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BACKGROUND: Mechanically ventilated Intensive Care Unit (ICU) patients often require wrist restraints, contributing to immobility and agitation, over-sedation, and delirium. The Exersides® Refraint® (Healthy Design, LLC), a novel restraint alternative, may be safe and facilitate greater mobility than traditional restraints. OBJECTIVE: This National Institutes of Health Small Business Technology Transfer (STTR) Program Grant-funded single-site Phase I feasibility study evaluated Exersides® safety and feasibility in anticipation of a multi-site Phase II randomized controlled trial (RCT). METHODS: In two academic ICUs, mechanically ventilated adults ⩾25 years old who were non-comatose, required restraints and had an expected stay of ⩾2 days were enrolled to wear Exersides® and traditional wrist restraints for 4 h on day 1, in a randomized order, and in the reverse order on day 2. Main outcomes were Exersides® safety (i.e., patient/clinician lacerations/injuries), feasibility (i.e., ⩾90% of required data collected), and patient/family/clinician feedback. RESULTS: Eight patients were enrolled; one no longer required restraints at initiation, yielding seven subjects (median [interquartile range (IQR)] age 65 [55, 70] years, 86% men). All seven wore Exersides®, averaging (SD) 2.5 (1.0) hours per session, with no safety events reported. Across restraint time periods, 92% and 100% of Richmond Agitation-Sedation Scale (RASS) and wrist actigraphy data, respectively, were collected. Feedback was positive (more movement and comfortable than traditional restraints) and constructive (bulky, intimidating to apply). CONCLUSIONS: This pilot study provided key safety and feasibility data for a Phase II RCT evaluating Exersides® versus traditional wrist restraints. Feedback motivated minor device modifications before RCT initiation.

Physical Restraint (PR) is a coercive procedure used in emergency psychiatric care to ensure safety in life-threatening situations. Because of its traumatic nature, studies emphasize the importance of considering the patient’s subjective experience. We pursued this aim by overcoming classic qualitative approaches and innovatively applying a multilayered semiautomated language analysis to a corpus of narratives about PR collected from 99 individuals across seven mental health services in Italy. Compared to a reference corpus, PR narratives were characterized by reduced fluency and lexical density, yet a greater use of emotional and cognitive terms, verbs, and first-person singular pronouns. Sadness was the most represented emotion, followed by anger and fear. One-third of the PR narratives contained at least one metaphor, with Animals and War/Prison as the most distinctive source domains. The quality and length of the PR experience impacted both the structure and the sentiment of the narratives. Findings confirm the distressful nature of PR but also point to the use of various linguistic mechanisms which might serve as an early adaptive response toward healing from the traumatic experience. Overall, the study highlights the importance of Natural Language Processing as an unobtrusive window into subjective experience, offering insights for therapeutic choices. [ABSTRACT FROM AUTHOR]

Background: The worldwide population is ageing and self-arm can be prevented with many techniques. Among them coercive measure consisting of physical restraint (PR) is one of the techniques. This study aims to assess the effects of the biological sex on the long-term survival after PR in geriatric patients during the initial emergency department (ED) visit. Methods: This retrospective study included patients between November 2019 to March 2021. All consecutive hospitalized patients after emergency department visit older than 75 years with PR were included. The population was compared according to the biological sex. One-year all-cause mortality was plotted with the Kaplan-Meier curve. Hazard ratios (HRs) for 1-year mortality were calculated using a Cox proportional hazards regression model. Mortality was monitored over a 3-year period. Results: PR was used in 149 patients representing 4.6% of 3210 hospitalized patients older than 75 years after ED visit. Women represented 52% of the study population. Compared to men, women were older [median (IQR) age 89 (85–93) vs. 85 (81–90) years, P = 0.002]. Women more often presented dementia (93 vs. 80%, P = 0.031). Both sexes presented the same limited independence. All-cause mortality was significantly lower for women than men after one year (25 vs. 51%, respectively, P = < 0.001). Likewise, adjusted HR of 1-year all-cause mortality was higher in men [a HR 3.4 (95% confidence interval 1.7–7.1), P < 0.001]. Conclusion: This study suggested that the use of physical restraint in older adults was a more related factor of mortality in men than women. Women were older with lower expectancy life but PR use seemed to be a sign of global health decline in men. Further prospective studies are needed to assess if mortality after PR use is a cause or a consequence of a global health decline. [ABSTRACT FROM AUTHOR]

To measure the association between patient race and physical restraint use in the ED. Adult patients presenting to eight rural, suburban, and urban EDs in a mid-Atlantic statewide hospital system ED between January 1, 2019 and June 30, 2022 were included. Those arriving already restrained, transported from detention centers, or who left before services were provided were excluded. Multivariable logistic regression measured the association of physical restraint use with patient race, adjusting for age, sex, weight, height, mode of arrival, history of violent behavior, comorbidities, ESI acuity level, homelessness, and site. Of 896,527 patient encounters included in the analysis, 3459 (0.39 %) had a physical restraint order. The study population was 48.7 % non-Hispanic White and 43.7 % non-Hispanic Black. Black patients had higher adjusted odds of being restrained relative to White patients (OR 1.26, 95 % CI 1.15–1.37). Other key variables associated with physical restraint use were an ESI level of 1 vs 3+ (OR 13.15, 95 % CI 11.49–15.04), arrival by law enforcement (8.39, 95 % CI 7.47–9.43), and arrival by EMS (5.36, 95 % CI 4.93–5.83 Among those who were restrained, the hazard of restraint was higher among Black compared to White patients in the first hour after ED arrival (adjusted hazard ratio 1.14, 95 % CI 1.01–1.30). Black patients were more likely to be physically restrained compared to White patients, though the magnitude of this association was small compared to that of other clinical risk factors. Future work should evaluate if these findings are driven by differences in patient characteristics or clinician decision-making to best inform interventions to reduce this disparity. [ABSTRACT FROM AUTHOR]

• What is the primary question addressed by this study? What are the patterns of chemical sedation and physical restraint use in the geriatric population in emergency department settings? • What is the main finding of this study? This retrospective, cross-sectional study found that there is an increased odds of chemical sedation and physical restraint use with increasing older age as well as Black race and Hispanic/Latinx ethnicity. • What is the meaning of the finding? Within the geriatric population, older adults and those from historically marginalized backgrounds may be more vulnerable to sedation and restraint use in the emergency settings, which may make these already high-risk populations even more susceptible to worse health outcomes. Older adults may present to the emergency department (ED) with agitation, a symptom often resulting in chemical sedation and physical restraint use which carry significant risks and side effects for the geriatric population. To date, limited literature describes the patterns of differential restraint use in this population. This retrospective cross-sectional study used electronic health records data from ED visits by older adults (age ≥65 years) ranging 2015–2022 across nine hospital sites in a regional hospital network. Logistic regression models were estimated to determine the association between patient-level characteristics and the primary outcomes of chemical sedation and physical restraint. Among 872,587 ED visits during the study period, 11,875 (1.4%) and 32,658 (3.7%) encounters involved the use of chemical sedation and physical restraints respectively. The populations aged 75-84, 85-94, 95+ years had increasingly higher odds of chemical sedation [adjusted odds ratios (AORs) 1.35 (95% CI 1.29–1.42); 1.82 (1.73–1.91); 2.35 (2.15–2.57) respectively] as well as physical restraint compared to the 65-74 group [AOR 1.31 (1.27–1.34); 1.55 (1.50–1.60); 1.69 (1.59–1.79)]. Compared to the White Non-Hispanic group, the Black Non-Hispanic and Hispanic/Latinx groups had significantly higher odds of chemical sedation [AOR 1.26 (1.18–1.35); AOR 1.22 (1.15–1.29)] and physical restraint [AOR 1.12 (95% CI 1.07–1.16); 1.22 (1.18–1.26)]. Approximately one in 20 ED visits among older adults resulted in chemical sedation or physical restraint use. Minoritized group status was associated with increasing use of chemical sedation and physical restraint, particularly among the oldest old. These results may indicate the need for further research in agitation management for historically marginalized populations in older adults. [ABSTRACT FROM AUTHOR]

ABSTRACT Aims Methods Results Conclusions Relevance to the Clinical Practice Patient or Public Contribution Trial Registration To identify and characterise the approaches and instruments used in recent literature to measure the prevalence of restrictive care practices in adult mental health inpatient units. Additionally, it sought to summarise the reported psychometric properties, including reliability and validity of these measures.A systematic review of recent litratures was conducted using Scopus, MEDLINE, CINAHL, PsycINFO, Web of Science and Embase databases to identify studies published from 1 January 2010 to 11 October 2023. A total of 128 studies measuring the use of restrictive care practices were included. Data on measurement methods were extracted from each study and summarised to compare how consistently these practices have been measured across studies and how authors consistently reported the reliability and validity of these measurment approaches. All findings were reported following the PRISMA 2020 checklist.There were significant variations in how the prevalence of restrictive care practices was measured, and the reliability and validity of these measurements were unclear for most studies. Only 11 studies reported inter/intra‐rater reliability. Key variations were observed in data sources utilised, how and by whom the data were collected, the timing and total duration of data collection during patient admission, how and by whom data were extracted from secondary sources, measurement instruments and the reported reliability and validity of measures.Methodological inconsistencies about the measurements approaches of restricitve care practices would introduduce potential random and/or systematic biases on the reported data which may obscure the the true prevalance these practices. This hinder the ability to acurately assess the effectiveness of reduction strategies and understand the naturally occuring practices. Establishing a standardised set of reliable measures is crucial for enabling valid comparisons for the rates of restricitve car epractice use across settings and countries, which could enhance the ongoing monitoring and reduction of these practices.The absence of standardised defintions and measurement approaches for restrictive care practices challenges the global effort to reduce their use. Without reliable and common measures, clinicians and researchers often face challenges in documening RCP incidents accurately, compromising efforts to improve care quality and support a recovery‐oriented approach. Such measurment errors would mislead decission‐maker which would furhter contribute to the inconsistency the the implementation of these practices.No patient or public contribution.PROSPERO: CRD:42022335167; https://www.crd.york.ac.uk/prospero/export_details_pdf.php [ABSTRACT FROM AUTHOR]

Introduction: This study reviewed the situation of physical restraints in 50 hospitals covered by the Osaka Psychiatric Hospitals Association in Osaka Prefecture. Subjects and Methods: Study I data included diagnoses, admission date, reasons for restraint, date and time of restraint initiation, site of restraint, date and time of partial or temporal release, and date and time of final release. In addition (Study II), to understand why elderly restraints are more common in Japan, we studied the admission routes of elderly admitted to Psychiatric Hospitals. Results and Discussion: (Study I) Each of the 901 patients underwent a 30-day study. 42 hospitals (84%) participated. More males were included than females, and 51.0% were over 65 years of age. F codes (the International Classification of Diseases, 10th Revision, diagnoses) included F2 in 39.5% and F0 in 33.1%. The dates of restraint initiation and admission were on the same day for 36.2% of patients, and the restraint was initiated after the day following the admission date for 63.8%. This study was not limited to emergency admissions; those who were given restraint on different and the same days in the emergency or acute care ward admissions were approximately equal. This suggests that efforts were made to see how the patient was doing without restraint at the time of admission; however, restraint was initiated when this was not possible. Restlessness or agitation were the most common reasons for restraint, but this state includes various psychopathological reasons. Therefore, defining these reasons further is necessary. Giving or releasing the restraint must be ordered only by the Designated Mental Health Physicians under the Act on Mental Health and Welfare for Persons with Mental Disorders or Disabilities in Japan. The time needed to initiate partial release should be thought of as the end of restraint because the study showed that efforts are made to reduce restraint through partial releases. If restraints are necessary again, other positions than Designated Mental Health Physicians should be allowed to issue restraint orders. The decision should be confirmed by Designated Mental Health Physicians within a certain time frame, as in other countries. Constant, or continuous observation should be prepared to further reduce restraint. (Study II) As a result of Study II, 310 patients had restraint orders on the study date, and 118 patients (38%) were transferred from other facilities due to psychiatric symptoms requiring physical restraint. Of these, 81 (68.6%) were from other medical facilities and 35 (29.7%) were from elderly care facilities. The most common disease codes were F0, including delirium, at 61.7% and 85.7%, respectively, and the most common reasons for restraint were restlessness or agitation at 49.4% and 80.0%, respectively. The results showed the following: restraints are legally acceptable only in Psychiatric Hospitals under the order of Designated Mental Health Physicians. Nearly 40% of the subjects came from other facilities, and as in Study I, the reason for this was the same unclear reason of "restlessness or agitation". Conclusion: It has been 36 years since the Designated Mental Health Physicians system was established, which is not the case in any other country. Although education and training has been conducted to increase the number of Designated Mental Health Physicians, there are not enough Designated Mental Health Physicians in all Psychiatric Hospitals to immediately comply with the act when enforcing behavioral restrictions such as seclusion and restraints. The largest increase of 261% is seen in psychiatric clinics (no responsibility for the right of inpatients at anytime), then this is nothing short of a structural and historical error in policy. [ABSTRACT FROM AUTHOR]

Physical restraint is an emergency procedure restricting the movement of an individual and is used in events where students pose an imminent threat of physical harm to themselves or others. Students with disabilities are subjected to these procedures seven times more than typically developing students. Over the past decade, there has been substantial policy reform on the use of restraint; however, policies still vary across the country. Additionally, research on experiences of the use of and policy on restraint in school settings is incredibly limited. The current study expands the body of literature by investigating teachers' experiences, and factors associated with experiences, of restraint events and district policy utilizing a multiple-methods survey design. One hundred eighty Prekindergarten through 12th-grade teachers working in a variety of school settings across the country completed a self-report online survey. Results revealed variability in experiences of restraint events and school district policies. While most participants reported following the district policy as written, level of education significantly impacted teachers' adhering to the policy, wherein those with higher levels of education were less likely to follow the policy. Implications for policy and practice are provided. [ABSTRACT FROM AUTHOR]

The International Psychogeriatric Association (IPA) has expressed significant concerns over the use of physical restraints in older people across diverse aged care settings. Following an extensive analysis of the available literature, the IPA's Early Career Network (ECN) has formulated a collection of evidence-based recommendations aimed at guiding the use of physical restraints within various care contexts and demographic groups. Physical restraints not only infringe upon human rights but also raise significant safety concerns that adversely impact the physical, psychological, social, and functional well-being of older adults. Furthermore, their effectiveness in geriatric settings remains inadequate. Given these considerations, the IPA and its ECN firmly assert that the use of physical restraints should only be considered as a final recourse in the care of older people. [ABSTRACT FROM AUTHOR]

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]

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Background: Restraint practice has been employed in psychiatry setting to manage patients with risk of aggression and violence. The restraint practice is also linked with the ethical, legal, and human rights of individuals and regulation has seen policies and laws on it across the globe. It is critical to assess the factors associated with restraints and its relationship with clinical variables in the Indian scenario. Materials and Methods: It was a retrospective chart review design study. It was conducted in the psychiatry department of a tertiary care hospital. The duration of the study considered from January 2024 to October 2024. We have considered purposive sampling (n = 68). We have included all patients with h/o restraints in ward stay will be included (restraint register) and excluded ward patients with no h/o any restraint and those with h/o medications given for sedation but not restraint. Results: This hospital has a 9.25% prevalence of restraint use. The main diagnoses found were alcohol use disorder presenting with delirium tremens (46.9%), mood disorder with manic or mixed episode (31.3%), schizophrenia and schizoaffective disorder (9.4%), other psychotic disorder (9.4%), and severe depression with psychotic symptom (3.1%). The main reasons for restraint were agitation/disorientation (46.9%), actual violence (46.9%), and threats of violence (6.3%). Conclusion: According to this study, receiving chemical and/or physical restraint was more frequently linked to male gender, young age, lower and middle socioeconomic status, alcohol use disorder diagnosis presenting with delirium tremens, and mood disorders presenting with mania or mixed episodes. [ABSTRACT FROM AUTHOR]

Background: The use of restraint in psychiatric inpatient settings is a contentious issue, balancing patient safety with ethical concerns. Despite India's Mental Healthcare Act of 2017, which prohibits seclusion and mandates stringent restraint regulations, restraint remains a critical intervention in managing acute behavioral crises. This study investigates the prevalence, patterns, and determinants of restraint use in a tertiary care psychiatric facility in Northern India. Materials and Methods: This hospital-based, observational, prospective study was conducted over 6 months in a 32-bedded psychiatry ward. Data were collected from ward registers, treatment charts, and patient records, documenting restraint events. Sociodemographic and clinical factors were analyzed using descriptive statistics, comparisons, and logistic regression. Results: Among 128 admissions (5,518 inpatient days), 35.1% of patients experienced restraint, yielding a restraint patient rate of 8.15 per 1000 inpatient days and an event rate of 26.1 per 1000 inpatient days. Chemical restraint was predominant (74.3% of events), followed by combined (22.9%) and physical restraint (2.8%). Restraint occurred primarily in young adults with mood and psychotic disorders, with no significant association between restraint use and sociodemographic or clinical factors. Most restraints were applied within the 1st week of admission. Conclusions: Restraint, primarily chemical, remains common in managing acute agitation and violence, especially early in hospitalization. The findings underscore the importance of balancing clinical needs with patient rights while striving for noncoercive, patient-centered psychiatric care. The findings also highlight the need for standardized reporting and continued training to minimize restraint use and promote ethical healthcare delivery. [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]

Background. The issue of restraint has long been considered a difficult political and social situation, affecting both healthcare workers and facilities. The practice of restraint is still widespread in many public and private care settings, but there is a lack of systemic studies capable of monitoring the phenomenon. The framing of the question essentially concerns the right to personal freedom, guaranteed by the Italian Constitution. Materials and Methods. An anonymous questionnaire was developed containing questions on knowledge of the regulations on restraints, how, ways, and when they are implemented, and general information such as age, gender, educational qualification, qualification, O.Us. to which they belong. The collected data were statistically processed (Chi-square test) with the Epi Info 7.1.5 program (CDC-Atlanta- USA). A total of 1002 questionnaires were completed. The stratification of the sample by structure shows that 73.9% were public facilities. The indicative figure is represented by the 23.8% of respondents who say that "the restraint is not noted in the medical record". Conclusions. Restraint could be a real risk for the healthcare worker, encroaching on the issue of health liability. It is therefore important to raise awareness among healthcare professionals and top management of the need to structure, at company level, procedures that comply with the "Recommendations on physical restraint" to overcome the use of restraint through the improvement of care pathways in compliance with organizational and risk management standards. [ABSTRACT FROM AUTHOR]

Physical restraints are widely used and accepted as protective measures during treatment in intensive care unit (ICU). This review of the literature summarizes the adverse events and outcomes associated with physical restraint use, and the risk factors associated with their use during treatment in the ICU. The PubMed, Scopus, and Google Scholar databases were screened using predefined search terms to identify studies pertaining to adverse events and/or outcomes associated with physical restraint use, and the factors associated with their use in adult patients admitted to the ICU. A total of 24 articles (including 6126 patients) that were published between 2006 and 2022 were identified. The described adverse events associated with physical restraint use included skin injuries, subsequent delirium, neurofunctional impairment, and a higher rate of post-traumatic stress disorder. Subsequent delirium was the most frequent adverse event to be reported. No alternative measures to physical restraints were discussed, and only one study reported a standardized protocol for their use. Although physical restraint use has been reported to be associated with adverse events (including neurofunctional impairment) in the literature, the available evidence is limited. Although causality cannot be confirmed, a definite association appears to exist. Our findings suggest that it is essential to improve awareness regarding their adverse impact and optimize approaches for their detection, management, and prevention using protocols or checklists.

Background Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. Aims To examine the impact of this intervention on people with lived experience, carers and staff. Method People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. Results Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. Conclusion This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts.

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]

Background: Nasogastric tube feeding under physical restraint is an intervention that clinicians working in specialist mental health in-patient units may need to implement. Aims: To examine the impact of this intervention on people with lived experience, carers and staff. Method: People with lived experience and parents and/or carers were recruited via UK eating disorder charity Beat. Clinicians were recruited via the British Eating Disorders Society's research forum. Qualitative semi-structured interviews were conducted and transcribed, and the results were thematically analysed. Results: Thirty-six participants took part, and overlapping themes were identified. All participants spoke in relation to four themes: (a) the short-term impact on the patient; (b) the impact on those around the patient; (c) the long-term impact; and (d) the positive impact. Subthemes were identified and explored. Conclusion: This lifesaving intervention can also negatively affect patients, parents and carers, peers and staff. Further research is needed to understand how interactions and environmental modifications can mitigate the negative impacts. [ABSTRACT FROM AUTHOR]

To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups. [ABSTRACT FROM AUTHOR]

Introduction: Protective stabilization techniques and physical restraints may be required for when the traditional techniques of behaviour management are ineffective. A papoose board (PB) is a safe stabilization device that is highly effective in managing uncooperative or anxious children. However, in the current era, the child, parent and operator preferences towards the use of papoose board needs to be explored. Material and Methods: A 12-point questionnaire was administered to child, parents and operator. Preferences to the use of papoose board were assessed quantitatively as well as qualitatively based on the images of papoose board usage shown. Quantitative data was expressed as frequency with percentage. Qualitative data was assessed through thematic analysis. Results: 30 children (3-12yrs) and their parents (11-Fathers; 19-Mothers), 15 operators were included in this study. Mean age of the children was 7.7 ± 2.6 yrs. 70% of children did not prefer the use of papoose board as they were scared and did not want to be tied up. 53.33% of parents preferred the use of papoose board as they thought of it as a protective device for their children. 46.66% of operators preferred the use of papoose board for unco-operative children. Conclusion: Children did not prefer the use of papoose board but parents and operators preferred the use of papoose board. [ABSTRACT FROM AUTHOR]

Background Physical restraints (PRs) are frequently used in adult critical care units to protect staff and prevent self-harm, despite the fact that they represent significant safety risks. Restraint complications may have an impact on the patient’s long- and short-term outcomes. This integrative review aimed to meticulously evaluate existing evidence pertaining to physical restraint practices in adult critical care settings. The review was specifically geared towards examining the prevalence of PR, identifying influential factors, elucidating the role of nurses in PR implementation, exploring nurses’ experiences in caring for patients under restraint, and scrutinizing the complications associated with PR application Method This integrative review included the studies published between January 2009 and December 2019 and the literature search was conducted in July 2020. The databases searched included EBSCOhost, Ovid, ProQuest, PubMed, Wiley Online Library, SCOPUS, and ScienceDirect. The keywords included in the search were restraint, critical care, intensive care, ICU, mechanical ventilation, intubation, nursing, and experience. A checklist based on the CASP checklist and the JBI Critical Appraisal Tool was used to assess the methodological quality. Results The findings were evaluated and summarized into seven key topics after twenty-one publications were found to be evaluated. i) High prevalence of PR application in adult critical care unit; ii) determinants of PR applications; iii) types of PR in adult critical care units; iv) decision maker of PR; v) moral and ethical dilemma in PR application; vi) awareness and guidelines for PR applications; vii) common complications and use of sedation, analgesics, antipsychotic drugs in PR application. Conclusion The number of days PR is used is related to the risk of an adverse event. In order to standardize nursing practice, ICU nurses require greater training on the ideas of PR use. Evidence-based recommendations will assist critical care nurses in making the best judgments possible concerning the use of PR.

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]

Restrictive interventions, such as physical restraint, should be a last resort for managing imminent risk. There has been growing recognition of the harmful effects of them, for both staff and service users. Limited research has considered the impact of physical restraint on the therapeutic relationship between staff and service users. The aim of this research was to address this gap in the literature and explore both service user and staff perspectives of the therapeutic relationship after physical restraint, in a UK-based service that provides low and medium secure care for adults. Ten semi-structured interviews were conducted with five service users and five staff members. All participants had been involved in at least one incident of physical restraint. Interpretative Phenomenological Analysis was used to analyze the data. Three master themes emerged from the service user experiences: emotional impact; changes to the therapeutic relationship; and appraisal of the necessity of physical restraint. A further three master themes were produced from the staff member experiences: emotional response; balancing professional roles and responsibilities within the relationship; and moving forward with the therapeutic relationship after physical restraint. Findings support the need to continue to reduce restrictive interventions including physical restraint in secure mental health services and consider the impact upon those involved, both emotionally and relationally. Contemporary approaches to reducing power imbalances between staff and services users, as well as those that would reduce the likelihood of (re)traumatising service users, are also recommended. [ABSTRACT FROM AUTHOR]

BACKGROUND: While effective apprehensions of non-compliant suspects are central to public safety, the minimal force needed to transition a suspect from standing to the ground, vital for apprehension success, has not been established. OBJECTIVE: To examine the technical-tactical behaviors of general duty police officers during simulated apprehensions and quantify the minimum force required to destabilize non-compliant suspects. METHODS: Task simulations conducted with 91 officers were analyzed to identify common grappling movements, strikes, control tactics, and changes in body posture. A separate assessment of 55 male officers aimed to determine the minimum force required for destabilization in five body regions (wrist, forearm, shoulder, mid-chest, and mid-back). Data are presented as mean±standard deviation. RESULTS: On average, apprehensions took 7.3±3.2 seconds. While all officers used grappling movements (100%) and the majority employed control tactics (75%), strikes were seldom used (4%). Apprehensions typically began with a two-handed pull (97%; Contact Phase), 55% then attempted an arm bar takedown, followed by a two-handed cross-body pull (68%; Transition/Control Phase), and a two-handed push to the ground (19%; Ground Phase). All officers began in the upright posture, with most shifting to squat (75%), kneel (58%), or bent (45%) postures to complete the apprehension. The minimum force required to disrupt balance differed across body regions (wrist: 54±12 kg; forearm: 49±12 kg; shoulder: 42±10 kg; mid-chest: 44±11 kg; mid-back: 30±7 kg, all P < 0.05), except between the shoulder and chest (P = 0.19). CONCLUSION: These findings provide insights that can enhance the design and accuracy of future apprehension evaluations and inform the optimization of law enforcement physical employment standards. [ABSTRACT FROM AUTHOR]

Physical restraint is a restrictive practice used in schools, but there are no up-to-date statistics concerning the frequency of its usage in England and there are concerns as to whether it is being used appropriately and effectively. Pupils with special educational needs are more likely to experience physical restraint in school, but opportunities for them to share their views through research are limited. Through semi-structured interviews, four primary-aged pupils from a specialist social, emotional and mental health (SEMH) educational setting shared their experiences of physical restraint, its impact on their relationships with staff members, and alternative strategies. Overall, participants had negative experiences of physical restraint, highlighting that it should be used for safety, but not for minor incidents. All participants identified useful alternative strategies that helped them to feel calmer. The ability to separate negative emotions associated with physical restraint and supporting staff members varied between participants. The findings are discussed in relation to implications for educational psychology practice and future research. [ABSTRACT FROM AUTHOR]

Copyright of Gerokomos is the property of Indemm Farma SL 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.)

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.)

Restraint use in the emergency department (ED) can pose significant risks to patients and health care workers. We evaluate the effectiveness of Code De-escalation– a standardized, team-based approach for management and assessment of threatening behaviors– in reducing physical restraint use and workplace violence in a community ED. A retrospective observational study of a pathway on physical restraint use among patients placed on an involuntary psychiatric hold in a community ED. This pathway includes a built-in step for the team members to systematically assess perceptions of threats from the patient behavior and threats perceived by the patient. Our primary outcome was the change in the rate of physical restraint use among patients on an involuntary psychiatric hold. Our secondary outcome was the change in the rate of workplace violence events involving all ED encounters. We evaluated our outcomes by comparing all encounters in a ten-month period before and after implementation, and compared our results to rates at neighboring community hospitals within the same hospital network. Pre intervention there were 434 ED encounters involving a psychiatric hold, post-intervention there were 535. We observed a significant decrease in physical restraint use, from 7.4% to 3.7% (ARR 0.028 [95% CI 0.002–0.055], p < 0.05). This was not seen at the control sites. A standardized de-escalation algorithm can be effective in helping ED's decrease their use of physical restraints in management of psychiatric patients experiencing agitation. [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 Physical restraints (PRs) are frequently used in adult critical care units to protect staff and prevent self-harm, despite the fact that they represent significant safety risks. Restraint complications may have an impact on the patient’s long- and short-term outcomes. This integrative review aimed to meticulously evaluate existing evidence pertaining to physical restraint practices in adult critical care settings. The review was specifically geared towards examining the prevalence of PR, identifying influential factors, elucidating the role of nurses in PR implementation, exploring nurses’ experiences in caring for patients under restraint, and scrutinizing the complications associated with PR application Method This integrative review included the studies published between January 2009 and December 2019 and the literature search was conducted in July 2020. The databases searched included EBSCOhost, Ovid, ProQuest, PubMed, Wiley Online Library, SCOPUS, and ScienceDirect. The keywords included in the search were restraint, critical care, intensive care, ICU, mechanical ventilation, intubation, nursing, and experience. A checklist based on the CASP checklist and the JBI Critical Appraisal Tool was used to assess the methodological quality. Results The findings were evaluated and summarized into seven key topics after twenty-one publications were found to be evaluated. i) High prevalence of PR application in adult critical care unit; ii) determinants of PR applications; iii) types of PR in adult critical care units; iv) decision maker of PR; v) moral and ethical dilemma in PR application; vi) awareness and guidelines for PR applications; vii) common complications and use of sedation, analgesics, antipsychotic drugs in PR application. Conclusion The number of days PR is used is related to the risk of an adverse event. In order to standardize nursing practice, ICU nurses require greater training on the ideas of PR use. Evidence-based recommendations will assist critical care nurses in making the best judgments possible concerning the use of PR.

Yue Chong,1 Can Wang,1 Haiying Min,1 Lei Zhang,1 Tingting Zhi,2 Xiaoning Wu,1 Yanbo Wang1 1Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China; 2Shanghai Baoshan Mental Health Center, Shanghai, 201900, People’s Republic of ChinaCorrespondence: Yanbo Wang, Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People’s Republic of China, Tel +86-21-65986226, Email wang_yb@tongji.edu.cnIntroduction: The use of physical restraint (PR) is considered a controversial practice and research in Western countries has demonstrated negative physical and psychological consequences for patients, as well as staff, family members/carers, organisations and society as a whole. However, there are few research reports on restraint experiences of patients with mental disorders in non-Western countries, especially in mainland China.Aim: This study aims to explore the subjective experiences and perceptions of patients with psychiatric disorders who have experienced PR in mainland China.Methods: Semi-structured interviews were conducted with 8 inpatients with mental disorders in convalescence at a specialized mental health hospital in Shanghai. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analyzed using thematic analysis.Results: Five themes emerged: “perception and understanding of PR”, “response to PR”, “negative physical and psychological experiences”, “unmet care needs during PR” and “changes after PR”, which together characterize patients’ perceptions, experiences, feelings, and needs in PR.Conclusion: The use of PR involves ethical issues and brings negative experiences to patients with mental disorders that cannot be ignored and should be used as a last resort. Different patients have different attitudes and reactions to PR. During PR, patients’ physical and psychological needs are not adequately met. Medical staff should give more attention to patients in PR, meet their physical and psychological needs, and actively seek PR alternatives and reduction options based on evidence-based resources on restraint reduction available in the West and the national context and culture of China.Keywords: physical restraint, psychiatric nursing, thematic analysis, qualitative research

Objectives: Restriction of the rights of patients in a psychiatric hospital, isolation and fixation, compulsory treatment, and round-the-clock monitoring are negatively perceived by them, contribute to the stigma of a psychiatric hospital, and prevent timely access to psychiatric help We assessed the opinions of patients in psychiatric hospitals and psychiatrists about coercion and violence in the provision of psychiatric care for recommendations on their prevention. Methods: An anonymous survey of psychiatrists and patients was conducted in psychiatric hospitals in three regions. Data were analyzed using descriptive and non-parametric statistical methods. Results: Psychiatrists and patients were positive about the coercive measures in the psychiatric hospital. Physical restraint was considered the prerogative of orderlies by 64.5% of psychiatrists and 35.4% of patients. According to 19.6% of doctors and 28.4% of patients, a psychiatrist can independently apply physical restraint to aggressive patients. Injections of sedative drugs by a psychiatrist personally were considered justified by 81.3% of physicians and 64.6% of patients. Most patients and physicians noted that the psychiatrist needed to be involved in the application of physical restraint to an aggressive patient. Discussion: Psychiatry is currently dominated by an archaic paternalistic model of doctor-patient relations and the delegation of additional functions of social control to psychiatrists. The introduction of a contractual model is required for more effective interaction between the psychiatrist and the patient. Coresponding author: Natalia Rzhevskaya, E-mail: konst_v@list.ru

Aim: This study aimed to evaluate the knowledge, attitudes, and skills of intensive care nurses regarding physical and chemical restraint. Material and Methods: It is a descriptive cross-sectional study conducted with 108 nurses working in a training and research hospital between March and April 2021. The data of the study were collected using the "Nurse Identification Form", "Level of Knowledge, Attitude, and Practices for Using Physical Restraint Scale for Nurses" and "Sedation Practice Scale". Results: It was found that the mean knowledge score was 7.96±2.73, the mean attitude score was 32.31±5.97 and the mean practice score was 36.86±4.55. The mean score of "Beliefs and Attitudes Regarding Sedation Practices" was 4.09±0.72, the mean score of "External Factors in Sedation Management" was 3.07±0.96, and the mean score of "Sedation Management Practices" was 3.89±0.60. Conclusion: It was determined that the average scores of intensive care nurses on the Sedation Practice Scale and the Level of Knowledge, Attitude, and Practices for Using Physical Restraint Scale for Nurses were high. [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]

Copyright of Enfermeir@s is the property of Colegio Oficial de Enfermeria de Lugo 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.)

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]