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Aim: This systematic review aimed to identify, describe and evaluate questionnaires measuring health professionals' attitudes towards restraints in mental healthcare. Design: A systematic review was undertaken in accordance with the COSMIN protocol for systematic review and the relevant sections of the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analyses. Data Sources: OVID Medline, OVID nursing, Psychinfo, Embase and Cinahl were systematically searched from databases inception, with an initial search in December 2021 and updated in April 2022. Review Methods: The inclusion criteria compromised articles reporting on self‐reported instruments of attitudes or perceptions, development or validation of instruments and the evaluation of one or more measurement properties. Articles using multiple instruments in one study or not published in English were excluded. Two researchers independently extracted the data and appraised the methodological quality using the COSMIN guidelines and standards (consensus‐based standards for the selection of health measurement instrument). A narrative synthesis without meta‐analysis was performed. The systematic review was registered in PROSPERO Protocol ID CRD42022308818. Results: A total of 23 studies reporting ten instruments were included. The findings revealed a broad variation in the content of the questionnaires, the use of terms/constructs and the context in which the various instruments measure attitudes towards coercive measures. Many studies lacked sufficient details on report of psychometric properties. Finally, the results were not summarized and the evidence not GRADED. Conclusions: There is a need for updated and adapted instruments with origins in theory and clear joint definitions such that attitudes towards coercive measures can be reliably assessed regarding the validity and reliability of instruments, which will be of importance to facilitate the use of instruments in research and clinical settings. Impact: Reviews addressing surveys, self‐reported attitudes towards restraints in mental healthcare and examination of psychometric properties seem limited. We highlight distinct complexity, psychometric limitations and broad variation in the context and content measuring attitudes towards coercive measures, and their various use of terms/constructs in the existing questionnaires. These findings contribute to further research regarding the development of questionnaires and the need of representing the concept well – carefully denoted by the indicators, likewise the importance of applying questionnaires with properly reported measurement properties in terms of validity and reliability to ensure the use in research and clinical settings. [ABSTRACT FROM AUTHOR]

Medical students (NSB, NM, JDW) spearheaded revision of the policy and clinical practice for shackling incarcerated patients at Boston Medical Center (BMC), the largest safety net hospital in New England. In American hospitals, routine shackling of incarcerated patients with metal restraints is widespread—except for perinatal patients—regardless of consciousness, mobility, illness severity, or age. The modified policy includes individualized assessments and allows incarcerated patients to be unshackled if they meet defined criteria. The students also formed the Stop Shackling Patients Coalition (SSP Coalition) of clinicians, public health practitioners, human rights advocates, and community members determined to humanize the inpatient treatment of incarcerated patients. Changes pioneered at BMC led the Mass General Brigham health system to follow suit. The Massachusetts Medical Society adopted a resolution authored by the SSP Coalition, which condemned universal shackling and advocated for use of the least restrictive alternative. This will be presented to the American Medical Association in June 2024. The Coalition led a similar effort to coauthor a policy statement on the issue, which was formally adopted by the American Public Health Association in November 2023. Most importantly, in an unprecedented human rights victory, a BMC patient who was incarcerated, sedated, and intubated was unshackled by correctional officers for the purpose of preserving human dignity. [ABSTRACT FROM AUTHOR]

Background Restraints are one of the common procedures performed in various medical settings, especially intensive care units, and psychiatric wards. There are various forms of restraints, including chemical, physical, and mixed restraints. The primary reasons for using restraints are to prevent injury to the patient and others, and to reduce violent behavior in psychotic patients. Objectives The aim of this article was to identify the types of restraints used for psychiatric patients and current restraint practices for patients in psychiatric wards of selected mental health facilities. Methods This was a descriptive cross-sectional study conducted among 100 psychiatric patients selected using purposive sampling techniques. An observational checklist was used to assess restraint practice in patients who met study criteria. Results The majority of patients (44%) received chemical restraints, some (28%) received physical restraints, but a minority (28%) used mixed restraints. In terms of practice, most patients (91%) received reasonably safe restraint care. An association was found between practice of restraints and restraints type with a p -value (0.001) less than 0.05 at a significance level of 0.05. Conclusions The development of mandatory practice protocols is critical for better nursing care. [ABSTRACT FROM AUTHOR]

The purpose of this study was to determine the impact of implementing hourly rounding on restraint use in the clinical setting. Study results indicate implementing an hourly rounding program had significant impact on restraint use. [ABSTRACT FROM AUTHOR]

Aim: This study aims to understand the perceptions regarding physical restraints of the elder‐care professional's stakeholders. Design: A qualitative methodology was employed. Methods: Semi‐structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. Results: Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework. [ABSTRACT FROM AUTHOR]

Spit hoods have been used for decades to reduce the ability of people to spit and bite police officers, corrective services officers, paramedics, doctors and nurses. However, historically and in public consciousness they have sinister resonances and often induce fear, panic and distress in persons to whom they are applied or in whose presence they are worn. Problematically frequently spit hoods have been used on detainees from ethnic minorities, including in Australia, on Indigenous persons, individuals with mental illnesses and children taken into custody. On a number of occasions spit hoods have been used with other forms of restraint and been associated with deaths in custody. This editorial reviews high profile cases internationally where spit hoods have played a role in precipitating deaths, important reports and reviews, including from coroners, ombudsmen and commissions of inquiry, into their abuse, and law reform in relation to spit hoods. It supports their abandonment and their replacement with other personal protective equipment options for maintaining custodians' and carers' occupational health and safety. [ABSTRACT FROM AUTHOR]

Purpose: Physical restraints are used routinely in intensive care units (ICUs) and have negative effects. It is critical to identify the impact factors of physical restraints on critically ill patients. The present study investigated the prevalence of physical restraints and impact factors associated with their use in a large cohort of critically ill patients over one year. Patients and Methods: A retrospective cohort study was performed in multiple ICUs at a tertiary hospital in China in 2019 using observational data from electronic medical records. The data consisted of demographics and clinical variables. Logistic regression was used to assess the independent impact factors for the use of physical restraint. Results: The analysis consisted of 3776 critically ill patients with a prevalence of physical restraint use of 48.8%. The logistic regression analysis indicated that physical restraint use was associated with independent risk factors, including surgical ICU admission, pain, tracheal tube placement, and abdominal drainage tube placement. Physical restraint use was associated with independent protective factors, including male sex, light sedation, muscle strength, and ICU length of stay. Conclusion: The prevalence of physical restraint use in critically ill patients was high. Tracheal tubes, surgical ICU, pain, abdominal drainage tubes, light sedation, and muscle strength were independent variables associated with the use of physical restraint. These results will assist health professionals in identifying high-risk physical restraint patients based on their impact factors. Early removal of the tracheal tube and abdominal drainage tube, pain relief, light sedation, and improvements in muscle strength may help reduce the use of physical restraints. [ABSTRACT FROM AUTHOR]

The article discusses the use of physical restraints for patients with hepatic encephalopathy, emphasizing the importance of patient safety and ethical considerations. The study found that the use of physical restraints in patients who did not require invasive care was associated with negative outcomes, such as increased length of stay and mortality. Additionally, disparities in restraint use were observed among different patient populations, raising concerns about healthcare equity and access. The article concludes by highlighting the need for improved patient management strategies and further research on the impact of restraint use on patients and their families. [Extracted from the article]

• In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. • The use of chemical restraints increased 460 % from 2016 to 2022 with ketamine the most common medication used. • Restraint use was associated with psychiatric illness, intoxication, altered mental status, injury severity, and health insurance type. Despite research linking chemical and physical restraints to negative outcomes including unplanned intubations and psychological distress, there is little guidance for their use in the care of trauma patients. We used institutional data to describe recent trends in chemical and physical restraint in the emergency department evaluation and treatment of trauma patients and to identify characteristics associated with their use. This study includes adult trauma activations at a United States urban level I trauma center from January 2016 to July 2022. Data were collected from the trauma registry and medical record. We assessed the use of chemical restraints and physical restraints during care provided in the trauma resuscitation bay and emergency department. We assessed trends over time graphically and with logistic regression. We used multivariable regression models to evaluate associations between restraint use and patient and clinical characteristics and the outcomes of ICU admission, hospitalization duration, and mortality. Of the 8,112 patients, most were male (74.8 %), White (55.8 %), and privately insured (35.2 %). Overall, 8.1 % were restrained with 7.1 % chemically restrained and 2.7 % physically restrained. Overall restraint use increased 254 % (p < 0.001) from 2016 to 2022 driven primarily by a 460 % (p < 0.001) increase in chemical restraint use including a 630 % increase in ketamine administrations (p < 0.001). Use of restraints was associated with pre-existing psychotic disorders, intoxication, altered mental status, increasing injury severity, and Medicaid insurance (p < 0.001). Chemical restraint administration was associated with a 3.5 percentage point (95 %CI 1.1–5.9; p = 0.004) increase in the probability of ICU admission and a 1.0 day (95 %CI 0.6–1.4; p < 0.001) increase in hospitalization duration. In this institutional study, nearly one-in-twelve trauma patients were restrained during emergency department evaluation and treatment. Restraint utilization increased during the study driven primarily by increases in ketamine and restraints utilized during trauma bay evaluation and resuscitation. Future research should assess the generalizability of these findings. It is important that rigorous guidelines are established to ensure the safe and effective use of restraints in trauma. [ABSTRACT FROM AUTHOR]

Global demographic changes and the strategy of 'ageing in place' will increase the importance of home care in the future. To deliver safe and high‐quality care, clinical data on nursing‐sensitive indicators and transparency are needed. A comprehensive narrative review of the literature was conducted to describe the prevalence and incidence of nursing‐sensitive indicators, namely, falls, incontinence, malnutrition, pain, pressure injury and restraints in home care. A literature search was carried out in May 2021 in PubMed and CINAHL, and 28 studies were included. Data were extracted using two extraction tables designed for this review. Prevalence and incidence rates varied widely and internationally within each indicator. The prevalence range for falls was 4.8%–48%; urinary incontinence, 33.7%–62.5%; malnutrition, 20%–57.6%; pain, 6.5%–68.5%; pressure injury, 16%–17.4% and physical restraints, 5%–24.7%. Due to various measurements and different instruments, the rates are not comparable. The use of standardised measurement and risk assessment tools to assess nursing‐sensitive indicators in home care is needed to implement suitable interventions and to prevent these indicators. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known about the subject?: Restraint has negative psychological, physical and relational consequences for mental health patients and care providers.Several countries have implemented seclusion and restraint (S/R) reduction programmes in which post‐incident reviews (PIRs) including patients and care providers are one of several strategies.Existing knowledge indicates that PIRs have the potential to contribute to S/R prevention, but knowledge of the patients' perspectives on PIRs is scarce. What the paper adds to existing knowledge?: The paper provides in‐depth knowledge about patients' experiences of being participants in PIRs after restraint events.Patients experience PIRs to result in being strengthened and developing new coping strategies.The paper reveals pitfalls when planning and conducting PIRs that make patients experience PIRs as meaningless, feel objectified or long for living communication and closeness.The patients' mental state, the quality of the relationships and the services' care philosophies, influence patients' experiences of PIRs as supporting their personal recovery processes or as continuation of coercive contexts. What are the implications for practice?: Patients' vulnerability during the PIRs must be acknowledged.Trusted persons or advocacy must support the patient in the PIR and thus reduce the power‐dependence imbalance.The PIR must be conducted in a supportive, non‐punishing atmosphere.Patients must influence planning for the PIR concerning time point and participants and themes to be discussed.The PIR forms should be extended to support the patients' empowerment and well‐being. Introduction: Post‐incident reviews (PIRs), including patients, nurses and other care providers, following incidents of restraints are recommended in mental health services. Few studies have examined patients' experiences and considerations concerning PIRs. Aim: The study aims to explore patients' perspectives on PIRs in relation to how they experience participation in PIRs and further view PIRs' potential for care improvement and restraint prevention. Method: We conducted a qualitative study based on individual interviews. Eight current and previous inpatients from two Norwegian mental health services were interviewed. Results: The patients experienced PIRs as variations on a continuum from being strengthened, developing new coping strategies and processing the restraint event to at the other end of the continuum; PIRs as meaningless, feeling objectified and longing for living communication and closeness. Discussion: PIRs' beneficial potential is extended in the study. The findings highlight however that personal and institutional conditions influence whether patients experience PIRs as an arena for recovery promotion or PIRs as continuation of coercive contexts. Implications for practice: We recommend patients' active participation in planning the PIR. PIRs should be conducted in a supportive atmosphere, including trusted persons, emphasizing and acknowledging a dialogical approach. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known about the subject?: In a survey conducted by the World Health Organization (WHO) in the summer of 2020, 93% of countries worldwide acknowledged negative impacts on their mental health services.Previous research during the H1N1 pandemic in 2009 established an increase of patient aggression in psychiatric facilities. What the paper adds to existing knowledge?: Despite expected worsening of mental health, our hospital observed reductions in aggressive behaviour among inpatients and subsequent use of coercive interventions by staff in the months following Covid‐19 pandemic restrictions being implemented.The downward trend in incidents observed during the pandemic has suggested that aggression in mental health hospitals may be more situation‐specific and less so a factor of mental illness. What are the implications for practice?: We believe that the reduction in aggressive behaviour observed during the pandemic is related to changes in our organization that occurred in response to concerns about patient well‐being; our co‐design approach shifted trust, choice and power. Therefore, practices that support these constructs are needed to maintain the outcomes we experienced.Rather than return to normal in the wake of the pandemic, we are strongly encouraged to sustain the changes we made and continue to find better ways to support and work with the individuals who rely on or use our services. The global COVID‐19 pandemic has dramatically changed the operation of health care such that many services were put on hold as patients were triaged differently, people delayed seeking care, and transition to virtual care was enacted, including in psychiatric facilities. Most of the media dialogue has been negative; however, there have been some silver linings observed. Coinciding with the pandemic has been a reduction in aggressive incidents at our psychiatric hospital, along with the decreased need to use restraints and seclusion to manage behaviour. In this paper, we are taking stock of the changes that have occurred in response to the pandemic in an attempt to share our learnings and offer suggestions so that health care does not necessarily return to "normal". [ABSTRACT FROM AUTHOR]

Aim: The focus was to explore the perceptions and experiences of healthcare workers with respect to the use of restraints in acute care hospitals. Design: The study followed a qualitative design. Methods: Three topic‐based focus group interviews were conducted, involving 19 participants from the fields of nursing, physical therapy and medicine. For data collection and analysis, the method of mapping techniques for rapid qualitative data analysis was used. After discussing and validating the individual mind maps, all data were condensed to identify the key findings. Results: Participants described restraints as safety measures for the patients. The implementation of most restraints was led by nurses. The use of restraints differed significantly, even in the interprofessional team. Attitudes and experiences were the main determinants for restraint use. Nurses asked for more discussion about restraints in the team, for more support at an interprofessional level and for better guidelines to help with the decision‐making process. [ABSTRACT FROM AUTHOR]

Timely use of pharmacological interventions to treat acute agitation has the potential to decrease physical restraint use. The aim of this study is to determine if adherence to standardized pharmacological recommendations for the treatment of acutely agitated pediatric patients decreases physical restraint use. Additionally, this study aims to identify predictors of physical restraint use and describe treatment related adverse events. This is a retrospective chart review of patient visits between September 1, 2016 and August 31, 2017. Patient visits were included if the patient presented to the pediatric emergency department, met ICD-10 codes, and received pharmacologic management or physical restraint to treat acute agitation. The differences in rate of physical restraint was assessed between patients treated according to the standardized pharmacological recommendations and patients who were not. 447 patients were included with a mean age of 13 years. No significant difference in physical restraint use was found when standardized pharmacological recommendations were followed compared to when they were not (P = 0.16). Only presentation on day shift when compared to evening shift resulted in increased odds of being restrained (OR 2.03; 95% CI 1.18, 3.50). Nine adverse events possibly related to medications were identified with none considered to be of significant clinical concern. Standardized pharmacological treatment recommendations was not associated with a decrease in physical restraint use for agitated patients presenting to the pediatric emergency department. The pharmacologic strategies utilized were generally safe and well tolerated in this patient population. [ABSTRACT FROM AUTHOR]

Background: Research regarding disparities in physical restraint use in the emergency department (ED) is limited. We evaluated the role of race, ethnicity, and preferred language on the application of physical restraint among ED patients held under a Massachusetts section 12(a) order for mandatory psychiatric evaluation. Methods: We identified all ED patient encounters with a section 12(a) order across a large integrated 11‐hospital health system from January 2018 through December 2019. Information on age, race, ethnicity, preferred language, insurance, mental illness, substance use, history of homelessness, and in‐network primary care provider was obtained from the electronic health record. We evaluated for differences in physical restraint use between subgroups via a mixed‐effect logistic regression with random‐intercept model. Results: We identified 32,054 encounters involving a section 12(a) order. Physical restraints were used in 2,458 (7.7%) encounters. Factors associated with physical restraint included male sex (adjusted odds ratio [aOR] = 1.44, 95% confidence interval [CI] = 1.28 to 1.63), Black/African American race (aOR = 1.22, 95% CI = 1.01 to 1.48), Hispanic ethnicity (aOR = 1.45, 95% CI = 1.22 to 1.73), Medicaid insurance (aOR = 1.21, 95% CI = 1.05 to 1.39), and a diagnosis of bipolar disorder or psychotic disorder (aOR = 1.51, 95% CI = 1.31 to 1.74). Across all age groups, patients who were 25 to 34 years of age were at highest risk of restraint (aOR = 2.01, 95% CI = 1.69 to 2.39). Patients with a primary care provider within our network (aOR = 0.81, 95% CI = 0.72 to 0.92) were at lower risk of restraint. No associations were found between restraint use and language, history of alcohol or substance use, or homelessness. Conclusion: Black/African American and Hispanic patients under an involuntary mandatory emergency psychiatric evaluation hold order experience higher rates of physical restraint in the ED. Factors contributing to racial disparities in the use of physical restraint, including the potential role of structural racism and other forms of bias, merits further investigation. [ABSTRACT FROM AUTHOR]

Background: The restraining of children is a pervasive but controversial practice that has resulted in the injury and death of children. Despite this threat of harm, little research has explored what factors contribute to the risk of a child becoming injured during a restraint event. Objective: This study examined multiple child and restraint factors to better understand what predicts the injury of a child during a restraint event. Methods: Longitudinal data (794 youth, 13,339 restraint events) from six residential treatment centers in the Midwest were utilized to predict injury associated with restraint using nested hierarchical logistic regression models. Results: Injuries to the child are a frequent outcome following the use of restraints on a child. Findings show that a child being male and older contributed to the likelihood of an injury, but the race of the child did not predict injury. In addition, three physical hold types—prone, supine, and settle—were associated with a greater likelihood of injury. Conclusions: Results suggest those who use restraints on children should reevaluate their behavior management plans to reduce their risk of hurting children by restraints. Eliminating or greatly reducing the use of prone, supine, and settle holds will likely lead to a drop in injuries of children. [ABSTRACT FROM AUTHOR]

Purpose: To reduce the use of mechanical restraints, Safewards was introduced to a ward in a psychiatric hospital in Poland. Design and Methods: Three aspects of Safewards were applied for 8 months. The comparison time period was the same time frame of the previous year. Findings: Restraint use dropped by 24%, and the number of patients restrained dropped 34%. The duration of restraint remained at 2.8 days per episode. Practice Implications: Simple techniques aimed at promoting positive interactions between staff and patients can reduce the frequency of restraints. [ABSTRACT FROM AUTHOR]

Objective: To explore the meaning and potential role of new Quality of Care Amendment (Minimising the Use of Restraints) Principles 2019, (Principles) which amend Quality of Care Principles 2014 in improving practice around physical and chemical restraint. Methods: We examined both Principles and accompanying Explanatory Statement in light of best practices around consent and use of chemical and physical restraint. Results: The chemical restraint definition is problematic by exclusion of medications for treating mental disorders, physical illness or physical conditions, which is not considered restraint. Inexplicably, physical restraint requirements are more rigorous than chemical restraint requirements, where assessment is optional, and consent sometimes obtained, after use, and from the person's "representative," rather than the person first, followed by their proxy decision‐maker. Conclusions: Although a start in promoting best practice around physical restraint, the Principles do not address the status quo of poor practice around chemical restraint and may instead codify it. [ABSTRACT FROM AUTHOR]

Objective: To map areas of discussion about use of seclusion and restraint in healthcare, as expressed in motifs posted on Twitter. Materials and method: We adopted a qualitative approach with an archival and cross-sectional observational design. 188 images from Twitter postings were analyzed. Results: Five categories were identified: Informative and educational messages; Equipment as artifacts; Spatiality; The restrained subjects; Sociopolitical connotations of restraint. Conclusions: Based on our results we conclude that Twitter included several aspects; the intention to educate others, show the spatiality in relation to restraint, imagining characterized by objects and persons, and a sociopolitical connotation. This in turn means that Twitter posts offer nurses a chance to engage in social marketing and connoting an ethical dimension to a person associated with measures used to exert power over others. This is because communication surrounding certain controversial issues in healthcare is free from hierarchies on Twitter. [ABSTRACT FROM AUTHOR]

News of teenager's death in California shocked the special education community in early December 2018. Despite the Individuals With Disabilities Education Act's provision for positive behavior supports for students with disabilities, these inidividuals continue to be secluded and restrained at disproportionately higher rates than their nondisabled peers. Using the Special Ed Connection® database, the authors identified 11 court cases from 2018 and analyzed their contents based on individualized education program (IEP) behavior components, type of restraints used, and prevalence of seclusion. Within these cases, all 12 included students were boys, four IEPs included behavior components, nine students were physically or mechanically restrained, and two were secluded. A review of the four cases that included the use of positive behavior supports is included. [ABSTRACT FROM AUTHOR]

Background: The utilization of seclusion and restraint during psychiatric inpatient treatment increases the risk of trauma, humiliation, physical injuries, psychological distress, and even death. Compared to adult patients, pediatric patients are more likely to be placed in seclusion and restraints. In a short‐term child and adolescent behavioral health unit, the average seclusion and restraint rate was 0.031. The hospital's goal was to achieve a zero seclusion and restraint rate. Purpose: The purpose of this project was to decrease the rate of seclusion and restraints at the study site. Method: A quality improvement study was implemented based on a bundled intervention strategy. The intervention included a decision‐making algorithm for initiation of seclusion and restraints, behavioral modification plans for patients at risk of seclusion and restraints, and a patient‐debriefing tool to be used post a seclusion and restraint event. Post implementation, data were collected over a 3‐month period. Results: The implementation of a seclusion and restraint decision‐making algorithm, behavioral modification, and patient debriefing successfully decreased the seclusion and restraint rate by 55% on an inpatient pediatric behavioral health unit. Conclusion: Although, the project resulted in a successful reduction in the rates for seclusion and restraint, continued quality improvement efforts are indicated to achieve zero restraint/seclusions on the unit. [ABSTRACT FROM AUTHOR]

Background: Physical restraints is one of the important responsibilities of nurses. Physical restraints are used by nurses in order to prevent patients from harming themselves and people around them but there are deaths and serious injuries due to physical restrictions. Aim: This research was carried out to determine the nurses' knowledge, attitudes and practices, with affecting factors, on the use of physical restraints. Methodology: The research is a descriptive, cross-sectional study. The research population consisted of 700 nurses. The sample consisted of 548 nurses who participated in the study voluntarily. Data were collected through the completion of a 'Personal Information Form' and a 'Levels of Knowledge, Attitudes, and Practices of Staff Regarding Physical Restraints Questionnaire'. The data were analyzed by percentage, arithmetic mean, ANOVA and t-test. Results: The nurses' knowledge average score relating to physical restraints was 7.8±1.8, the mean score for attitudes was 31.9±3.8 and mean score for practices was 37.2±3.8. A statistically significant difference was found between the hospitals and clinics where nurses work, and knowledge, attitude and practice scores relating to the use of physical restraints (p<0.05). Conclusions: Nurses have a good level of information on the use of the physical restraints, and they largely reflect a positive attitude towards applying this knowledge to the practice of physical restraints. However, the ratio of developing positive attitude was found to be lower than the mean scores of knowledge and practice. [ABSTRACT FROM AUTHOR]

Restraint and seclusion are measures to restrict the movement of a person. The predominant reason cited for the use of restraint in mental health settings is the safety of the staff and the patient in times of aggression and to control problem behaviors. However, there have been significant issues in terms of ethics, rights of the patient, and the harmful effects of restraint. Recently, there has been a move in Western countries to decrease its use by incorporating alternative methods and approaches. In India, the Mental Healthcare Act of 2017 advocates the use of least restrictive measures and alternatives to restraint in providing care and treatment for person with mental illness. In this context, approach to restraints is all the more relevant. This article looks to overview the types of restraints, complications of restraints, and the alternatives to restraint in diverse settings. [ABSTRACT FROM AUTHOR]

For decades, aged care facility residents at risk of pressure ulcers (PUs) have been repositioned at two-hour intervals, twenty-four-hours-a-day, seven-days-a-week (24/7). Yet, PUs still develop. We used a cross-sectional survey of eighty randomly selected medical records of residents aged ≥ 65 years from eight Australian Residential Aged Care Facilities (RACFs) to determine the number of residents at risk of PUs, the use of two-hourly repositioning, and the presence of PUs in the last week of life. Despite 91 per cent (73/80) of residents identified as being at risk of PUs and repositioned two-hourly 24/7, 34 per cent (25/73) died with one or more PUs. Behaviours of concern were noted in 72 per cent (58/80) of residents of whom 38 per cent (22/58) were restrained. Dementia was diagnosed in 70 per cent (56/80) of residents. The prevalence of behaviours of concern displayed by residents with dementia was significantly greater than by residents without dementia (82 per cent v 50 per cent, p = 0.028). The rate of restraining residents with dementia was similar to the rate in residents without dementia. Two-hourly repositioning failed to prevent PUs in a third of at-risk residents and may breach the rights of all residents who were repositioned two-hourly. Repositioning and restraining may be unlawful. Rather than only repositioning residents two-hourly, we recommend every resident be provided with an alternating pressure air mattress. [ABSTRACT FROM AUTHOR]

Abstract Background Although there is evidence that use of restraints in home care is increasing, research into the factors associated with restraints in this setting is scarce. Objective To gain insight into the factors associated with restraints in older adults receiving home care. Design A s econdary analysis of a cross-sectional survey about restraint use in home care. Settings Older adults receiving home care in Belgium. Participants 8000 subjects were randomly selected from a total of 45,700 older adults. The mean age of the sample (n = 6397) was 80.6 years, 66.8% were women and 46.4% lived alone. Methods A cross-sectional survey of restraint use on older adults receiving home care from a nursing organisation in Belgium was completed by the patients' primary care nurses. A binary logistic regression model with generalised estimating equations was used to evaluate factors associated with restraint use. Additional analyses focused on the subgroups with and without an informal caregiver and living alone / with others. Data from 6397 participants were analysed in detail. Results Multivariate logistic regression indicated that restraint use was associated with supervision [OR = 2.433, 95% CI = 1.948–3.038]; dependency in activities of daily living (i.e. eating [OR = 2.181, 95% CI = 1.212–3.925], transfer [OR = 2.131, 95% CI = 1.191–3.812] and continence [OR = 1.436, 95% CI = 0.925–2.231]; perceived risk of falling in the nurses' clinical judgement [OR = 1.994, 95% CI = 1.710–2.324], daily behavioural problems [OR = 1.935, 95% CI = 1.316–2.846] and less than daily behavioural problems [OR = 1.446, 95% CI = 1.048–1.995]; decreased well-being of the informal caregiver [OR = 1.472, 95% CI = 1.126–1.925], the informal caregiver's dissatisfaction with family support [OR = 1.339, 95% CI = 1.003–1.788]; patient's cognitive impairment [OR = 1.398, 95% CI = 1.290–1.515]; and polypharmacy [OR = 1.415, 95% CI = 1.219–1.641]. The nurses' perception of risk of falling, cognitive impairment (observed with the Cognitive Performance Scale) and supervision are the only variables consistently associated with restraint use across all the analyses. Conclusion The study results provide insight into new and context-specific factors associated with restraint use in home care (e.g. supervision, informal caregiver's decreased well-being and dissatisfaction with family support). These insights could support the development of interventions to reduce restraint use in home care. [ABSTRACT FROM AUTHOR]

Restraint use has been linked to longer lengths of stay and other undesirable outcomes. This evidence-based project explored the impact of a restraint management bundle on restraint use, quality, and safety outcomes. Results indicated that the proportion of intensive care unit patients restrained decreased significantly (24.3% vs 20.9%) following program implementation. Project results suggest that the restraint management bundle may provide a framework for guiding the process to reduce restraint use, minimize harm, and improve patient safety. [ABSTRACT FROM AUTHOR]

Aims This systematic quantitative review identifies and summarizes the current knowledge and effects of training interventions for managing patients' challenging behaviour. Background Challenging behaviour is an acknowledged worldwide healthcare problem and its management can have a huge impact on quality of care. Evidence-based training interventions that focus on managing challenging behaviour are needed, but few tools for the systematic evaluation of these interventions are currently offered. Design A quantitative systematic review following the 2008 Centre for Reviews and Dissemination guidelines. Data Sources CINAHL, Scopus, PsycInfo, PubMed and Cochrane were searched using the same terms for papers published in English from 2005-2015. Review Methods Studies were assessed for quality and risk of bias, according to the Cochrane Effective Practice and Organisation of Care Group criteria. A narrative summary was conducted. Results We included 17 studies and evaluated 16 training interventions. Interventions were classified into four key themes: disengagements, communication, controlling behavioural symptoms and restrictive measures. Our review showed that interventions were more likely to decrease violent incident rates and increase staff confidence than change staff attitudes or increase knowledge. The elements of competence used to manage challenging behaviour were measured unilaterally. The evidence provided by studies was largely weak. Conclusion The variety of measurements used in the studies made comparing the effectiveness of the training interventions difficult. An individual's competence to manage challenging behaviour needs to be defined and a comprehensive scale for evaluating competence is also needed. Patient safety should be included in future evaluations. [ABSTRACT FROM AUTHOR]

Objective: This study's primary objective was to investigate the prevalence of physical and chemical restraint use in selected elderly hospitalized patients. Results: This study was conducted in April 2014 in four major acute care hospitals. Trained data collectors assessed the use of physical and chemical restraint among all admitted elderly patients. There were 287 elderly patients (median age 64 years, 46% women). 32 patients were restrained. The overall prevalence of restraints was 11.1%, with physical restraint use alone at 3.2% and chemical restraints use alone at 7.3%. Restraint use varied by hospital type, with the highest at the private hospital (22.9%) and the lowest at the two university hospitals (< 6%). In conclusion the prevalence of physical and chemical restraint use among admitted elderly patients in Egypt is comparable to that seen in developed countries. However, the use appears to vary widely by hospital type. The use of restraints in the elderly remains an important question considering the increasing number of elderly. [ABSTRACT FROM AUTHOR]

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Objectives To determine the prevalence, types, frequency, and duration of restraint use in older adults receiving home nursing care and to determine factors involved in the decision-making process for restraint use and application. Design Cross-sectional survey of restraint use in older adults receiving home care completed by primary care nurses. Setting Homes of older adults receiving care from a home nursing organization in Belgium. Participants Randomized sample of older adults receiving home care (N = 6,397; mean age 80.6; 66.8% female). Measurements For each participant, nurses completed an investigator-constructed and -validated questionnaire collecting information demographic, clinical, and behavioral characteristics and aspects of restraint use. A broad definition of restraint was used that includes a range of restrictive actions. Results Restraints were used in 24.7% of the participants, mostly on a daily basis (85%) and often for a long period (54.5%, 24 h/d). The most common reason for restraint use was safety (50.2%). Other reasons were that the individual wanted to remain at home longer, which necessitated the use of restraints (18.2%) and to provide respite for the informal caregiver (8.6%). The latter played an important role in the decision and application process. The physician was less involved in the process. In 64.5% of cases, there was no evaluation after restraint use was initiated. Conclusion Use of restraints is common in older adults receiving home care nursing in Belgium. These results contribute to a better understanding of the complexity of use of restraints in home care, a situation that may be even more complex than in nursing homes and acute hospital settings. [ABSTRACT FROM AUTHOR]

Copyright of L'Infermiere is the property of IPASVI - Italian Nursing Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: The number of incarcerated women in the United States has been steadily increasing over the last 30 years. An estimated 6-10% of these women are pregnant at intake. Previous studies on the health needs and care of pregnant incarcerated women have focused mainly on prison settings. Therefore, we examined the pregnancy-related accommodations and health care provided for regional jail populations. Method: The present study is a quantitative survey (administered through phone or email to employees of predominately jail medical facilities) of common practices and policies employed across 53 jail facilities in the United States as a function of geographic region (North vs. South; West vs. Central vs. East). We examined provision of pregnancy screening, special diets, and drug rehabilitation and prohibition of shackling. Results: Strikingly, across all aspects of the care of pregnant incarcerated women there are areas to be improved upon. Notably, only 37.7% of facilities pregnancy test all women upon entry, 45.7% put opioid addicted women through withdrawal protocol, and 56.7% of facilities use restraints on women hours after having a baby. Conclusion: In this first study to examine practices in regional jails nationwide, we found evidence that standards of care guidelines to improve health and well-being of pregnant incarcerated women, set by agencies such as American College of Obstetricians and Gynecologists, are not being followed in many facilities. Because not following these guidelines could pose major health risks to the mother and developing fetus, better policies, better enforcement of policies, and better common practices are needed to improve the health and welfare of pregnant incarcerated women. [ABSTRACT FROM AUTHOR]

A quality improvement initiative was undertaken to reduce restraint use in 4 acute care hospitals within a single health system. A variety of initiatives and interventions were used including the following: implementation of multidisciplinary rounds on restrained patients, increased availability of restraint alternatives, development of unit-based restraint champions, and education of both staff and health care providers about restraints. The health care system has maintained a quarterly restraint prevalence rate of less than 2.26% with 1 variant. [ABSTRACT FROM AUTHOR]

There have been a number of changes in the clinical practice of seating and wheeled mobility (SWM) for older adults in nursing homes. Twenty years ago, physical restraints were being used indiscriminately with the intent to protect the person from falling. Currently, we know that physical restraints increased the risk of falls, discomfort, functional limitations, and fatalities. Some of those restrained were in ill-fitting wheelchairs. Through specific projects, collaborative efforts, awareness, education, and improved products, clinical practice has changed. The 5-step mat assessment and common postural problems in elders remain the same. Major barriers to improved seating and wheeled mobility still exist such as insufficient funding, inadequate education of practitioners, and poor maintenance of equipment. These barriers inhibit the availability of improved seating and wheeled mobility for older adults in nursing homes. Continued attention by practitioners, policy makers, and payers is necessary to increase access. [ABSTRACT FROM AUTHOR]

Objective: to determine the prevalence and predictors of bedrail use in an acute hospital.Design and setting: overnight survey in a University teaching hospital.Subjects: Three-hundred and twenty-seven beds and patients in 14 wards.Methods: data were collected on bedrail use and on the bed system, ward and patient characteristics. Medical, nursing and physical therapy notes were examined and the night and day nurses and, if necessary, the doctors and therapists caring for the patient interviewed to determine patients' diagnoses, functional and cognitive status.Results: there were 133 (40.7%) beds with one or more raised rails. Independent predictors of bedrail use were use of electric profiling beds, confusion, reduced alertness and any difficulty with transferring from bed. The most common reported indication for bedrail use was ‘to prevent rolling out of bed’ (59%); ‘to prevent getting out of bed’ was recorded in 11% of cases. Use of bedrails was judged inappropriate in 27/133 (20.3%) patients and in 14/43 (32.6%) patients with abnormal mental status; misuse was particularly common in those with confusion or agitation [13/34 (38.2%)]. Failure to use bedrails was potentially inappropriate in 32/194 (16.5%) of those without bedrails.Conclusion: this study using individual patient data shows that the use of electric profiling beds, abnormal mental states and difficulty transferring from bed are the main predictors of bedrail use in acute hospitals. Inappropriate use of bedrails is common in those with cognitive impairment or with agitation. [ABSTRACT FROM AUTHOR]

Objectives To assess whether reductions in physical restraint use associated with quality reporting may have had the unintended consequence of increasing antipsychotic use in nursing home ( NH) residents with severe cognitive impairment. Design Retrospective analysis of NH clinical assessment data from 1999 to 2008 comparing NHs subject to public reporting of physical restraints with nonreporting NHs. Setting Medicare- and Medicaid-certified NHs in the United States. Participants Observations (N = 3.9 million) on 809,645 residents with severe cognitive impairment in 4,258 NHs in six states. Intervention Public reporting of physical restraint use rates. Measurements Use of physical restraints and antipsychotic medications. Results Physical restraint use declined significantly from 1999 to 2008 in NH residents with severe cognitive impairment. The decline was larger in NHs that were subject to reporting of restraints than in those that were not (-8.3 vs -3.3 percentage points, P < .001). Correspondingly, antipsychotic use in the same residents increased more in NHs that were subject to public reporting (4.5 vs 2.9 percentage points, P < .001). Approximately 36% of the increase in antipsychotic use may be attributable to public reporting of physical restraints. Conclusion This analysis suggests that public reporting of physical restraint use had the unintended consequence of increasing use of antipsychotics in NH residents with severe cognitive impairment. [ABSTRACT FROM AUTHOR]

Aim The aim of this article was to describe the design of an international audit of the prevalence of care problems in different healthcare sectors using identical methodologies. Background Audits, defined as a monitor of quality of health care, are increasingly applied in many countries as a strategy to improve professional practice and quality and safety of care. A prerequisite to enable a reliable comparison of quality of care audits is the use of identical instruments and methodology. Design Annual cross-sectional multi-centre point prevalence survey. Method This international prevalence measurement of care problems in hospitals, care homes and home care is performed in the Netherlands, Austria, Switzerland and New Zealand. This study is based on a prevalence measurement of care problems originally performed in the Netherlands. For each care problem (pressure ulcer, incontinence, malnutrition, falls and restraints) at patient level, next to patient characteristics, data are gathered about the prevalence, prevention and treatment of each care problem. In addition, at ward/department and institution level, specific quality indicators are measured related to the care problems. After the measurement, institutions enter their data into a web-based data-entry program. Institutions receive an overview of their own results and results at national level to enable a process of benchmarking. Discussion A uniform way of measuring the prevalence of care problems internationally is a significant step forward in gaining insight into the quality of basic care in different healthcare settings in different countries and may lead to more awareness and improvement programmes. [ABSTRACT FROM AUTHOR]

Abstract: Advanced Automatic Crash Notification (AACN) systems, capable of predicting post-crash injury severity and subsequent automatic transfer of injury assessment data to emergency medical services, may significantly improve the timeliness, appropriateness, and efficacy of care provided. The estimation of injury severity based on statistical field data, as incorporated in current AACN systems, lack specificity and accuracy to identify the risk of life-threatening conditions. To enhance the existing AACN framework, the goal of the current study was to develop a computational methodology to predict risk of injury in specific body regions based on specific characteristics of the crash, occupant and vehicle. The computational technique involved multibody models of the vehicle and the occupant to simulate the case-specific occupant dynamics and subsequently predict the injury risk using established physical metrics. To demonstrate the computational-based injury prediction methodology, three frontal crash cases involving adult drivers in passenger cars were extracted from the US National Automotive Sampling System Crashworthiness Data System. The representative vehicle model, anthropometrically scaled model of the occupant and kinematic information related to the crash cases, selected at different severities, were used for the blinded verification of injury risk estimations in five different body regions. When compared to existing statistical algorithms, the current computational methodology is a significant improvement toward post-crash injury prediction specifically tailored to individual attributes of the crash. Variations in the initial posture of the driver, analyzed as a pre-crash variable, were shown to have a significant effect on the injury risk. [Copyright &y& Elsevier]

Seclusion and restraint are frequent procedures to intervene in aggressive and potentially dangerous patients in psychiatric settings. However, little is known about their utilization and effectiveness in pediatric populations. We aimed to examine the prevalence and determinants of seclusion and restraint utilization in children and adolescents in psychiatric settings. Using PubMed, PsychInfo and Cinahl, we performed a systematic literature review of studies published in the last 10 years reporting on the prevalence of seclusion and restraint use in psychiatrically ill youth (<21 years old) treated in psychiatric settings. Only seven publications addressed the topic. Primary outcomes were prevalence rates, reported either as the proportion of patients restrained/secluded or as the number of restraints/seclusions per number of patient days. All studies found relatively high baseline rates of seclusion (26% of patients; 67/1,000 patient days), and restraints (29% of patients; 42.7/1,000 patient days). In four studies, an intervention, implemented to reduce seclusion and restraints, resulted in a dramatic weighted mean reduction in the more restrictive use of restraints by 93.2%, with a 54.2% shorter duration. There was a small, weighted mean reduction in the use of less restrictive seclusions (−0.6%), but results were heterogeneous (−97.2 to +71.0%), with the only increase in seclusions being reported in one study in which the intervention-based padded seclusion room was utilized more frequently instead of more restrictive measures. Otherwise, seclusion episodes reduced by 74.7%, including a 32.4% shorter duration. Few studies reported on risk-factors and predictors, consisting of past or current aggression and/or violence, suicidal behavior, more severe psychopathology, non-White ethnicity, emergency admissions, out-of-home placement, and poorer family functioning, while findings regarding age were inconsistent Except for duration, data about the effectiveness of seclusion and restraints were missing, although there is some indication that seclusion and restraints can lead to severe psychological and physical consequences. Future research should focus on indications, predictors, preventive and alternative strategies, as well as on clinical outcomes of seclusion and restraints in psychiatrically ill youth. In addition, there is a clear need for transparent policies and guidelines. [ABSTRACT FROM AUTHOR]

In this article we discuss the necessity of fully informing patients and their families of what constitutes physical interventions and their attendant risks under the established principles and obligations of informed consent. After a brief review of the elements of informed consent and the nature of the duty to advise patients and their families of treatment risks, we argue that physical interventions are an unvalidated treatment for aggressive and violent behavior and should be used only as a safety intervention. We focus our discussion on the informed consent issues for school aged children, adolescents, and emancipated minors and contend that if restraints are used they must pose less risk than the behavior they are trying to alleviate. We also opine that if restraints are misused by mental health or child welfare treatment settings, then their misuse may be considered a subject of a patient maltreatment, abuse, criminal or civil action. A central thesis of the article is that informed consent must be seen as an integral and dynamic process of treatment. We recommend strategies that gain parental permission and child assent, that view informed consent as a dynamic and individualized process that aids and supports the therapeutic relationship, and that stress the importance of simplicity and clarity. [ABSTRACT FROM AUTHOR]

A survey of a convenience (nonrandom) sample of parents and guardians of children with disabilities was undertaken to document the use of restraints, seclusion, and aversive procedures. A 23-item questionnaire was presented to participants using SurveyMonkey, a Web-based program. Participants were informed of the survey by different advocacy organizations. Within a 2-week period, 1,300 individuals accessed the survey, and 1,293 answered the first question, which asked if their child had been subjected to restraints, seclusion, or aversive procedures; of the 1,293,837 (64.7%) said "yes. " Responses to other questions provided more detail about the nature of the procedures used and associated conditions. Among other findings, the results showed that children with disabilities were often exposed to restraints, seclusion, and aversive procedures; most of the time the parents had not approved of the procedures, and often, the procedures adversely affected the student. [ABSTRACT FROM AUTHOR]

There has been a strong movement in residential treatment programs to reduce the use of restraints. In the article, a restraint reduction initiative is described as implemented at a large children's residential agency. Results were examined and compared between 2004 (prior to implementation) and 2008. Results indicated a significant decrease in the number of restraints, amount of staff time spent in restraints, and the number of child injuries related to restraint per year. Additionally, the average number of staff injury due to client behavior stayed the same despite the belief that decreasing restraints will lead to increased staff injury. [ABSTRACT FROM AUTHOR]

Hospital emergency departments are not well prepared to meet the needs of individuals with intellectual disabilities. Negative experiences can be very traumatic, particularly when the emergency visit is because of a behavioural or psychiatric problem. A focus group study was conducted in 2005 in Toronto, Canada with four women with intellectual disabilities who had paid repeated visits to their local emergency department due to a psychiatric or behavioural crisis. These women spoke about not feeling respected, the trauma of being restrained physically or chemically, and about hospital staff not being comfortable working with women with intellectual disabilities. Clinical implications are discussed and recommendations are presented to improve the experience of women who require emergency services in the future. [ABSTRACT FROM AUTHOR]

The physician can play an important role in managing high-risk nursing home residents without restraints and working with interdisciplinary care teams in comprehensive fall evaluations. A reduction or elimination of physical restraints can be measured for a facility over time, and it represents a relevant quality indicator of physician and facility interactions during the process of care. We discuss how the physician's role fits into this quality of care equation for nursing homes and its implications for new clinical, research, and policy directions for long-term care. [ABSTRACT FROM AUTHOR]

Aim. To describe Registered Nurses’ and enrolled nurses’ views and reasoning on falls, fall risk, use of physical restraints and patients’ safety and security in nursing homes. Background. Nursing home patients frequently suffer from diseases which require medication. Both Registered Nurses and enrolled nurses must make decisions about how to protect patients from falls and fall-related injuries. Physical restraints are frequently used. When patients are unable to understand or do not wish to limit their freedom of movement, staff must consider each decision carefully. Method. A qualitative approach was used. Data were analysed using a thematic content analysis method. Findings. Staff have sufficient knowledge about which pathologically related conditions lead to fall risk. An insufficient number of staff on duty jeopardizes patient safety. Wheelchairs with safety belts, and bed rails, are sometimes used. For Registered Nurses it was not an easy decision to use restraints. Enrolled nurses’ actions were based on standard procedure, to protect and supervise patients. Conclusion. Staff often use restraints to protect their patients, even though this may mean compromising the patient’s integrity. Relevance to clinical practice. Nurses, occupational therapists, physiotherapists and physicians should plan the care together. Restrictive measures should be adapted to each individual patient. [ABSTRACT FROM AUTHOR]

The study aimed to determine rates and types of patient restraint, and their relationship to age, gender and immigrant background. The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period. Each patient is only counted once in this period, controlling for readmission. Of 960 admitted patients, 14% were exposed to the use of restraints. The rate was significantly higher among patients with immigrant background, especially in the younger age groups. Most commonly used were mechanical restraint alone for native-born patients and a combination of mechanical and pharmacological restraints for patients with immigrant background. The use of restraints decreased when patients reached 60 years. Both patients' age and immigrant background seem to have an impact on the use of restraint. [ABSTRACT FROM AUTHOR]

Objective. We hypothesized that the assaults on EMS personnel by patients requiring restraints can be correlated with demographic information, patient condition, and other scene information such as presence the of law enforcement. Methods. The study was a one-year cross-sectional study of paramedic restraint use and assault on EMS personnel in an urban area. A data collection form was completed by EMS for each patient placed in restraints. Study outcome variable was “Assault on EMS personnel.” Predictor variables included demographic and EMS call information, patient condition, law-enforcement related variables, and the paramedic's perception of the need for chemical restraints. To compare predictor and outcome variables, a multivariable model with odds ratios and 95% confidence intervals was used. Results. The study included 271 restrained patients over a 12-month period from April 2002 to April 2003. Seventy-seven (28%) cases were positive for assaults on EMS personnel. Multivariable analysis including 8 variables, indicated the following 6 variables were associated with assault on EMS personnel: time of day between midnight and 6 am (OR = 4.4, 95% CI = 1.6–12.7); female patient (OR for males 0.6, 95% CI = 0.3–1.0); violent patient (OR = 10.1, 95%CI = 2.3–48.2); patient injured under supervision (OR = 3.9, 95% CI = 1.1–13.8); arrested patient (OR = 4.4, 95% CI = 1.1–18.5); and perceived need for chemical restraint (OR = 2.1, 95% CI = 1.2–3.9). Conclusion. Multiple factors are correlated with assaults on EMS personnel by patients requiring restraints. By specifically targeting patients exhibiting these factors, EMS providers can help prevent injury to themselves. Patients not exhibiting these factors may be less dangerous. [ABSTRACT FROM AUTHOR]

In this article, Quality Management Specialists at the Philadelphia Veterans Affairs Medical Center describe an innovative model for restraint use designed to ensure patient safety. They discuss the impetus of the model, its evolution, and purposes. The model provides alternatives to restraint use, education to staff, patients, and families, and electronic tools to monitor restraint usage. Descriptive statistics and analyses of outcomes generated from the electronic tools are presented to demonstrate the utility and value of the model. Future directions for the use of the model and data generated through the electronic record are highlighted. [ABSTRACT FROM AUTHOR]

Scand J Caring Sci; 2004; 18; 281–286Prevalence of patients subjected to constraint in Norwegian nursing homesA recent questionnaire showed that different kinds of constraint such as physical restraint, electronic surveillance, use of force or pressure in medical treatment and in activities of daily living (ADL) are frequently used in Norwegian nursing homes. The study did not include information at patient level, and except for studies about physical restraints, we have not found any studies reporting the prevalence of various forms of constraint.To describe the prevalence of various types of constraint in Norwegian nursing homes.A structured interview was carried out with the primary carers of a random sample of 1501 patients from 222 nursing-home wards in 54 municipalities representing all five health regions in Norway. Data were collected from regular units (RUs) and special care units (SCUs) for persons with dementia. Episodes of constraint during 1 week were recorded. Five main groups of constraint were aggregated, mechanical restraint, nonmechanical restraint, electronic surveillance, force or pressure in medical examination or treatment and force or pressure in ADL.Patients (36.7%) in RUs and 45.0% of the patients in SCUs were subjected to any constraint. Most frequent was use of mechanical restraint (23.3% in RUs; 12.8% in SCUs) and use of force or pressure in ADL (20.9% in SCUs; 16.6% in RUs). Use of force or pressure in medical examination or treatment was more frequent used in SCUs (19.1%) compared with RUs (13.5%). Nonmechanical restraint was less frequently used (8.3% in SCUs; 3.0% in RUs) and electronic surveillance was seldom used (7.2% in RUs; 0.9% in SCUs).The use of constraint is a problem in Norwegian nursing homes. Studies are needed to learn more about why constraint is used, and if there is patient or ward characteristics that can explain the use of constraint. [ABSTRACT FROM AUTHOR]

Patients are frequently involuntarily, physically restrained in the emergency department (ED). The purpose of this study was to determine the type and rate of complications experienced by patients physically restrained in the ED. A prospective, observational study was performed on consecutive patients who were restrained in a community, inner-city teaching hospital ED for a 1-year period. The ED nurses or physicians completed a restraint study checklist. The checklist included the reasons for restraints, restraint duration, method and number of restraints, use of chemical restraint, and complications resulting from the use of restraints. The 298 patients were accumulated during a 1-year period. The mean age was 36.5 years (range 14–89). Sixty-eight percent were men; 73% were African-Americans, 16% Hispanic, and 11% Caucasian. One hundred six patients had more than one indication for patient restraint. Patients were restrained for a mean of 4.8 h (range 0.2–25.0 h), with psychosis being the most frequent discharge diagnosis (33%). Patients were most frequently restrained on a cart with two restraints (59%), in the supine position (86%), and 27.5% had chemical restraint added. There were 20 complications (7%); getting out of restraints was the most common (10) and the remainder included vomiting (3), injured others (2), spitting (2), injured self (1), increased agitation (1), and other (1). These complications were not correlated with age, gender, race, number of restraints, use of chemical restraint, diagnosis, or duration of restraint. This study demonstrates a low rate of minor complications. We found that male patients were most often restrained for violent and disruptive behavior. Most commonly, two restraints were used in combination with chemical restraints for a duration of almost 5 h. [Copyright &y& Elsevier]