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Belayneh Z, Chavulak J, Lee DCA, Petrakis M, Haines TP. Prevalence and variability of restrictive care practice use (physical restraint, seclusion and chemical restraint) in adult mental health inpatient settings: A systematic review and meta-analysis. J Clin Nurs 2024; 33:1256-1281. [PMID: 38304928 DOI: 10.1111/jocn.17041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 11/15/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised. AIMS This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates. METHODS Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta-analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta-regression was also computed to identify factors that may contribute to variations in the proportion estimates. RESULTS A total of 77 studies were included in this meta-analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I2 > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions. CONCLUSION There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations. RELEVANCE TO CLINICAL PRACTICE Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities. PATIENT/PUBLIC CONTRIBUTION This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study. PROTOCOL REGISTRATION The protocol for this review has been registered to PROSPERO: CRD42022335167.
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Affiliation(s)
- Zelalem Belayneh
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- Department of Psychiatry, College of Health, and Medical Sciences, Dilla University, Dila, Ethiopia
| | - Jacinta Chavulak
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
| | - Den-Ching A Lee
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University (Peninsula Campus), Frankston, Victoria, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia
| | - Melissa Petrakis
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- St Vincent's Hospital Mental Health Service, Melbourne, Victoria, Australia
| | - Terry P Haines
- Faculty of Medicine, Nursing and Health Sciences, School of Primary and Allied Health Care, Monash University Peninsula Campus, Melbourne, Victoria, Australia
- National Centre for Healthy Ageing, Monash University, Frankston, Victoria, Australia
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Baggio S, Kaiser S, Wullschleger A. Effect of Seclusion on Mental Health Status in Hospitalized Psychiatric Populations: A Trial Emulation using Observational Data. Eval Health Prof 2024; 47:3-10. [PMID: 36898680 PMCID: PMC10858627 DOI: 10.1177/01632787231164489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The use of coercive practices, i.e., interventions against a person's will, is controversial. Recent observational studies highlighted their potential detrimental effects on patients' mental health, but this topic remains understudied. This study investigated the effect of a common coercive practice, seclusion (i.e., being locked in a closed room), on mental health using a trial emulation of observational data to allow causal inference. We used data from 1200 psychiatric inpatients, classified as being either secluded or non-secluded during their hospital stay. Inverse probability of treatment weighting was used to emulate the random assignment to the intervention. The primary outcome was the Health of the Nations Outcome Scales (HoNOS). The secondary outcome was the first item of the HoNOS, which focuses on overactive, aggressive, disruptive, or agitated behavior. Both outcomes were assessed at hospital discharge. There was a significant effect of seclusion with increases in both total HoNOS score (p = .002) and item 1 of the HoNOS (p = .01). Seclusion may have a negative causal effect of patients' mental health status and should therefore be avoided in mental health care settings. Training efforts should raise the awareness of the medical staff about potential adverse effects instead of therapeutic benefits.
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Affiliation(s)
- Stéphanie Baggio
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
| | - Alexandre Wullschleger
- Adult Psychiatry Division, Department of Psychiatry, Geneva University Hospitals, Geneva, Switzerland
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Dauriac-Le Masson V, El-Khoury Lesueur F, Lahaye J, Launay C, Christodoulou A, Boiteux C, Maman J, Bonnemaison X, Perquier F, Vacheron MN. Characteristics and correlates of seclusion and mechanical restraint measures in a Parisian psychiatric hospital group. Front Psychiatry 2024; 15:1296356. [PMID: 38445090 PMCID: PMC10913196 DOI: 10.3389/fpsyt.2024.1296356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Seclusion or restraint (S/R) are last-resort measures used in psychiatry to ensure the safety of the patient and the staff. However, they have harmful physical and psychological effects on patients, and efforts to limit their use are needed. We describe the characteristics and correlates of S/R events in four Parisian psychiatric centers. Methods Within a 3-month period, November 5, 2018 to February 3, 2019, we recorded data for patients experiencing an S/R measure as well as characteristics of the measures. We studied the mean duration of a S/R event, the time between hospital admission and the occurrence of the event, as well as correlates of these durations. We also examined factors associated with use of a restraint versus a seclusion measure. Results For the 233 patients included, we recorded 217 seclusion measures and 64 mechanical restraints. Seclusion measures mostly occurred after the patient's transfer from the emergency department. The duration of a seclusion measure was about 10 days. Patients considered resistant to psychotropic treatments more frequently had a longer seclusion duration than others. The mean duration of a mechanical restraint measure was 4 days. Male sex and younger age were associated with experiencing mechanical restraint. Discussion S/R measures mostly occur among patients perceived as resistant to psychotropic drugs who are arriving from the emergency department. Developing specific emergency department protocols might be useful in limiting the use of coercive measures.
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Affiliation(s)
| | - Fabienne El-Khoury Lesueur
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Sorbonne Universite, INSERM UMRS_1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
| | - Justine Lahaye
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Corinne Launay
- Pôle Psychiatrie Précarité, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | | | | | | | | | - Florence Perquier
- Cellule épidémiologie, GHU Paris Psychiatrie et Neurosciences, Paris, France
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Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To investigate the effects of post‐incident debriefing after coercive measures for people with schizophrenia or schizophrenia‐type psychosis.
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Montanari Vergallo G, Gulino M. Physical Restraint in Psychiatric Care: Soon to Fall Out of Use? PSYCHIAT CLIN PSYCH 2021; 31:468-473. [PMID: 38765646 PMCID: PMC11079647 DOI: 10.5152/pcp.2021.21237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/05/2021] [Indexed: 05/22/2024] Open
Abstract
International directives all recommend that using restraints on psychiatric patients should be avoided, yet scientific literature shows that such practices are still largely in use. This article aims to lay out strategies that could be put in place in order to gradually discard the use of restraints, particularly through a "restraint-free" approach, nursing, logistic-environmental pathways, and locally centered health care provision. All such tools have proven valuable for the purpose of safeguarding the health of psychiatric patients. Hence, the failure to put in place such measures may lead to litigation and lawsuits against physicians and particularly health care facilities. Undoubtedly, the ability to effectively implement such methods largely depends on the financial resources available, which in countries such as Italy are poorer than in others. Still, the risk of being sued and held professionally liable may constitute a factor in raising awareness among operators, facilities, and public health care management, leading to the implementation of policy changes aimed at minimizing the use of restraints.
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Affiliation(s)
- Gianluca Montanari Vergallo
- Department of Anatomical, Histological, Forensic and Orthopaedic Science, Sapienza University of Rome, Rome, Italy
| | - Matteo Gulino
- Department of Clinical Sciences and Translational Medicine, TorVergata University of Rome, Rome, Italy
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Ye J, Xia Z, Wang C, Liao Y, Xu Y, Zhang Y, Yu L, Li S, Lin J, Xiao A. Effectiveness of CRSCE-Based De-escalation Training on Reducing Physical Restraint in Psychiatric Hospitals: A Cluster Randomized Controlled Trial. Front Psychiatry 2021; 12:576662. [PMID: 33679467 PMCID: PMC7928340 DOI: 10.3389/fpsyt.2021.576662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/19/2021] [Indexed: 02/05/2023] Open
Abstract
Background: The use of physical restraint (PR) causes clinical and ethical issues; great efforts are being made to reduce the use of PR in psychiatric hospitals globally. Aim: This study aimed to examine the effectiveness of CRSCE-based de-escalation training on reducing PR in psychiatric hospitals. Method: The proposed study adopted cluster randomized controlled trial design. Twelve wards of a psychiatric hospital were randomly allocated to experimental group (n = 6) and control group (n = 6). Wards of control group were assigned to routine training regarding PR; wards of experimental group underwent the same routine training while additionally received CRSCE-based de-escalation training. Before and after CRSCE-based de-escalation training, the frequency of and the duration of PR, and the numbers and level of unexpected events caused by PR, were recorded. Results: After CRSCE-based de-escalation training, the frequency (inpatients and patients admitted within 24 h) of and the duration of PR of experimental group, showed a descending trend and were significantly lower than those of control group (P < 0.01); compared to control group, the numbers of unexpected events (level II and level III) and injury caused by PR of experimental group had been markedly reduced (P < 0.05). Conclusions: CRSCE-based de-escalation training would be useful to reduce the use of PR and the unexpected event caused by PR in psychiatric hospitals. The modules of CRSCE-based de-escalation training can be adopted for future intervention minimizing clinical use of PR. Clinical Trial Registration: This study was registered at Chinese Clinical Trial Registry (Registration Number: ChiCTR1900022211).
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Affiliation(s)
- Junrong Ye
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Zhichun Xia
- Department of Adult Psychiatry, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chen Wang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yao Liao
- Department of Cardiothoracic Surgery, Jingzhou Central Hospital, Jingzhou, China
| | - Yu Xu
- Department of Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
| | - Yunlei Zhang
- Department of Cardiothoracic Surgery, Jingzhou Central Hospital, Jingzhou, China
| | - Lin Yu
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Sijue Li
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jiankui Lin
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Aixiang Xiao
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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Ye J, Wang C, Xiao A, Xia Z, Yu L, Lin J, Liao Y, Xu Y, Zhang Y. Physical restraint in mental health nursing: A concept analysis. Int J Nurs Sci 2019; 6:343-348. [PMID: 31508457 PMCID: PMC6722410 DOI: 10.1016/j.ijnss.2019.04.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Physical restraint is frequently used in medical services, such as in mental health settings, intensive care units and nursing homes, but its nature varies in different institutions. By reviewing related literature, this study aims to clarify the concept of physical restraint in mental health nursing. METHOD Three databases (PubMed, PsycINFO and CINAHL) were retrieved, and Walker and Avant's concept analysis method was used to analyze the concept of physical restraint in mental health nursing. RESULTS Physical restraint is a coercive approach that enables the administration of necessary treatment by safely reducing the patient's physical movement. It should be the last option used by qualified personnel. Antecedents of physical restraint are improper behavior (violence and disturbance) of patients, medical assessment prior to implementation and legislation governing clinical usage. Consequences of physical restraint are alleviation of conflict, physical injury, mental trauma and invisible impact on the institution. DISCUSSION This study defined the characteristics of physical restraint in mental health nursing. The proposed concept analysis provided theoretical foundation for future studies.
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Affiliation(s)
- Junrong Ye
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Chen Wang
- Early Intervention Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Aixiang Xiao
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Zhichun Xia
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Lin Yu
- Traditional Chinese Medicine Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Jiankui Lin
- Nursing Administration Department, Affiliated Brain Hospital of Guangzhou Medical University, China
| | - Yao Liao
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
| | - Yu Xu
- Intensive Care Unit Department, West China Hospital of Sichuan University, China
| | - Yunlei Zhang
- Cardiovascular Surgery Department, Jingzhou Central Hospital, China
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Quinn C, Ryan J, Fullam R, McKenna B. The Use of Restrictive Practices on Males Released from Prison and Entering Acute Mental Health Services: A Retrospective Cross-sectional Comparative Study. Issues Ment Health Nurs 2019; 40:626-631. [PMID: 31050565 DOI: 10.1080/01612840.2019.1572845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is understood about restrictive practices (seclusion, physical restraint, mechanical restraint) for those admitted to mental health services from prison. This study aimed to determine restrictive practices use on males admitted involuntarily from prison compared to those admitted from the community. A retrospective cross-sectional, comparative research design was used. Those admitted from prison were no more likely to experience restrictive practices; but were more likely to have a co-existing diagnosis of alcohol/substance use or personality disorder, in addition to a primary diagnosis of psychotic illness. The proportionate use of restrictive practices despite such complex presentations is potentially indicative of the clinical use of effective alternative management strategies.
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Affiliation(s)
- Chris Quinn
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Jo Ryan
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Rachael Fullam
- a Forensicare, Victorian Institute of Forensic Mental Health , Fairfield , Australia.,b Centre for Forensic Behavioural Science, Swinburne University of Technology , Melbourne , Australia
| | - Brian McKenna
- c School of Clinical Sciences, Auckland University of Technology , Auckland , New Zealand.,d Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board , Auckland , New Zealand
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Chieze M, Hurst S, Kaiser S, Sentissi O. Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Front Psychiatry 2019; 10:491. [PMID: 31404294 PMCID: PMC6673758 DOI: 10.3389/fpsyt.2019.00491] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background: Determining the clinical effects of coercion is a difficult challenge, raising ethical, legal, and methodological questions. Despite limited scientific evidence on effectiveness, coercive measures are frequently used, especially in psychiatry. This systematic review aims to search for effects of seclusion and restraint on psychiatric inpatients with wider inclusion of outcomes and study designs than former reviews. Methods: A systematic search was conducted following PRISMA guidelines, primarily through Pubmed, Embase, and CENTRAL. Interventional and prospective observational studies on effects of seclusion and restraint on psychiatric inpatients were included. Main search keywords were restraint, seclusion, psychiatry, effect, harm, efficiency, efficacy, effectiveness, and quality of life. Results: Thirty-five articles were included, out of 6,854 records. Studies on the effects of seclusion and restraint in adult psychiatry comprise a wide range of outcomes and designs. The identified literature provides some evidence that seclusion and restraint have deleterious physical or psychological consequences. Estimation of post-traumatic stress disorder incidence after intervention varies from 25% to 47% and, thus, is not negligible, especially for patients with past traumatic experiences. Subjective perception has high interindividual variability, mostly associated with negative emotions. Effectiveness and adverse effects of seclusion and restraint seem to be similar. Compared to other coercive measures (notably forced medication), seclusion seems to be better accepted, while restraint seems to be less tolerated, possibly because of the perception of seclusion as "non-invasive." Therapeutic interaction appears to have a positive influence on coercion perception. Conclusion: Heterogeneity of the included studies limited drawing clear conclusions, but the main results identified show negative effects of seclusion and restraint. These interventions should be used with caution and as a last resort. Patients' preferences should be taken into account when deciding to apply these measures. The therapeutic relationship could be a focus for improvement of effects and subjective perception of coercion. In terms of methodology, studying coercive measures remains difficult but, in the context of current research on coercion reduction, is needed to provide workable baseline data and potential targets for interventions. Well-conducted prospective cohort studies could be more feasible than randomized controlled trials for interventional studies.
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Affiliation(s)
- Marie Chieze
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Samia Hurst
- Institute for Ethics, History and the Humanities, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stefan Kaiser
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
| | - Othman Sentissi
- Adult Psychiatry Division, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland
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Green R, Shelly C, Gibb J, Walker T. Implementing seclusion in forensic mental health care: A qualitative study of staff decision making. Arch Psychiatr Nurs 2018; 32:764-768. [PMID: 30201206 DOI: 10.1016/j.apnu.2018.04.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 10/17/2022]
Abstract
Forensic mental health nursing is a complex role and there is a tension between maintaining safety and promoting a therapeutic and patient centred approach. The use of restrictive practises such as seclusion is an issue. Two focus groups with registered nurses exploring attitudes and factors used in decision-making about seclusion use were analysed using interpretive description. Participants described the need to reduce the use of seclusion and the problematic nature of its utility as an ongoing intervention in contemporary mental healthcare. It was clear that there were complexities and competing variables involved in the decision-making process.
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Affiliation(s)
- Rachel Green
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich Hospital, Bury New Rd, Manchester, M25 3BL, United Kingdom.
| | - Catriona Shelly
- Manchester Metropolitan University, Department of Psychology, 53 Bonsall Street, Manchester M15 6GX, United Kingdom.
| | - Jonathan Gibb
- University of Manchester, Division of Psychology and Mental Health, School of Medical Sciences, Oxford Road, Manchester M13 9PL, United Kingdom.
| | - Tammi Walker
- The University of Huddersfield, Human and Health Sciences, Queensgate, Huddersfield HD1 3DH, United Kingdom.
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Eguchi R, Onozuka D, Ikeda K, Kuroda K, Ieiri I, Hagihara A. Psychological assessment of acute schizophrenia patients who experienced seclusion either alone or in combination with restraint. Int J Psychiatry Med 2018; 53:171-188. [PMID: 29280688 DOI: 10.1177/0091217417749788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective Numerous studies on the effects of seclusion and/or restraint in acute psychiatric treatment have reported both positive and negative effects. However, no studies to date have evaluated the effects of seclusion and/or restraint on schizophrenia patients using a rating scale. Thus, to examine the effects of seclusion and/or restraint on schizophrenia patients, we used the Brief Psychiatric Rating Scale and assessed the psychological condition of patients. Methods Factor analysis was conducted to create subscales of Brief Psychiatric Rating Scale, and psychiatric changes were assessed with respect to each subscale using multiple logistic regression analyses. Analyses were performed on three groups (i.e. entire, higher functioning, and lower functioning groups) involving a total of 1559 schizophrenia patients aged 18 to 65 years. Results In the entire and lower functioning groups, seclusion was a significant predictor of improvements related to the "hostility/suspiciousness" subscale. Seclusion combined with restraint was associated with improvements related to the "psychosis/thinking disorder" subscale. In the higher functioning group, there were no significant predictors. Conclusions It is implied that seclusion and/or restraint is related to improved psychiatric symptoms only among patients whose functioning is impaired. To verify the present findings, further studies involving multiple sites and additional psychiatric measures are necessary.
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Affiliation(s)
- Rika Eguchi
- 1 Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Fukuoka, Japan.,2 Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Science, Kyushu University, Fukuoka, Japan
| | - Daisuke Onozuka
- 1 Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
| | | | | | - Ichiro Ieiri
- 2 Department of Clinical Pharmacokinetics, Graduate School of Pharmaceutical Science, Kyushu University, Fukuoka, Japan
| | - Akihito Hagihara
- 1 Department of Health Services Management and Policy, Graduate School of Medicine, Kyushu University, Fukuoka, Japan
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Costemale-Lacoste JF, Cerboneschi V, Trichard C, De Beaurepaire R, Villemain F, Metton JP, Debacq C, Ghanem T, Martelli C, Baup E, Loeb E, Hardy P. [Predictive factors of seclusion duration in patients hospitalized in psychiatry settings. A prospective multisite study in the DTRF Paris-Sud]. Encephale 2018; 45:107-113. [PMID: 29580706 DOI: 10.1016/j.encep.2018.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 01/24/2018] [Accepted: 01/26/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In psychiatric inpatient settings seclusion is a last resort to ensure the safety of the patient, other patients, and staff from disturbed behaviors. Despite its major interest for patients, seclusion could negatively impact treatment adherence and patient/staff relationships. Indeed, some secluded patients report a feeling of guilt during the measure and do not consider seclusion to be a healthcare intervention. To be more beneficial and to reduce the feeling by patients of being forced, seclusions should be as short and rare as possible. In other words, measures to reduce seclusion are available and have been clearly identified. Such measures could be applied, in the first instance, in patients with longer duration. In this way, the aim of this study was to investigate predictive factors of a seclusion of long duration. METHODS Our study was based on the dataset of the EPIC study, an observational prospective French multicenter study of seclusion and restraint. The EPIC study occurred in seven French psychiatric hospitals in the southern region of Paris. Inclusions were realized for 73days and allowed a data collection of 302 seclusion measures. Of these measures 236 were effectively a seclusion in a standardized room. Because the median duration was 7days, we defined two groups of patients: duration<7days and duration ≥ 7 days. Our variable to be explicated was duration ≥ 7 days. Explicative variables available in EPIC study were age, sex, forced hospitalization, autoagressivity, heteroagressivity, use of sedative treatment (oral or intramuscular), history of seclusion and patient diagnoses. We used bivariate and multivariate analyses to explore the association between a seclusion duration ≥ 7 days and explicative variables. Diagnoses were classified as psychotic disorders, mood disorders and others diagnoses. To be included in multivariate logistic regressions, diagnoses were treated as dummy variables (mood disorder vs psychotic disorders; psychotic disorders vs others; mood disorders vs others). Statistical analyses were performed using SPSS software 20.0 and R 3.4.0. RESULTS Of the 236 measures of seclusion the mean age was 38.2 (±12.8), 196 (83%) patients were forcibly hospitalized prior to their seclusion, 147 (62%) had a diagnosis of psychotic disorder, 43 (18%) a diagnosis of mood disorder and 33 (14%) an "other diagnosis". Mean duration was 10.2 (1.5) days and median was 7.1 days. One hundred and thirty-five (47%) patients were in the group of duration ≥ 7 days. In bivariate analyses, variables associated with a duration ≥ 7 days were: being in forced hospitalization prior to the seclusion (P=0.04), administration of a sedative treatment (P=0.01) and against the group of others diagnoses the diagnosis of mood disorders (P<0.0005) and psychotic disorders (P=0.001). Multivariate analyses showed that, against the group of other diagnoses, the group of psychotic disorders [OR=3.3, CI 95% (1.3-8.4), P=0.01], the group of mood disorder [OR=2.7, CI 95% (1.4-4.9), P=0.002] and administration of sedative treatment [OR=8.1, CI 95% (2.0-32.5), P=0.003] were significantly associated with a duration ≥ 7 days. These results were independent from other confusion variables. Considering the hospitalization status, psychotic disorders was the only diagnosis which showed an association between duration ≥ 7 days and forced hospitalization [OR=2.9 CI 95% (1.1-7.8), P=0.03]. CONCLUSION Our study highlighted two profiles of higher risk to remain ≥ 7days in seclusion. The first one is patients with a diagnosis of mood disorder who needed sedative treatment. The second one is patients with a diagnosis of psychotic disorder who needed sedative treatment and forced hospitalized before seclusion. Thus, these two profiles could be a good target to practice, in the first instance, measures to reduce seclusion duration in psychiatry settings.
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Affiliation(s)
- J-F Costemale-Lacoste
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France.
| | - V Cerboneschi
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, CH Paul-Guiraud, 54, avenue de la République, 94800 Villejuif, France
| | - C Trichard
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France
| | - R De Beaurepaire
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, CH Paul-Guiraud, 54, avenue de la République, 94800 Villejuif, France
| | - F Villemain
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Barthélémy-Durand, avenue du 8-Mai-1945, 91150 Etampes, France
| | - J-P Metton
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Erasme, 143, avenue Armand-Guillebaud, 92160 Antony, France
| | - C Debacq
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Sud-Francilien, 40, avenue Serge-Dassault, 91100 Corbeil-Essonnes, France
| | - T Ghanem
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Orsay, 4, place du Général-Leclerc, 91400 Orsay, France
| | - C Martelli
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Paul-Brousse, HUPS, Assistance publique des Hôpitaux de Paris, 12, avenue Paul-Vaillant-Couturier, 94800 Villejuif, France; Inserm Unité 1000 neuro-imagerie et psychiatrie, SHFJ CEA, boulevard Dubreuil, 91400 Orsay, France
| | - E Baup
- Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, hôpital Corentin-Celton, HUPO, Assistance publique des Hôpitaux de Paris, 4, parvis Corentin-Celton, 92130 Issy-les-Moulineaux, France
| | - E Loeb
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - P Hardy
- Inserm UMRS 1178, Team "Depression and Antidepressants", CESP, 94275 Le Kremlin-Bicêtre, France; Faculté de médecine Paris-Sud, université Paris-Sud, 94275 Le Kremlin-Bicêtre, France; Psychiatry Department, Hôpital Bicêtre, HUPS, Assistance publique des Hôpitaux de Paris, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France; Dispositif territorial de recherche et de formation (DTRF) Paris-Sud, 94275 Le Kremlin-Bicêtre, France
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Ye J, Xiao A, Yu L, Wei H, Wang C, Luo T. Physical restraints: An ethical dilemma in mental health services in China. Int J Nurs Sci 2017; 5:68-71. [PMID: 31406804 PMCID: PMC6626237 DOI: 10.1016/j.ijnss.2017.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/25/2017] [Accepted: 12/01/2017] [Indexed: 11/30/2022] Open
Abstract
Given that physical restraints cause adverse effects to patients and nurses, their wide and frequent use has resulted in various clinical and ethical controversies in mental health services. The rate of physical restraints is significantly higher in China than in other countries. Some western and domestic media blamed relevant institutions for compromising the basic rights of psychiatric patients. Therefore, this study aims to collect and synthesize the relevant ethical evidence and to provide corresponding guidance for the nursing practice based on the current situation of the mainland of China. This study synthesized the ethical issue according to the ethical principle of autonomy, justice, beneficence, and non-maleficence. Given the current situation where the nursing workforce is limited and the mental health service is under-developed in China, applying physical restraints in the psychiatric inpatients to guarantee the safety of patients and nurses is crucial. In regard to respect the basic rights of psychiatric patients, it is recommended to protect the their autonomy, and eliminate the adverse effects of physical restraint. This goal would be achieved by ensuring the informed consent, providing humane care, and regulating the implementation of physical restraints.
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Affiliation(s)
- Junrong Ye
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Aixiang Xiao
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Lin Yu
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Hongmei Wei
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chen Wang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Tianyun Luo
- Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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14
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Loi F, Marlowe K. East London Modified-Broset as Decision-Making Tool to Predict Seclusion in Psychiatric Intensive Care Units. Front Psychiatry 2017; 8:194. [PMID: 29046647 PMCID: PMC5632740 DOI: 10.3389/fpsyt.2017.00194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/19/2017] [Indexed: 11/16/2022] Open
Abstract
Seclusion is a last resort intervention for management of aggressive behavior in psychiatric settings. There is no current objective and practical decision-making instrument for seclusion use on psychiatric wards. Our aim was to test the predictive and discriminatory characteristics of the East London Modified-Broset (ELMB), to delineate its decision-making profile for seclusion of adult psychiatric patients, and second to benchmark it against the psychometric properties of the Broset Violence Checklist (BVC). ELMB, an 8-item modified version of the 6-item BVC, was retrospectively employed to evaluate the seclusion decision-making process on two Psychiatric Intensive Care Units (patients n = 201; incidents n = 2,187). Data analyses were carried out using multivariate regression and Receiver Operating Characteristic (ROC) curves. Predictors of seclusion were: physical violence toward staff/patients OR = 24.2; non-compliance with PRN (pro re nata) medications OR = 9.8; and damage to hospital property OR = 2.9. ROC analyses indicated that ELMB was significantly more accurate that BVC, with higher sensitivity, specificity, and positive likelihood ratio. Results were similar across gender. The ELMB is a sensitive and specific instrument that can be used to guide the decision-making process when implementing seclusion.
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Affiliation(s)
- Felice Loi
- Juniper Court Churchill Hospital CAS Behavioural Health, London, United Kingdom
| | - Karl Marlowe
- Millharbour PICU Mile End Hospital East London NHS Foundation Trust, London, United Kingdom
- Centre for Psychiatry Queen Mary University of London, London, United Kingdom
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15
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Välimäki M, Yang M, Normand SL, Lorig KR, Anttila M, Lantta T, Pekurinen V, Adams CE. Study protocol for a cluster randomised controlled trial to assess the effectiveness of user-driven intervention to prevent aggressive events in psychiatric services. BMC Psychiatry 2017; 17:123. [PMID: 28372555 PMCID: PMC5379524 DOI: 10.1186/s12888-017-1266-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 03/11/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND People admitted to psychiatric hospitals with a diagnosis of schizophrenia may display behavioural problems. These may require management approaches such as use of coercive practices, which impact the well-being of staff members, visiting families and friends, peers, as well as patients themselves. Studies have proposed that not only patients' conditions, but also treatment environment and ward culture may affect patients' behaviour. Seclusion and restraint could possibly be prevented with staff education about user-centred, more humane approaches. Staff education could also increase collaboration between patients, family members and staff, which may further positively affect treatment culture and lower the need for using coercive treatment methods. METHODS This is a single-blind, two-arm cluster randomised controlled trial involving 28 psychiatric hospital wards across Finland. Units will be randomised to receive either a staff educational programme delivered by the team of researchers, or standard care. The primary outcome is the incidence of use of patient seclusion rooms, assessed from the local/national health registers. Secondary outcomes include use of other coercive methods (limb restraint, forced injection, and physical restraint), service use, treatment satisfaction, general functioning among patients, and team climate and employee turn-over (nursing staff). DISCUSSION The study, designed in close collaboration with staff members, patients and their relatives, will provide evidence for a co-operative and user-centred educational intervention aiming to decrease the prevalence of coercive methods and service use in the units, increase the functional status of patients and improve team climate in the units. We have identified no similar trials. TRIAL REGISTRATION ClinicalTrials.gov NCT02724748 . Registered on 25th of April 2016.
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Affiliation(s)
- Maritta Välimäki
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
- Turku University Hospital, Turku, Finland
| | - Min Yang
- West China Research Center for Rural Health Development, Sichuan University Huaxi Medical Center, Sichuan University of China, Administration Building, No 17,Section 3,Ren Ming Nan Lu, Chengdu, Sichuan China
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Sharon-Lise Normand
- Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115-5899 USA
| | - Kate R. Lorig
- Department of Medicine - Med/Immunology & Rheumatology, Stanford University, 1000 WELCH RD. #204, Stanford, CA 94305-5755 USA
| | - Minna Anttila
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Tella Lantta
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Virve Pekurinen
- Department of Nursing Science, Faculty of Medicine, University of Turku , Turku, Finland
| | - Clive E. Adams
- Institute of Mental Health, Division of Psychiatry, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB UK
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16
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Barnett R, Stirling C, Hall J, Davies A, Orme P. Perceptions of supported and unsupported prone-restraint positions. J Psychiatr Ment Health Nurs 2016; 23:172-8. [PMID: 27018515 DOI: 10.1111/jpm.12295] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Although the use of prone restraint should be avoided, it may remain a last resort emergency intervention for violent behaviour in psychiatric settings. However, when used as a last resort, concerns remain about the ability of staff to maintain the dignity, welfare and safety of the patient and minimize the potential adverse outcomes associated with restraint. This study builds on existing research regarding the risks of prone restraint by focusing on the psychological perceptions of individuals held in this position. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Individuals, who were asked to rate the psychological impact of two different prone-restraint positions (Supported and Unsupported Prone Positions) reported that the Supported Prone Position was more comfortable, less anxiety inducing and less limiting to breathing. Although no individual found prone restraint a positive experience, it shows that individuals found the psychological impact of the Supported Prone Position was less than the Unsupported Prone Position. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals have a clear responsibility to maintain the dignity, safety and wellbeing of individuals subject to prone restraint as a short-term emergency procedure for the management of violent behaviour. Reducing both the physiological and psychological impact of prone restraint will help to reduce any adverse impact on individuals subject to such interventions. The findings will help influence current practice and promote the removal of the USPP as a specific prone-restraint intervention. ABSTRACT Aim Restraint-related deaths are multi-factorial with prone restraint remaining a concern due to the physiological and psychological risks. This study builds on evidence presented by (Barnett et al. Medicine, Science and the Law (2012b): 1) that the Supported Prone Position (SPP) reduces physiological risks, by examining if the SPP also reduces the psychological impact of prone restraint. Methods Twenty participants ran to near maximal exertion before being held in two prone-restraint positions: SPP and Unsupported Prone Position (USPP). Perceptions of comfort, anxiety and breathing limitation were measured using Visual Analogue Scales. Results Results showed that (1) comfort was 23% greater in the SPP; (2) anxiety was 55% less in the SPP; and (3) perception of breathing limitation was 32% less in the SPP when compared with the USPP. Negative perceptions expressed for the USPP included feeling trapped, vulnerable and concern over heart rate. Discussion In addition to reducing physiological risks, this study shows that the SPP reduced the psychological impact of prone restraint compared to USPP. Implications for Practice Settings where prone restraint cannot be avoided should remove the USPP as an emergency procedure in favour of the SPP as a way of maintaining safety and reducing the psychological impact of prone restraint.
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Affiliation(s)
- R Barnett
- School of Health and Rehabilitation, University of Keele, Staffordshire England, UK
| | - C Stirling
- Crisis Prevention Institute, Manchester, UK.,School of Health and Wellbeing, University of Wolverhampton, West Midlands, England
| | - J Hall
- School of Health and Rehabilitation, University of Keele, Staffordshire England, UK
| | - A Davies
- School of Health and Rehabilitation, University of Keele, Staffordshire England, UK
| | - P Orme
- School of Health and Rehabilitation, University of Keele, Staffordshire England, UK
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