93–3.91) and with encounters in the West relative to the South (aOR 1.23, 95% CI 1.16–1.32). Physical restraint use was associated with encounters by patients 6–11 years old relative to those 12–17 years old (aOR 1.35, 95% CI 1.27–1.44), the West relative to the South (aOR 3.49, 95% CI 3.27–3.72), and private nonhospital EMS systems relative to fire departments (aOR 3.39, 95% CI 3.18–3.61). Conclusions: Among pediatric prehospital behavioral health EMS encounters, the use of sedative medications and physical restraint varies by demographic, clinical, and EMS system characteristics. Regional variation suggests opportunities may be available to standardize documentation and care practices during pediatric behavioral health EMS encounters. [ABSTRACT FROM AUTHOR]

Background: Guidelines advocate for minimization of physical restraint (PR) use in intensive care units (ICU). Interprofessional team perspectives on PR practices can inform the design and implementation of successful PR minimization interventions. Aim: To identify ICU staff perspectives of contextual influences on PR practices and minimization strategies. Study Design: A qualitative descriptive study in a single ICU in Toronto, Canada. One‐on‐one semi‐structured interviews were conducted with 14 ICU staff. A deductive content analysis of interviews was undertaken using the integrated–Promoting Action on Research Implementation in Health Services (i‐PARIHS) framework. Results: Five themes were developed: risk‐averse culture, leadership, practice monitoring and feedback processes, environmental factors, and facilitation. Participants described a risk‐averse culture where prophylactic application of PR for intubated patients was used to prevent unplanned extubation thereby avoiding blame from colleagues. Perceived absence of leadership and interprofessional team involvement situated nurses as the primary decision‐maker for restraint application and removal. Insufficient monitoring of restraint practices, lack of access to restraint alternatives, and inability to control environmental contributors to delirium and agitation further increased PR use. Recommendations as to how to minimize restraint use included a nurse facilitator to advance leadership‐team collaboration, availability of restraints alternatives, and guidance on situations for applying and removing restraints. Conclusions: This analysis of contextual influences on PR practices and minimization using the i‐PARIHS framework revealed potentially modifiable barriers to successful PR minimization, including a lack of leadership involvement, gaps in practice monitoring, and collaborative decision‐making processes. A team approach to changing behaviour and culture should be considered for successful implementation and sustainability of PR minimization. Relevance to Practice: The establishment of an interprofessional facilitation team that addresses risk‐averse culture and promotes collaboration among ICU stakeholders will be crucial to the success of any approach to restraint minimization. [ABSTRACT FROM AUTHOR]

Physical restraint is a controversial practice in psychiatric inpatient settings. Research has clearly demonstrated its physical and psychological risks, but few studies investigate how mental health support workers understand their experiences of restraint use. This study uses interpretative phenomenological analysis to explore support workers' understanding of these experiences. The COREQ checklist was used to ensure explicit reporting of the study. Semi‐structured interviews were conducted with three participants and were then analysed using an interpretative phenomenological process. One superordinate theme emerged: 'You have to be a certain sort of person'. Restraints require not only the ability to overcome one's emotions, but also the ability to connect with the person being restrained. The implications of these findings for psychiatric care provision and for further research are discussed. [ABSTRACT FROM AUTHOR]

In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio‐narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's 'quest narrative'. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238]. [ABSTRACT FROM AUTHOR]

The use of physical restraint had caused a series of unexpected impacts on patients, particularly psychological trauma. This qualitative study aimed to identify perspectives on physical restraint among patients with mental health conditions and to seek effective interventions targeting the psychological trauma which is caused by physical restraint. A semi‐structured interview was conducted in a public psychiatric hospital in China to explore perspectives on physical restraint among 26 patients who had undergone or witnessed physical restraint. The interview was conducted by experienced and qualified interviewers with mental health service backgrounds. The interviews were recorded and transcribed into words, and then preliminary themes were extracted and coded, finally thematic analysis was used to identify focused themes. Five themes were extracted: these were as follows: (1) The negative effects of physical restraint on patients; (2) The impairment of the relationship between nurse and patient due to physical restraint; (3) The decrease in patients' treatment adherence caused by physical restraint; (4) The positive outcomes of physical restraint; (5) The expectations of patients for improving the quality of nursing care. Conclusively, the use of physical restraint had critical impacts on patients, including psychological trauma, destruction of the nurse–patient relationship, and decreased adherence of treatment. These negative effects could impede clinical work. [ABSTRACT FROM AUTHOR]

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: 'Building a Recovery Focused Therapeutic Relationship'; 'Authoritarian Role'; 'Inevitable Imbalance'; 'Rebuilding the Therapeutic Relationship'; plus two sub‐themes 'Facilitators to rebuilding' and 'Barriers to rebuilding'. Findings suggest that an inevitable imbalance exists in building a recovery‐focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post‐restraint‐focused clinical supervision would also be beneficial to mental health nursing staff. [ABSTRACT FROM AUTHOR]

Physical restraint is a restrictive practice used in schools across the UK and there have been recent concerns around the appropriateness and frequency of using this intervention with pupils. Current data suggest that pupils with Special Educational Needs (SEN), a vulnerable and diverse group, are experiencing the majority of physical restraint used in educational settings. Physical restraint can lead to negative emotional and physical consequences in pupils who experience it and it is, therefore, important to explore alternative strategies to reduce or eliminate its use in educational settings. A systematic literature search found 15 studies (date range 1999–2019) that explored the effectiveness of school‐wide or individual approaches in reducing the frequency and/or duration of physical restraint. Most studies saw a significant decrease in physical restraint, and this study will discuss the key elements of the successful approaches, as well as consider the facilitators and barriers to implementation. [ABSTRACT FROM AUTHOR]

Manual restraint is a hands‐on type of physical restraint used to prevent harm to service users and staff, and to administer necessary treatments. This article reports on a review and meta‐synthesis of the qualitative literature on healthcare staff's experiences of using manual restraint. Three electronic databases (CINAHL Complete, MEDLINE, and PsycINFO) were systematically searched, and 19 studies were included. Thematic synthesis was used to synthesize the findings. The Critical Appraisal Skills Programme (CASP) checklist was used to appraise study quality. The synthesis generated one overarching interpretive theme, "unpleasant but necessary," and five subthemes: "maintaining safety triumphs all," "emotional distress," "significance of coping," "feeling conflicted," and "depletion." Seven studies indicated that, from staff perspectives, manual restraint was not always used as a last resort. Healthcare staff experience manual restraint as a psychologically and physically unpleasant practice, yet paradoxically deem its use to be sometimes necessary to keep themselves and service users safe from harm. The findings indicate a need for healthcare staff support, post‐restraint debriefing meetings with service users, and the implementation of manual restraint minimization programs in healthcare settings. [ABSTRACT FROM AUTHOR]

The failure of efforts to significantly reduce the use of physical coercive measures (PCMs) in psychiatric hospitals remains a global concern. There is a gap in the understanding of staff's characteristics that may affect their attitudes and perceptions towards PCMs. This study used a cross‐sectional design to examine the attitudes and perceptions of staff working at a mental health centre in Israel regarding the use of PCMs and to explore whether staff attitudes differed depending on their professional and demographic background. This study also sought to explore staff willingness to accept a policy of reducing the use of PCMs. The data were collected from 149 staff members (nurses, physicians, and auxiliary staff) working at mental health centre, using a questionnaire developed for this study. The findings indicate a low degree of support for use of PCMs among participants who were older, female, more qualified psychiatric nurses, with longer duration of employment, and those who have not participated in coercive intervention in the past year. The majority of the sample reported a low willingness to reduce the use of PCMs, and a lack of institutional support after participating in a coercive event. High hospital occupancy and insufficient staffing were perceived as contributing factors to coercive incidents. Therefore, availability of trained and experienced staff, elimination of organizational barriers, along with creating and maintaining a safe clinical environment should be a priority. Alternative non‐coercive interventions should further be taught and used for managing aggressive and violent behaviour in the psychiatric clinical settings. [ABSTRACT FROM AUTHOR]

Background: Several nonpharmacological strategies for the prevention and treatment of delirium have been increasingly used because the aetiology of delirium is multifactorial. Aims: To verify the association between nonpharmacological strategies (presence of companion, mobilization, absence of physical restraint and natural light) and the occurrence of delirium, and to identify risk factors for delirium in intensive care unit (ICU) patients. Study Design: The study was conducted in a Brazilian medical and surgical ICU. The sample included patients older than 18 years with length of ICU stay greater than 24 h and without delirium on admission. Delirium was identified by applying the Confusion Assessment Method for the Intensive Care Unit (CAM‐ICU). The association between the variables and delirium was analysed using Mann–Whitney and chi‐square tests, and multivariate logistic regression to identify the predictive factors. Results: Of the 356 patients, 64 (18%) had delirium. The presence of a companion, mobilization, and physical restraint were associated with delirium, and the first two were identified as protective factors. That is, the odds of delirium decreased by 88% when a companion was present and by 95% when the patient was mobilized. The risk factors of delirium were length of ICU stay and age. Conclusions: The presence of a companion and patient mobilization were identified as protective factors against delirium, highlighting their importance as preventive actions, especially in patients with a higher risk of developing this disorder. The findings regarding physical restraint can also be considered evidence indicating the need for careful use of this measure in clinical practice until evidence of its relationship with delirium is confirmed. Relevance to Clinical Practice: The implementation of strategies such as early mobilization, presence of a companion and careful assessment for the use of physical restraint by the multidisciplinary team can help control the occurrence of delirium in the ICU. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the factors associated with nurses' intent to use physical restraint. Design and Methods: This cross‐sectional study used a questionnaire to survey 403 nurses from a hospital in northern Taiwan. Findings: Nurses who participated in a simulation training program had better knowledge and behavioral intent toward physical restraint use. Seniority and workplace significantly influenced the knowledge of physical restraint use, whereas workplace and clinical ladder level significantly shaped nurses' attitude toward it. Practice Implications: The results showed that the simulated physical restraint training program was effective. The impact of nurses' workplace, seniority, and clinical ladder level on an educational intervention should be considered before formulating a plan to reduce physical restraint use. [ABSTRACT FROM AUTHOR]

Self‐harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self‐harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self‐cutting management compared with for disturbed behaviours in general using a cross‐sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by individuals for self‐cutting management. Respondents disapproved of using each coercive measure for self‐cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self‐cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self‐cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self‐harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative. [ABSTRACT FROM AUTHOR]

Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone ('face down') restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular. [ABSTRACT FROM AUTHOR]

A high proportion of psychiatric inpatients experience Restrictive Practice (RP) during admission. Numerous reports have highlighted adverse effects on patients and staff. However, qualitative research focussed on experience, impact, and coping mechanisms of healthcare staff in the UK is limited. Therefore, this study explored psychiatric healthcare staff experience of RP on inpatient wards in the UK. Eight semi‐structured, audio‐recorded interviews, of ~60 min, were conducted via telephone/Skype and transcribed verbatim. A critical realist epistemology was used to thematically analyse data. Three themes were identified: the coexistence of accountability, power and subjection; impacts on the individual and professional relationships, and coping with difficult experiences and emotions. Restrictive practice can negatively affect staff experience, working relationships, and wellbeing. Opportunities for support could mediate adverse effects. Future research could further explore coping mechanisms and organizational factors contributing to negative staff experiences. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to evaluate the effect of empathy skills of psychiatric nurses on their attitudes and practices towards the use of physical restraint. Design and Methods: This cross‐sectional, correlational, descriptive study included 100 nurses (88.49% of the population). Data were collected using a sociodemographic characteristics form, the empathy skills scale (ESS) form B, and the knowledge, attitudes, and practices of staff towards physical restraints questionnaire (KAPS‐PR) were used. Findings: The total mean ESS score was found to be 152.34 ± 24.44, indicating moderate empathy skills. Mean KAPS‐PR scores were 29.54 ± 4.43 for the attitude scale and 33.94 ± 3.26 for the practice scale, indicating appropriate attitudes and ideal practices related to physical restraint, respectively. ESS score was significantly higher among nurses with higher educational levels (p =.001) and weakly correlated with KAPS‐PR attitude score (r =.25; p <.05). Implications for Practice: Improving the empathy skills of psychiatric nurses could improve their attitudes towards physical restraint, thereby reducing its use. [ABSTRACT FROM AUTHOR]

Background: Evidence regarding the feelings evoked, distress caused, and the best way to conduct protective stabilization for the management of young children is lacking. Aim: Describe the perceptions of mothers, psychologists, and pediatric dentists regarding the use of protective stabilization during the dental care of children up to three years of age attending a University Dental Clinic in southern Brazil. Design: After watching a video of dental care involving the protective stabilization technique, individualized qualitative interviews were held with three groups [mothers (n = 5), psychologists (n = 7), and pediatric dentists (n = 4)] to investigate four categories of interest: importance of the technique, affective attitude, distress caused to the child, and participation of parents. After the transcription of the recorded comments, qualitative content analysis was performed. Results: Protective stabilization generated emotional discomfort but was well accepted by all groups. All expressed the need to create a bond between the dentist and caregiver; and the active participation of the caregiver was considered fundamental. The mothers and psychologists rejected other options, such as passive restraint, general anesthesia, and sedation. Conclusion: The three groups admitted having negative feelings, recognized the importance of protective stabilization, and suggested conditions for its use. [ABSTRACT FROM AUTHOR]

Background: Physical restraint is still widely used despite studies supporting a reduction in its use. The development of guidelines to reduce the use of PR first requires the identification of factors related to the use of alternative methods. Aim: This study aimed to determine factors associated with the use of alternatives to physical restraint (PR) in intensive care units. Design: This was a cross‐sectional descriptive study. Methods: Data were collected from adult intensive care units of three hospitals in Turkey using the Physical Restraint Knowledge, Attitude and Practice Scale and a questionnaire including open‐ended questions. Results: Overall, 202 nurses (80% response rate) completed the questionnaire. Nurses' knowledge, attitude, and practice scores regarding PR were 6.89 ± 1.79, 29.85 ± 4.93, and 36.76 ± 3.36, respectively. PR was reported to be necessary for patients at risk of self‐harm, with dangerous behaviours, and who were trying to remove their catheters. Most nurses (64.9%) stated that they needed a written doctor's order. Analysis of free‐text responses showed that patient disorientation (because of delirium, sedation, or agitation), nurses' workload, and lack of training regarding restraint were the primary reasons why nurses could not use alternatives. The main alternatives suggested by nurses were categorized as sedation, communication, and environmental regulation. Logistic regression analysis identified training (P =.009), working unit (P =.001), and nurses' practice score to use PR (P =.004) as independent risk factors for not using alternative methods of PR. Conclusions: The results of this study revealed a moderate level of knowledge, attitude, and practice among nurses regarding the use of PR. Thus, education of nurses about the prevention of delirium and alternatives to PR according to the characteristics of their units is required. Relevance to clinical practice: Clinical guidelines and in‐service training need to be developed to increase the use of alternatives to PR and delirium management. [ABSTRACT FROM AUTHOR]

Aim: To explore nurses' opinions regarding restraint measures and attitudes towards physical restraints use in nursing homes. Design: Cross‐sectional study. Methods: Nursing staff of 33 Portuguese nursing homes was asked to complete the Portuguese version of the Maastricht Attitude Questionnaire (MAQ), an instrument on attitudes regarding physical restraints (reasons, consequences and appropriateness of restraint use) and opinions about restraint measures (restrictiveness and discomfort). Descriptive statistics and bivariate analysis were performed. Results: Data from 186 nurses were included in the analysis. Overall, nurses expressed neutral to moderately positive attitudes towards physical restraints usage. Nurses with longer professional experience reported a more positive attitude regarding the appropriateness of restraint use in their clinical practice. Wrist and ankle restraints were the measures that nurses reported feeling most uncomfortable using, and the most restrictive. Bilateral bedrails were globally assessed as a slightly restrictive measure and nurses reported not feeling uncomfortable using them. [ABSTRACT FROM AUTHOR]

Background and purpose: Delirium is a neuropsychiatric disorder of attention and awareness that develops over a short time and fluctuates in severity. Although delirium has been extensively studied in intensive care units, the incidence of delirium in stroke units and its predictors in stroke patients need further investigation. The endpoints of our study were incidence of delirium in acute stroke and the risk factors that predispose to this condition. Methods: Patients were consecutively enrolled in a stroke unit from April to October 2020. Inclusion criteria were: age ≥18 years, acute stroke and National Institute of Health Stroke Scale (NIHSS) score ≥1 at the time of clinical assessment of delirium. Exclusion criteria were: transient ischemic attack; absence of neuroimaging evidence of brain lesion; cerebral venous thrombosis; subarachnoid hemorrhage; and clinical conditions requiring intensive care unit treatment. All patients were evaluated by means of Richmond Agitation‐Sedation Scale (RASS) and Confusion Assessment Method‐Intensive Care Unit (CAM‐ICU) scores at baseline, evaluations which were repeated within 72 h or when patients developed symptoms suggesting delirium. Results: The overall incidence of delirium was 36/120 (30%). Delirium was associated with aphasia (odds ratio [OR] 9.77; confidence interval [CI] 1.2–79.6), chronic obstructive pulmonary disease (COPD; OR 16.67; CI 1.1–263.0), deep Fazekas score (OR 5.05; CI 1.7–14.8), and physical restraint (OR 45.02; CI 1.4–1411.5). Diabetes was associated with a lower incidence of delirium (OR 0.04; CI 0.026–0.7). Conclusions: Nearly one‐third of patients (30%) had delirium in the acute phase of stroke. This finding supports the notion that delirium is a common complication of stroke. Delirium was associated with speech disorder, leukoencephalopathy, COPD and early use of physical restraint. [ABSTRACT FROM AUTHOR]

Mental health nurses use forcible touch during physical restraint. Little research considers nurses' experiences and the meanings they give to forcible touch. This study investigated nurses' lived experiences of forcibly touching service users during physical restraint. A qualitative approach informed by phenomenology guided the study. The COREQ checklist ensured explicit and detailed reporting of the study. Fourteen nurses participated in semi‐structured interviews analysed using a phenomenological process. The participants' experienced their touch during restraint as a problematic aspect of practice. They expressed preferences for holding different parts of the service user's body, described their proximity to the service user's body, and their experience of intimacy. The meanings of touch included forced, gentle, protective, and compassionate touches. Three themes revealed the complexity of this previously unproblematized area of nursing practice identified through their narratives. These were 'needing to justify', 'inconsistent knowing', and 'compassionate whilst careworn'. Physical restraint training requires reconceptualization towards touch to help nurses connect with the meanings of their bodily contact with service users, and the potential influence upon care. Articulation of these touch meanings will help to develop a nursing discourse on this neglected area of nursing practice. Training courses orientate primarily towards techniques, whilst nurses' conversations about touch are unclear. Training courses and practice fora can enhance understanding of the nursing contribution to physical restraint by addressing the nature of nurses' bodywork. This discourse will help to reveal the complexity of this touch intervention, identify areas of good practice, and areas for practice development. [ABSTRACT FROM AUTHOR]

Manual restraint, a type of physical restraint, is a common practice in inpatient mental health settings linked to adverse physical and psychological staff and patient outcomes. However, little is known about the use of manual restraint for compulsory nasogastric feeding of patients with anorexia nervosa within inpatient eating disorder settings. The present phenomenological study aimed to explore nursing assistants' experiences of administering manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa. The study followed COREQ guidelines. Eight semi‐structured interviews were conducted with eight nursing assistants from one UK inpatient child and adolescent eating disorder service. Interviews were transcribed verbatim and analysed using thematic analysis. Three themes were extracted: An unpleasant practice, importance of coping, and becoming desensitized and sensitized. Nursing assistants commonly experienced emotional distress, physical exhaustion, physical injury and physical aggression as a result of their manual restraint use. Nursing assistants appeared to cope with their distress by talking with colleagues and young persons who were further in their recovery, and by detaching themselves during manual restraint incidents. The findings highlight that the use of manual restraint for compulsory nasogastric feeding of young persons with anorexia nervosa in the UK is a highly distressing practice for nursing assistants. It is therefore important that sufficient supervision, support, and training are made available to staff working in these settings. [ABSTRACT FROM AUTHOR]

Missed nursing care and physical restraint have been identified as indicators of patient safety, but no studies to date have explored their relation. To explore the relation between these two phenomena, a secondary analysis of a longitudinal study on 1464 in‐hospital patients and 314 registered nurses was performed. The use of physical restraint was assessed at the bedside on a daily basis; missed care was assessed with the MISSCARE survey. Individual, nursing care, and hospital‐level variables were measured. A total of 184 (12.6%) patients were restrained for 20.33% of their in‐hospital stay. No significant differences emerged in the occurrence of missed care between restrained and unrestrained patients. However, some common antecedents of these two phenomena emerged: in units where there is a lack of personnel, both an increase in missed care and physical restraint duration should be expected. As a consequence, patients are threatened in their right to receive the required care and they are at risk of being restrained. Moreover, a higher skill mix is a preventive factor, which suggests that the increased numbers of registered nurses on the team, may prevent routine forms of physical restraint use by analyzing the physical restraint in place critically and removing them as soon as possible, thus reducing the duration of the restraints. [ABSTRACT FROM AUTHOR]

Objective: To determine current clinical practices for managing behavioural emergencies within Victorian public hospital EDs. Methods: A multi‐centre retrospective study involving all patients who attended ED in 2016 at the Alfred, Ballarat, Dandenong, Geelong and Royal Melbourne Hospitals. The primary outcome was the rate of patient presentations with at least one restrictive intervention. Secondary outcomes included the rate of security calls for unarmed threats (Code Grey), legal status under the Mental Health Act at both the time of ED arrival and the restrictive intervention, and intervention details. For each site, data on 100 patients who had a restrictive intervention were randomly extracted for indication and methods of restraint. Results: In 2016, 327 454 patients presented to the five EDs; the Code Grey rate was 1.49% (95% CI 1.45–1.54). Within the Code Grey population, 942 had at least one restrictive intervention (24.3%, 95% CI 23.0–25.7). Details were extracted on 494 patients. The majority (62.8%, 95% CI 58.4–67.1) were restrained under a Duty of Care. Physical restraint was used for 165 (33.4%, 95% CI 29.3–37.8) patients, 296 were mechanically restrained (59.9%, 95% CI 55.4–64.3), median mechanical restraint time 180 min (IQR 75–360), and 388 chemically restrained (78.5%, 95% CI 74.6–82.0). Conclusions: Restrictive interventions in the ED largely occurred under a Duty of Care. Care of patients managed under legislation that covers assessment and treatment of mental illness has a strong clinical governance framework and focus on minimising restrictive interventions. However, this is not applied to the majority of patients who experience restraint in Victorian EDs. [ABSTRACT FROM AUTHOR]

Purpose: This study examines the knowledge, attitudes, and practice of psychiatric nurses towards the use of physical restraint in Saudi Arabia. Design and Methods: Descriptive explanatory cross‐sectional design, 101 participants were invited to complete a set of questionnaires to assess the knowledge, attitude, and practice towards the use of physical restraint. Findings: Participants had a moderate knowledge and attitude as well as practice in using physical restraint. Less than half reported that they recognized alternative approaches to physical restraint and most of them did not understand the reasons for the restraint. Practice Implications: This study highlights some important misunderstandings of nurses about using physical restraint. The findings serve as a supporting reason for recognizing the importance of educating nurses about its use. [ABSTRACT FROM AUTHOR]

To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence‐based patient care, we need more knowledge about patients' subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients' perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: 'overt protest reactions', 'silent protest reactions', 'illness‐related behaviour', and 'genuinely calm', which together characterize patients' perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: 'pattern of protest' and 'pattern of illness'. Further research is needed to illuminate the associations between patients' perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint. [ABSTRACT FROM AUTHOR]

Aim: To investigate nurses' knowledge, attitudes and practices related to physical restraint in tertiary hospitals and identify the factors that influence physical restraint use. Background: Physical restraint is used to maintain patient safety. Nurses play an important role in the restraint process. It is important to identify their understanding, feelings and approach regarding the use of physical restraint. Introduction: Physical restraint is widely practiced in hospitals in China. However, it results in a range of serious negative consequences. This article provides a clear description of nurses' knowledge, attitudes and practices related to physical restraint. Methods: A cross‐sectional survey was conducted. The participants were asked to complete a questionnaire examining their knowledge, attitudes and practices related to physical restraint use. A total of 200 questionnaires were distributed in four tertiary hospitals in Hubei Province, China between August and October 2014. Results: The nurses' responses indicated a good level of knowledge regarding physical restraint use. However, they held some misconceptions. The nurses' attitudes towards physical restraint tended to be neutral. The nurses were well experienced in the use of physical restraint. Nurses who had received on‐the‐job training performed better than those who had received no training related to knowledge and practices regarding physical restraint use. Conclusions and implication for nursing/health policy: In‐service training is highly recommended for nursing managers to improve nurses' physical restraint related knowledge and practices. Regulations regarding the use of restraints should be established as soon as possible by healthcare administration system. Implications for nursing: Nurses should be open to evaluate and improve their views and attitudes regarding effective physical restraint use via multidimensional interventions. [ABSTRACT FROM AUTHOR]

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma‐informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use. [ABSTRACT FROM AUTHOR]

Aim: To examine the perceptions of nurse managers, registered nurses and healthcare assistants of physical restraint use on older people in a long‐term care setting in the Republic of Ireland. Background: The use of physical restraint, although controversial, persists in long‐term care settings, despite recommendations for restraint‐free environments. Perception and attitude of staff can influence use of physical restraint. Methods: A descriptive cross‐sectional design was used. A total of 250 nursing and healthcare assistant staff were recruited. A questionnaire incorporating demographics and the Perceptions of Restraint Use Questionnaire was used. Descriptive and inferential statistical analyses were conducted. Results: Mean age of respondents (n = 156) was 41 years, and the majority were female. Overall, a low level of importance was attached to the use of restraint. Nurse managers and registered nurses compared favourably with healthcare assistants who attached a higher importance to use of restraint. Across all three staff groups, greatest importance was attached to the use of physical restraint for reducing falls, followed by prevention of treatment interference. Restraint was least favoured as a means of impairment management. Education was not an explanatory factor in perceived importance of physical restraint use. Conclusion: Nurse managers and registered nurses are unlikely to use physical restraint. However, there is concern regarding perception of healthcare assistants on use of restraint. Implications for nursing and health policy: Results from this study compare favourably with those in countries that have no policy on physical restraint use. Educational programmes alone are insufficient to address use of physical restraint. Attention to skill mix with adequate support for healthcare assistants in long‐term care settings is recommended. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Use of physical restraints is common in nursing homes, although empirical evidence has shown it to be a hazardous measure. This article aims to understand whether there were any changes in nursing home staff's knowledge, attitudes, and practices of using physical restraints in Hong Kong, after years of deliberation on this topic. Methods: A questionnaire about the knowledge, attitude, and practice of using physical restraint was sent to all 298 staff members in four nursing homes in Hong Kong run by a nongovernmental organization. The results were compared with previous findings from 1999 using the same questionnaire. Results: Overall, the staff had satisfactory knowledge of the daily application of physical restraints, such as the operational procedure and daily assessment. Concerning the conceptual knowledge of minimizing physical restraint use, their performance in the survey was less satisfactory. For example, only 6.6% of respondents were aware that residents had a right to reject the use of physical restraints, and 70% believed that there were no good alternatives to restraints. They showed appropriate attitudes in their practice of daily use of physical restraints. Compared with the previous study in 1999, a significant improvement was found in the attitudes (p = .0014) and practice (p = .0002) of using restraints, but there was no difference in their knowledge test results (p = .29). Conclusions: The results of this study show a significant improvement among the nursing home staff in terms of their attitudes and practice of using restraints. In‐service training for nursing staff should focus more on their knowledge of ethical considerations and the hands‐on practice of using alternative devices (e.g., motion detectors or anti‐slip pads). Clinical Relevance: The findings of this study suggest that in‐service training for nursing staff should focus more on their knowledge of ethical considerations, the principles of using physical restraint, and the alternatives to restraint in order to fill the knowledge gaps of staff and improve the quality of care in nursing homes. [ABSTRACT FROM AUTHOR]

Abstract: In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five‐stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness. [ABSTRACT FROM AUTHOR]

Abstract: One of the main reasons for prolonged duration of mechanical restraint is patient behaviour in relation to the clinician‐patient alliance. This article reports on the forensic mental health clinicians experiences of the clinician‐patient alliance during mechanical restraint, and their assessment of parameters of alliance regarding the patient's readiness to be released from restraint. We used a qualitative, descriptive approach and conducted focus group interviews with nurses, nurse assistants and social and healthcare assistants. The results show that a pre‐established personal clinician‐patient alliance formed the basis for entering into, and weighing the quality of, the alliance during mechanical restraint. In consideration of the patient's psychiatric condition, the clinicians observed and assessed two quality parameters for the alliance: ‘the patient's insight into or understanding of present situation’ (e.g. the reasons for mechanical restraint and the behaviour required of the patient to discontinue restraint) and ‘the patient's ability to have good and stable contact and cooperation with and across clinicians. These assessments were included, as a total picture of the quality of the alliance with the patient', in the overall team assessment of the patient's readiness to be released from mechanical restraint. The results contribute to inform the development of a short‐term risk assessment instrument, with the aim of reducing the duration of mechanical restraint. [ABSTRACT FROM AUTHOR]

Restraint in mental health care has negative consequences, and guidelines/policies calling for its reduction have emerged internationally. However, there is tension between reducing restraint and maintaining safety. In order to reduce restraint, it is important to gain an understanding of the experience for all involved. The aim of the present study was to improve understanding of the experience of restraint for patients and staff with direct experience and witnesses. Interviews were conducted with 13 patients and 22 staff members from one UK National Health Service trust. The overarching theme, 'is restraint a necessary evil?', contained subthemes fitting into two ideas represented in the quote: 'it never is very nice but...it's a necessary evil'. It 'never is very nice' was demonstrated by the predominantly negative emotional and relational outcomes reported (distress, fear, dehumanizing, negative impact on staff/patient relationships, decreased job satisfaction). However, a common theme from both staff and patients was that, while restraint is 'never very nice', it is a 'necessary evil' when used as a last resort due to safety concerns. Mental health-care providers are under political pressure from national governments to reduce restraint, which is important in terms of reducing its negative outcomes for patients and staff; however, more research is needed into alternatives to restraint, while addressing the safety concerns of all parties. We need to ensure that by reducing or eliminating restraint, mental health wards neither become, nor feel, unsafe to patients or staff. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Physical restraint is mainly used in intensive care units ( ICUs) to prevent delirious or agitated patients from removing tubes and lines connected to them. However, inappropriate use of physical restraint could have many detrimental physical effects on the patient, such as nerve damage, asphyxiation or even death. Aim The aim of the study is to investigate nurses' knowledge, attitude and practice of physical restraint in ICUs in Jordanian hospitals, about which little is known. Design A descriptive and cross-sectional design was used. Methods A convenience sample of 400 nurses working in three public hospitals and one university-affiliated hospital from different geographical regions in Jordan was selected. An Arabic version of the Physical Restraint Questionnaire ( PRQ) was used to collect the data. Results A total of 300 completed questionnaires were returned, with a response rate of 75%. Of the total sample, 51% were males, 65.7% were from public hospitals and 80.3% held a bachelor's degree. The mean score in the knowledge section was 9.7 ( SD =1.7) out of 15; in the attitude section, it was 24.7 ( SD = 4.8) out of 33; and in the practice section, it was 30.9 ( SD = 3.5) out of 42. Nurses who reported previous related education scored higher on the knowledge section (mean = 10.7; SD = 1.4) than nurses who reported no previous related education (mean = 9.1; SD = 1.6; p < .001). However, no significant differences between these categories were found in relation to attitude and practice. Conclusions The study demonstrated some lack of knowledge and unsafe practices regarding physical restraint in ICUs in Jordan. It suggests improving nurses' knowledge, attitude and practices through in-service education on best practice for physical restraint, developing policies/guidelines and providing adequate staff and equipment to maintain patient safety and prevent complications. Relevance to clinical practice Conducting education programmes on physical restraint for ICU nurses and providing other preventive strategies are important in improving nurses' knowledge, attitude and practice. [ABSTRACT FROM AUTHOR]

Purpose Physical restraints are used frequently in Korea, suggesting a growing need for access to programs focused on reduction. The aim of this study was to evaluate the effects of a multicomponent restraint reduction program (MRRP) for nursing staff in Korean nursing homes. Design A cluster-randomized, single-blind, controlled pretest-posttest design was used. A total of 122 nursing staff (nurses and geriatric care assistants) in two Korean nursing homes participated in this study: 62 in the experimental group (EG) and 60 in the control group (CG). Methods Nursing staff in the EG home received the MRRP comprising three educational sessions (two classroom-based and one web-based) and two unit-based consultations. Three instruments were used to measure nursing staff's knowledge, perceptions, and attitudes regarding physical restraints. Data were collected immediately before and after the intervention, and again 1 and 3 months later. Findings Repeated measures analysis of variance showed significant differences between groups in knowledge ( p < .001), perceptions ( p < .001), and attitudes ( p = .011) over time. These significant improvements in the MRRP group (EG) were sustained over the 3-month period. Conclusions The MRRP effectively improved the knowledge, perceptions, and attitudes of nursing home staff about restraint use with older adults. Additional studies are recommended to evaluate effects of its components while using larger samples and rigorous research methods and measurements, and the inclusion of boosters or other supports to sustain change. Clinical Relevance These results provide valuable knowledge regarding a multicomponent intervention for changing nursing home staff attributes that likely influence clinical practice. Elements of the educational content and methods found useful for nursing home staff may also be effective in vocational and continuing education as well as for families of older nursing home residents. [ABSTRACT FROM AUTHOR]

Objectives To develop an internationally accepted research definition of physical restraint. Design Comprehensive literature search followed by a web-based, three-round, modified Delphi technique comprising reviews and feedback. Setting Clinical care settings. Participants An international group of 48 experts consisting of researchers and clinicians from 14 countries who have made sustained contribution to research and clinical application in the field of physical restraint in clinical care. Measurements Data were collected using an online survey program and one in-person meeting. Results of the online survey and the in-person meeting were used for distribution in subsequent rounds until consensus on a definition was reached. Consensus was defined as 90% of the participating experts agreeing with the proposed definition of physical restraint. Results Thirty-four different definitions were identified during the literature search and served as a starting point for the modified Delphi technique. After three rounds, 45 (95.7%) of 47 remaining experts agreed with the newly proposed definition: 'Physical restraint is defined as any action or procedure that prevents a person's free body movement to a position of choice and/or normal access to his/her body by the use of any method, attached or adjacent to a person's body that he/she cannot control or remove easily.' Conclusion A multidisciplinary, internationally representative panel of experts reached consensus on a research definition for physical restraints in older persons. This is a necessary step toward improved comparisons of the prevalence of physical restraint use across studies and countries. This definition can further guide research interventions aimed at reducing use of physical restraints. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Patients within the adult intensive care unit have the potential to develop delirium and agitation. This can result in the patient displaying unwanted behaviours such as attempting to remove the medical devices to which they are attached. Some adult intensive care units within the UK are starting to adopt physical restraint as a method of managing unwanted behaviours. Aim To determine the experiences, attitudes and opinions of adult intensive care nurses in relation to the application of physical restraint. Design Questionnaire survey. Methods A postal questionnaire was distributed to all nurses ( n = 192) within two purposefully selected large adult intensive care units in the UK. Results Data were collected between November 2012 and February 2013. The questionnaire was completed by 38·9% ( n = 75) of the nurses contacted. All believed that physical restraint had a place, with the majority of the view that the reason for its application was to maintain patient safety. Some expressed discomfort about the use of physical restraint. Nurses were happy to discuss the use of restraint with families. There was a perceived need for training and support for nursing staff as well as the need for medical staff to support the decision-making process. Conclusion Nurses require more support and evidence to base their decision-making upon. They require guidance from professional bodies as well as support from medical colleagues. The findings have limited generalizability as they can only be applied to the units accessed and the response rate was poor. Relevance to clinical practice Alternative approaches such as pain management, sleep promotion and the involvement of relatives need to be explored before physical restraint policy can be written. Further research is required into the safety of physical restraint, alternative methods of managing the risk of agitation and identifying predisposing factors to accidental device removal. [ABSTRACT FROM AUTHOR]

Background Feline night monkeys are very susceptible to stress when handled, and because of that, the use of anesthetic and physical restraint methods should be carefully evaluated. To ensure a safer anesthesia to the animals the present study aimed to observe the influence of four restraint protocols in the blood pressure of Aotus azarae infulatus. Methods Blood pressure was obtained from 10 animals subjected to restraining protocols using tiletamine and zolazepam, isoflurane, ketamine and midazolam, and physical restraint and results were evaluated to determine their effect on this exam. Results Among the restraint protocols tested, the anesthetic isoflurane promoted lower blood pressure values and no differences were observed between values measured in both arms in all groups. Conclusion The results of our study suggest that all restraint protocols tested significantly alter blood pressure in this species of primates. [ABSTRACT FROM AUTHOR]

Psychological stress is a risk factor for atherosclerosis, yet the pathophysiological mechanisms involved remain elusive. The transfer of cholesterol from macrophage foam cells to liver and feces (the macrophage-specific reverse cholesterol transport, m- RCT) is an important antiatherogenic pathway. Because exposure of mice to physical restraint, a model of psychological stress, increases serum levels of corticosterone, and as bile acid homeostasis is disrupted in glucocorticoid-treated animals, we investigated if chronic intermittent restraint stress would modify m- RCT by altering the enterohepatic circulation of bile acids. C57Bl/6J mice exposed to intermittent stress for 5 days exhibited increased transit through the large intestine and enhanced fecal bile acid excretion. Of the transcription factors and transporters that regulate bile acid homeostasis, the mRNA expression levels of the hepatic farnesoid X receptor ( FXR), the bile salt export pump ( BSEP), and the intestinal fibroblast growth factor 15 ( FGF15) were reduced, whereas those of the ileal apical sodium-dependent bile acid transporter ( ASBT), responsible for active bile acid absorption, remained unchanged. Neither did the hepatic expression of cholesterol 7 α-hydroxylase ( CYP7A1), the key enzyme regulating bile acid synthesis, change in the stressed mice. Evaluation of the functionality of the m- RCT pathway revealed increased fecal excretion of bile acids that had been synthesized from macrophage-derived cholesterol. Overall, our study reveals that chronic intermittent stress in mice accelerates m- RCT specifically by increasing fecal excretion of bile acids. This novel mechanism of m- RCT induction could have antiatherogenic potential under conditions of chronic stress. [ABSTRACT FROM AUTHOR]

Purpose Physical restraint ( PR) is a highly controversal topic in psychiatry. Little is known about PR among psychiatric inpatients in China. This study examined the frequency of PR and its relationships with demographic and clinical characteristics among a large psychiatric institution in the Hunan Province, China. Design and Methods The study included a consecutively assessed sample of 160 psychiatric inpatients. Sociodemographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. Findings The frequency of PR was 51.3% in the whole sample; 63.2% among female and 39.2% among male patients. In multiple logistic regression analysis PR was independently associated with male gender ( p = 0.001, odds ratio [ OR] = 0.2, 95% confidence interval [ CI] 0.1-0.6), less outpatient treatment prior to admission ( p = 0.03, OR = 0.3, 95% CI 0.1-0.9), more frequent use of mood stabilizers ( p = 0.002, OR = 5.6, 95% CI 1.9-16.7), more aggressive behavior prior to admission ( p = 0.002, OR = 1.1, 95% CI 1.04-1.2), and younger age ( p = 0.04, OR = 0.97, 95% CI 0.93-0.99). Practice Implications PR is very common in clinical practice in China. Its demographic and clinical correlates are similar to findings in Western settings. [ABSTRACT FROM AUTHOR]

Purpose To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. Design and Methods This study employed a retrospective association design, and linear regression was used to assess the associations. Findings Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). Practice Implications None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures. [ABSTRACT FROM AUTHOR]

Physical restraint is used as a last resort emergency measure to calm and safeguard agitated and/or aggressive psychiatric patients. This can sometimes cause injuries, and rare fatalities have occurred. One mechanism of injury and death while in physical restraint is that of severe asphyxiation. We present the case of a hospitalized man in his mid-30s, suffering from schizophrenia. The patient was obese. He became aggressive and had to be manually restrained with a 'takedown.' After having been put in the prone position on the floor with a significant weight load on his body, he lost respiration and consciousness. Subsequently, he was given CPR. He regained consciousness and respiration, while the cyanosis receded in 1-2 min. Psychiatrists and pathologists should be aware that physically restraining a patient in the prone position with a significant weight load on the torso can, in rare cases, lead to asphyxiation. [ABSTRACT FROM AUTHOR]

PURPOSE: To analyze physical restraint use in an Italian acute psychiatric ward, where mechanical restraint by belt is highly discouraged but allowed. DESIGN AND METHODS: Data were retrospectively collected from medical and nursing charts, from January 1, 2005, to December 31, 2008. Physical restraint rate and relationships between restraints and selected variables were statistically analyzed. FINDINGS: Restraints were statistically significantly more frequent in compulsory or voluntary admissions of patients with an altered state of consciousness, at night, to control aggressive behavior, and in patients with 'Schizophrenia and other Psychotic Disorders' during the first 72 hr of hospitalization. PRACTICAL IMPLICATIONS: Analysis of clinical and organizational factors conditioning restraints may limit its use. [ABSTRACT FROM AUTHOR]

Alterations in cellular and chemical constituents in blood are indicators of physical or chemical restraint in deer. The aim of this study was to determine the effects of physical and chemical restraint on hematologic and biochemical analytes in captive brown brocket deer ( Mazama gouazoubira). Six adult deer were physically restrained and randomly anesthetized in a crossover design using 3 protocols (P). In P1, anesthesia was induced directly with isoflurane using a face mask and was maintained with isoflurane delivered by endotracheal tube. In P2, oral premedication with midazolam was followed 1 hour later by induction and maintenance of anesthesia with isoflurane, as in P1. In P3, intravenous anesthesia with a combination of ketamine, xylazine, and atropine was followed by anesthesia with isoflurane, as in P1. Blood was collected immediately after physical restraint (T0) and during anesthesia at 20-minute intervals (T15, T35, and T55). Hematologic and biochemical constituents were determined using manual methods or automated analyzers, with cortisol measured by enzyme immunoassay. During physical restraint, following food and water restriction, significant hemoconcentration, increased WBC count, and lower cortisol concentration were observed compared with results at T15, T35, and T55. During anesthesia, lymphocyte count was lower in P2 than P1, urea concentration was decreased at T15 using P2, and plasma glucose concentration was increased after T0 ( P<.01). Among the anesthetic protocols, there was a trend for decreased cortisol concentration using P2. Physical restraint and anesthesia affect some blood constituents in captive brown brocket deer, and midazolam premedication may modify the intensity of the stress response. [ABSTRACT FROM AUTHOR]