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Xu L, Wang S, Wu L, Cao H, Fan Y, Wang X, Yu Z, Zhou M, Gao R, Wang J. Coprococcus eutactus screened from healthy adolescent attenuates chronic restraint stress-induced depression-like changes in adolescent mice: Potential roles in the microbiome and neurotransmitter modulation. J Affect Disord 2024; 356:737-752. [PMID: 38649105 DOI: 10.1016/j.jad.2024.04.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 02/20/2024] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
The onset of depression commonly occurs in adolescence; therefore, depressive prevention and intervention are pivotal during this period. It is becoming evident that neurotransmitter imbalance and gut microbiota dysbiosis are prominent causes of depression. However, the underlying links and mechanisms remain poorly understood. In this study, with 16S ribosomal RNA gene sequencing, genus Coprococcus markedly differentiated between the healthy and unmedicated depressive adolescents. Based on this, transplantation of Coprococcus eutactus (C.e.) was found to dramatically ameliorate the chronic restraint stress (CRS) induced depression-like changes and prevent synaptic loss and glial-stimulated neuroinflammation in mice. The Ultra-high performance liquid chromatography tandem mass spectrometry analysis (UHPLC-MS/MS) further showed that neurotoxic neurotransmitters in kynurenine pathway (KP) such as 3-hydroxykynurenine (3-HK) and 3-hydroxyanthranilic acid (3-HAA) decreased in mouse brains, mechanistically deciphering the transfer of the tryptophan metabolic pathway to serotonin metabolic signaling in the brain after C.e. treatment, which was also verified in the colon. Molecularly, blockage of KP activities mediated by C.e. was ascribed to the restraint of the limit-step enzymes responsible for kynurenine, 3-HK, and quinolinic acid generation. In the colon, C.e. treatment significantly recovered goblet cells and mucus secretion in CRS mice which may ascribe to the rebalance of the disordered gut microbiota, especially Akkermansia, Roseburia, Rikenella, Blautia, and Alloprevotella. Taken together, the current study reveals for the first time the beneficial effects and potential mechanisms of C.e. in ameliorating CRS-induced depression, unraveling the direct links between C.e. treatment and neurotransmitter rebalance, which may provide efficacious therapeutic avenues for adolescent depressive intervention.
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Affiliation(s)
- Liuting Xu
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Sizhe Wang
- Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Linlin Wu
- Department of Physical and Chemical Inspection, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Hui Cao
- Department of Hygienic Analysis and Detection, Nanjing Qixia District Center for Disease Control and Prevention, Nanjing, China
| | - Yichun Fan
- Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Xi Wang
- Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Zheng Yu
- Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Manfei Zhou
- Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Rong Gao
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Hygienic Analysis and Detection, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
| | - Jun Wang
- Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China; Department of Toxicology, The Key Laboratory of Modern Toxicology of Ministry of Education, School of Public Health, Nanjing Medical University, Nanjing, China.
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Pedersen ML, Gildberg FA, Baker J, Tingleff EB. A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings. Int J Ment Health Nurs 2024; 33:505-522. [PMID: 38017713 DOI: 10.1111/inm.13267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/25/2023] [Accepted: 11/13/2023] [Indexed: 11/30/2023]
Abstract
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.
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Affiliation(s)
- Martin Locht Pedersen
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - Frederik Alkier Gildberg
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
| | - John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | - Ellen Boldrup Tingleff
- Forensic Mental Health Research Unit Middelfart, Department of Regional Health Research, University of Southern Denmark, Middelfart, Denmark
- Psychiatric Department Middelfart, Mental Health Services in the Region of Southern Denmark, Middelfart, Denmark
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Liu X, Xu X, Liao Y, Yao W, Geng X, Zeng X, Sun X, Tang A, Yang P. Psychological stress to ovalbumin peptide-specific T-cell receptor transgenic mice impairs the suppressive ability of type 1 regulatory T cell. Immunology 2024; 172:210-225. [PMID: 38366844 DOI: 10.1111/imm.13767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/03/2024] [Indexed: 02/18/2024] Open
Abstract
Numerous diseases of the immune system can be traced back to the malfunctioning of the regulatory T cells. The aetiology is unclear. Psychological stress can cause disruption to the immune regulation. The synergistic effects of psychological stress and immune response on immune regulation have yet to be fully understood. The intention of this study is to analyse the interaction between psychological stress and immune responses and how it affects the functional status of type 1 regulatory T (Tr1) cells. In this study, ovalbumin peptide T-cell receptor transgenic mice were utilised. Mice were subjected to restraint stress to induce psychological stress. An airway allergy murine model was established, in which a mouse strain with RING finger protein 20 (Rnf20)-deficient CD4+ T cells were used. The results showed that concomitant exposure to restraint stress and immune response could exacerbate endoplasmic reticulum stress in Tr1 cells. Corticosterone was responsible for the elevated expression of X-box protein-1 (XBP1) in mouse Tr1 cells after exposure to both restraint stress and immune response. XBP1 mediated the effects of corticosterone on inducing Rnf20 in Tr1 cells. The reduction of the interleukin-10 expression in Tr1 cells was facilitated by Rnf20. Inhibition of Rnf20 alleviated experimental airway allergy by restoring the immune regulatory ability of Tr1 cells. In conclusion, the functions of Tr1 cells are negatively impacted by simultaneous exposure to psychological stress and immune response. Tr1 cells' immune suppressive functions can be restored by inhibiting Rnf20, which has the translational potential for the treatment of diseases of the immune system.
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MESH Headings
- Animals
- T-Lymphocytes, Regulatory/immunology
- T-Lymphocytes, Regulatory/metabolism
- Ovalbumin/immunology
- Stress, Psychological/immunology
- Mice, Transgenic
- Mice
- Interleukin-10/metabolism
- Receptors, Antigen, T-Cell/metabolism
- Receptors, Antigen, T-Cell/immunology
- X-Box Binding Protein 1/metabolism
- X-Box Binding Protein 1/genetics
- Corticosterone/blood
- Ubiquitin-Protein Ligases/metabolism
- Ubiquitin-Protein Ligases/genetics
- Endoplasmic Reticulum Stress/immunology
- Disease Models, Animal
- Restraint, Physical
- Mice, Knockout
- Mice, Inbred C57BL
- Respiratory Hypersensitivity/immunology
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Affiliation(s)
- Xiaoyu Liu
- Institute of Allergy & Immunology of Shenzhen University School of Medicine, State Key Laboratory of Respiratory Diseases Shenzhen University Division, Shenzhen, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen, China
| | - Xuejie Xu
- Institute of Allergy & Immunology of Shenzhen University School of Medicine, State Key Laboratory of Respiratory Diseases Shenzhen University Division, Shenzhen, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen, China
| | - Yun Liao
- Institute of Allergy & Immunology of Shenzhen University School of Medicine, State Key Laboratory of Respiratory Diseases Shenzhen University Division, Shenzhen, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen, China
- Shenzhen Clinical College, Guangzhou Chinese Traditional Medical University, Shenzhen, China
| | - Wenkai Yao
- Institute of Allergy & Immunology of Shenzhen University School of Medicine, State Key Laboratory of Respiratory Diseases Shenzhen University Division, Shenzhen, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen, China
| | - Xiaorui Geng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Xianhai Zeng
- Department of Otolaryngology, Longgang ENT Hospital and Shenzhen ENT Institute, Shenzhen, China
| | - Xizhuo Sun
- Department of General Practice Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Aifa Tang
- Department of General Practice Medicine and Respirology, Third Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Pingchang Yang
- Institute of Allergy & Immunology of Shenzhen University School of Medicine, State Key Laboratory of Respiratory Diseases Shenzhen University Division, Shenzhen, China
- Guangdong Provincial Regional Disease Key Laboratory, Shenzhen, China
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4
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Lindridge J, Edwards T, Blackwood L. Advanced paramedics' restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation. PLoS One 2024; 19:e0302524. [PMID: 38753728 PMCID: PMC11098407 DOI: 10.1371/journal.pone.0302524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
Acute behavioural disturbance (ABD), sometimes called 'excited delirium', is a medical emergency. In the UK, some patients presenting with ABD are managed by advanced paramedics (APs), however little is known about how APs make restraint decisions. The aim of this research is to explore the decisions made by APs when managing restraint in the context of ABD, in the UK pre-hospital ambulance setting. Seven semi-structured interviews were undertaken with APs. All participants were experienced APs with post-registration, post-graduate advanced practice education and qualifications. The resulting data were analysed using reflexive thematic analysis, informed by critical realism. We identified four interconnected themes from the interview data. Firstly, managing complexity and ambiguity in relation to identifying ABD patients and determining appropriate treatment plans. Secondly, feeling vulnerable to professional consequences from patients deteriorating whilst in the care of APs. Thirdly, negotiating with other professionals who have different roles and priorities. Finally, establishing primacy of care in relation to incidents which involve police officers and other professionals. A key influence was the need to characterise incidents as medical, as an enabler to establishing clinical leadership and decision-making control. APs focused on de-escalation techniques and sought to reduce physical restraint, intervening with pharmacological interventions if necessary to achieve this. The social relationships and interactions with patients and other professionals at the scene were key to success. Decisions are a source of anxiety, with fears of professional detriment accompanying poor patient outcomes. Our results indicate that APs would benefit from education and development specifically in relation to making ABD decisions, acknowledging the context of inter-professional relationships and the potential for competing and conflicting priorities. A focus on joint, high-fidelity training with the police may be a helpful intervention.
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Affiliation(s)
- Jaqualine Lindridge
- Department for Health, University of Bath, Bath, Somerset, England
- London Ambulance Service NHS Trust, London, England
| | | | - Leda Blackwood
- Department of Psychology, University of Bath, Bath, Somerset, England
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5
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Abe Y, Murase T, Mitsuma M, Shinba Y, Yamashita H, Ikematsu K. Dynamics of somatostatin 4 receptor expression during chronic-stress loading and its potential as a chronic-stress marker. Sci Rep 2024; 14:10045. [PMID: 38698013 PMCID: PMC11066077 DOI: 10.1038/s41598-024-58621-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 04/01/2024] [Indexed: 05/05/2024] Open
Abstract
Chronic stress has been implicated in mental illnesses and depressive behaviors. Somatostatin 4 receptor (SSTR4) has been shown to mediate anxiolytic and depression-like effects. Here, we aimed to explore the potential of SSTR4 as a diagnostic marker for chronic stress in mice. The mice were divided into single stress, chronic restraint stress, and control groups, and Sstr4 mRNA expression in the pituitary, lungs, and thymus, its protein expression in the thymus, were analyzed. Compared to controls, Sstr4 mRNA expression decreased significantly in the pituitary gland of the chronic and single-stress groups (P = 0.0181 and 0.0022, respectively) and lungs of the single-stress group (P = 0.0124), whereas it significantly increased in the thymus of the chronic-stress group (P = 0.0313). Thymic SSTR4 expression did not decrease significantly in stress groups compared to that in the control group (P = 0.0963). These results suggest that SSTR4 expression fluctuates in response to stress. Furthermore, Sstr4 mRNA expression dynamics in each organ differed based on single or chronic restraint stress-loading periods. In conclusion, this study suggests that investigating SSTR4 expression in each organ could allow for its use as a stress marker to estimate the stress-loading period and aid in diagnosing chronic stress.
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Affiliation(s)
- Yuki Abe
- Division of Forensic Pathology and Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| | - Takehiko Murase
- Division of Forensic Pathology and Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan.
- Department of Forensic Medicine, Faculty of Medicine, Kagawa University, 1750-1, Miki, Kita, Kagawa, 761-0793, Japan.
| | - Masahide Mitsuma
- Division of Forensic Pathology and Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| | - Yoriko Shinba
- Division of Forensic Pathology and Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
| | - Hiromi Yamashita
- Division of Forensic Dental Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kazuya Ikematsu
- Division of Forensic Pathology and Science, Department of Medical and Dental Sciences, Graduate School of Biomedical Sciences, School of Medicine, Nagasaki University, 1-12-4, Sakamoto, Nagasaki, 852-8523, Japan
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6
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Valipour H, Jahromi GP, Mohammadi A, Meftahi GH. Effects of the suppression of 5-HT 1A receptors in the left, right, or bilateral basolateral amygdala on memory consolidation in chronic stress in male rats. Naunyn Schmiedebergs Arch Pharmacol 2024; 397:3049-3064. [PMID: 37874340 DOI: 10.1007/s00210-023-02790-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/12/2023] [Indexed: 10/25/2023]
Abstract
The serotonin-1A receptors (5-HT1A) in the two cerebral hemispheres are differentially involved in memory. The distribution of 5-HT1A receptors in the left and right amygdala is different. Furthermore, evidence shows that the 5-HT1A receptors in the left and right amygdala work differently in memory function. The basolateral amygdala (BLA) also regulates hippocampal long-term potentiation (LTP) during stress. However, which BLA structure in each hemisphere underlies such lateralized function is unclear. The present research investigated the possible involvement of 5-HT1A lateralization in the BLA on stress-induced memory impairment. 5-HT1A receptor antagonist (Way-100-635) was injected into the left, right, or bilateral BLA twenty minutes before chronic restraint stress (CRS) for 14 consecutive days. Results indicated that suppression of 5HT1A-receptors in the BLA plays an essential role in reducing the acquisition of passive avoidance in the shuttle box test and spatial memory in the Barnes maze test in the stress animals. This decrease was significant in the CRS animals with left and bilateral suppressed 5HT1A-receptors in the BLA. Field potential recording results showed that the left, right, and bilateral injection of Way-100-635 into the BLA significantly reduced the slope and amplitude of fEPSP in the CA1 area of the hippocampus in stressed rats. No significant difference was observed in neuronal arborization in the CA1 area of the hippocampus. In conclusion, the 5-HT1A receptor in the left and right sides of BLA nuclei play a different role in memory consolidation in the hippocampus under stress.
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Affiliation(s)
- Habib Valipour
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Student Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Gila Pirzad Jahromi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Alireza Mohammadi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Gholam Hossein Meftahi
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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7
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Bedi NS, Mathur N, Wang JD, Rech A, Gaden N, Annas GJ, Crosby SS. Human Rights in Hospitals: an End to Routine Shackling. J Gen Intern Med 2024; 39:1048-1052. [PMID: 38169026 DOI: 10.1007/s11606-023-08584-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/13/2023] [Indexed: 01/05/2024]
Abstract
Medical students (NSB, NM, JDW) spearheaded revision of the policy and clinical practice for shackling incarcerated patients at Boston Medical Center (BMC), the largest safety net hospital in New England. In American hospitals, routine shackling of incarcerated patients with metal restraints is widespread-except for perinatal patients-regardless of consciousness, mobility, illness severity, or age. The modified policy includes individualized assessments and allows incarcerated patients to be unshackled if they meet defined criteria. The students also formed the Stop Shackling Patients Coalition (SSP Coalition) of clinicians, public health practitioners, human rights advocates, and community members determined to humanize the inpatient treatment of incarcerated patients. Changes pioneered at BMC led the Mass General Brigham health system to follow suit. The Massachusetts Medical Society adopted a resolution authored by the SSP Coalition, which condemned universal shackling and advocated for use of the least restrictive alternative. This will be presented to the American Medical Association in June 2024. The Coalition led a similar effort to coauthor a policy statement on the issue, which was formally adopted by the American Public Health Association in November 2023. Most importantly, in an unprecedented human rights victory, a BMC patient who was incarcerated, sedated, and intubated was unshackled by correctional officers for the purpose of preserving human dignity.
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Affiliation(s)
- Neil Singh Bedi
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
- Center for Health Law, Ethics, and Human Rights, Boston University School of Public Health, Boston, MA, USA
| | - Nisha Mathur
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | - Judy D Wang
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA
| | | | | | - George J Annas
- Center for Health Law, Ethics, and Human Rights, Boston University School of Public Health, Boston, MA, USA
| | - Sondra S Crosby
- Boston University Chobanian and Avedisian School of Medicine, Boston, MA, USA.
- Center for Health Law, Ethics, and Human Rights, Boston University School of Public Health, Boston, MA, USA.
- Boston Medical Center, Boston, MA, USA.
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Miller O, Treseler J, Pignataro S. Reducing (Behavioral) Restraint Use Through Simulation at the Bedside. J Nurses Prof Dev 2024; 40:144-148. [PMID: 38687709 DOI: 10.1097/nnd.0000000000001046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Hospitals are experiencing an influx of patients in active behavioral crises, leading to restraints as a behavior management strategy. Over 100 staff participated in simulation training designed to manage escalating patient behavior. The training had a direct impact on the reduction of restraint use and increased preparedness and confidence of participants managing escalating patient behavior. Results suggest simulation can be an effective strategy to train medical staff to manage challenging behavior and reduce restraint use.
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Carballo LH, Li P, Senek R, Yan Z. Systemic histone deacetylase inhibition ameliorates the aberrant responses to acute stress in socially isolated male mice. J Physiol 2024; 602:2047-2060. [PMID: 38500302 PMCID: PMC11068487 DOI: 10.1113/jp285875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 03/01/2024] [Indexed: 03/20/2024] Open
Abstract
Adverse experiences in early life can induce maladaptive responses to acute stress in later life. Chronic social isolation during adolescence is an early life adversity that can precipitate stress-related psychiatric disorders. We found that male mice after 8 weeks of adolescent social isolation (SI) have markedly increased aggression after being exposed to 2 h of restraint stress (RS), which was accompanied by a significant increase of AMPA receptor- and NMDA receptor-mediated synaptic transmission in prefrontal cortex (PFC) pyramidal neurons of SIRS males. Compared to group-housed counterparts, SIRS males exhibited a significantly decreased level of histone H3 acetylation in PFC. Systemic administration of class I histone deacetylase inhibitors, romidepsin or MS-275, ameliorated the aggressive behaviour, as well as general social interaction deficits, of SIRS males. Electrophysiological recordings also found normalization of PFC glutamatergic currents by romidepsin treatment of SIRS male mice. These results revealed an epigenetic mechanism and intervention avenue for aggression induced by chronic social isolation. KEY POINTS: Adolescent chronic social isolation can precipitate stress-related psychiatric disorders. A significant increase of glutamatergic transmission is found in the prefrontal cortex (PFC) of socially isolated male mice exposed to an acute stress (SIRS). Treatment with class I histone deacetylase (HDAC) inhibitors ameliorates the aggressive behaviour and social interaction deficits of SIRS males, and normalizes glutamatergic currents in PFC neurons. It provides an epigenetic mechanism and intervention avenue for aberrant stress responses induced by chronic social isolation.
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Affiliation(s)
- Luis Hernandez Carballo
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Pei Li
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Rachel Senek
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
| | - Zhen Yan
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY 14203, USA
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Ismail N, Mohd Yusof MYP, Wan Mokhtar I. Factors influencing parental acceptance toward the use of passive immobilisation as behaviour guidance in children during dental treatment: a scoping review. J Clin Pediatr Dent 2024; 48:6-14. [PMID: 38755976 DOI: 10.22514/jocpd.2024.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/10/2023] [Indexed: 05/18/2024] Open
Abstract
Exploring parental opinions regarding the use of passive immobilisation during dental treatment is critical when identifying behaviour guidance application priorities. Instead of being dismissed as an inappropriate and less favourable option, this article aims to systematically evaluate factors affecting parental acceptance toward the use of passive immobilisation as behaviour guidance among children during dental treatment in various populations and regions. This research follows Arksey and O'Malley framework and updated by Joanna Briggs Institute Framework for Scoping Reviews methodology to summarise 40 research papers from 1984 to 2022 in PubMed, Web of Science, Science Direct, EBSCO Host, Scopus, grey literature and Google search outlining the research trend of parental acceptance toward passive immobilisation as behaviour guidance. Factors influencing parental acceptance toward the use of passive immobilisation were classified into parental socio-economic and demographic characteristics, exposure method of the devices to the parents, type of dental procedures, and children's cooperation and cognitive level. In conclusion, the current explorative review of the parental perspective toward passive immobilisation proposed a recommendation and facilitate the dentist to consider this technique as an alternative option for behaviour guidance in paediatric dentistry.
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Affiliation(s)
- Norsaima Ismail
- Centre for Paediatric Dentistry & Orthodontics Studies, Faculty of Dentistry, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, SEL, Malaysia
- Ministry of Health, Kompleks E, Pusat Pentadbiran Kerajaan Persekutuan, 62000 Petaling Jaya, Malaysia
| | - Mohd Yusmiaidil Putera Mohd Yusof
- Centre of Oral & Maxillofacial Diagnostics and Medicine Studies, Faculty of Dentistry, Sungai Buloh Campus, Universiti Teknologi MARA, 47000 Sungai Buloh, SEL, Malaysia
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Sungai Buloh Campus, Universiti Teknologi MARA, 47000 Sungai Buloh, SEL, Malaysia
| | - Ilham Wan Mokhtar
- Centre for Comprehensive Care Studies, Faculty of Dentistry, Sungai Buloh Campus, Universiti Teknologi MARA, Jalan Hospital, 47000 Sungai Buloh, SEL, Malaysia
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11
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Deering K, Wagstaff C, Williams J, Bermingham I, Pawson C. Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital. Int J Ment Health Nurs 2024; 33:420-430. [PMID: 37882636 DOI: 10.1111/inm.13245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 10/02/2023] [Accepted: 10/09/2023] [Indexed: 10/27/2023]
Abstract
Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital.
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Affiliation(s)
- Kris Deering
- Nursing Academy, University of Exeter, Exeter, UK
| | - Chris Wagstaff
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - Jo Williams
- School of Nursing and Midwifery, University of the West of England, Blackberry Hill, Bristol, UK
| | - Ivor Bermingham
- Service user and carer involvement coordinator, Southwest of England, England
| | - Chris Pawson
- Psychology Department, University of the West of England, Frenchay Campus, Bristol, UK
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12
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Arends L. Improving Child Passenger Safety Through Proper Restraint System Use. Am J Nurs 2024; 124:11. [PMID: 38511692 DOI: 10.1097/01.naj.0001010512.24155.5b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Nurses could help close caregivers' knowledge gap.
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Affiliation(s)
- Leslie Arends
- Leslie Arends is an assistant professor at the University of Iowa College of Nursing, Iowa City. Contact author: . The author has disclosed no potential conflicts of interest, financial or otherwise
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13
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Barsky BA, Shields MC. Psychiatric Restraint Use as Carceral State Practice. Psychiatr Serv 2024; 75:307. [PMID: 38557135 DOI: 10.1176/appi.ps.24075006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
- Benjamin A Barsky
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Shields); Edmond & Lily Safra Center for Ethics, Harvard University, and Harvard Law School Project on Disability, Harvard Law School, Cambridge, Massachusetts (Barsky)
| | - Morgan C Shields
- George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis (Shields); Edmond & Lily Safra Center for Ethics, Harvard University, and Harvard Law School Project on Disability, Harvard Law School, Cambridge, Massachusetts (Barsky)
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14
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Havilla S, Alanazi FK, Boon B, Patton D, Ho YC, Molloy L. Exploring the impact of a multilevel intervention focused on reducing the practices of seclusion and restraint in acute mental health units in an Australian mental health service. Int J Ment Health Nurs 2024; 33:442-451. [PMID: 37964469 DOI: 10.1111/inm.13255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/16/2023]
Abstract
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.
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Affiliation(s)
- Sizwile Havilla
- Illawarra Shoalhaven Local Health District Mental Health Service, Shellharbour, New South Wales, Australia
| | | | - Brad Boon
- Illawarra Shoalhaven Local Health District Mental Health Service, Shellharbour, New South Wales, Australia
| | - Declan Patton
- School of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yen-Chung Ho
- School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan ROC
| | - Luke Molloy
- School of Nursing, University of Wollongong, Wollongong, New South Wales, Australia
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15
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Askola R, Lantta T. Factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint in acute forensic services. Evid Based Nurs 2024; 27:70. [PMID: 37640424 DOI: 10.1136/ebnurs-2023-103798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Riitta Askola
- Department of Nursing, University of Turku, Turku, Finland
| | - Tella Lantta
- Department of Nursing, University of Turku, Turku, Finland
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Hawthorn, Victoria, Australia
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16
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Huang YC, Ko PH, Wu LL. Age-dependent effects of acute stress on the behavior, blood parameters, immunity, and enteric nerves of mice. Behav Brain Res 2024; 461:114848. [PMID: 38185382 DOI: 10.1016/j.bbr.2024.114848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/28/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024]
Abstract
The impact of stress on mental and digestive health has been extensively studied, with chronic stress being associated with various disorders. However, age-related differences in the response to acute stress, both behaviorally and physiologically, remain poorly understood. Therefore, this study aimed to develop a model to detect transient stress in mice of different ages. The stressor employed in our experiments was a restraint stress procedure, where mice were subjected to brief periods of immobilization to induce an acute stress response. Male C3H/HeN mice aged 3, 6, 12, and 30 weeks were subjected to acute restrain stress (ARS) by being placed in a 50 ml conical centrifuge tube for 15 min. Subsequently, their behavior, organ tissues, hematological parameters, cortisol concentration, and immune responses were assessed. Following ARS, the increased in time and entries into the center by the 12-week-old mice following stress. In comparison to mice of other ages, those aged 6 weeks demonstrated notable elevations in erythrocytes, platelets, hemoglobin, and hematocrit, all of which were influenced by the time-dependent changes and the recovery process of ARS. Blood corticosterone levels were substantially elevated in all age groups after ARS. Furthermore, ARS induced a notable increase in leukocytes, basophils, residential macrophages, and CD4+ T cells in all age groups except for 3-week-old mice. However, the number of monocyte-derived macrophages and CD8+ T cells did not change significantly. Additionally, mice aged 3 and 6 weeks demonstrated an increase in GFAP+ cells following ARS, whereas NeuN+ cells decreased across all ages. These results suggest that ARS has varying effects on the behavior, cortisol concentration, and quantity of blood cells as well as hepatic immune cells in mice of different ages. These age-dependent responses shed light on the complex interplay between stress and physiological systems and contribute to the broader understanding of stress-related diseases.
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Affiliation(s)
- Yi-Chen Huang
- Department and Institute of Physiology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Pin-Hao Ko
- Department of Traditional Chinese Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan 330215, Taiwan
| | - Li-Ling Wu
- Department and Institute of Physiology, College of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan; Health Innovation Center, National Yang-Ming Chiao Tung University, Taipei 11221, Taiwan; Microbiota Research Center, National Yang-Ming Chiao Tung University, Taipei 11221, Taiwan.
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17
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Griffith R. Residual liberty and the detained mental health patient. Br J Nurs 2024; 33:273-274. [PMID: 38446516 DOI: 10.12968/bjon.2024.33.5.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Richard Griffith, Senior Lecturer in Health Law at Swansea University, considers the notion of residual liberty and the need for further authorisation when a detained patient is given treatment for a physical disorder under restraint.
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18
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Dalton EM, Raymond K, Kovacs B, Vespe K, Kaufmann V, Lasoski M, Gunnison C, Beauchamps J, Kane E, Andrade G. Reducing Physical Restraint Use in the Medical Behavioral Unit. Pediatrics 2024; 153:e2023062747. [PMID: 38415305 PMCID: PMC10904888 DOI: 10.1542/peds.2023-062747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 02/29/2024] Open
Abstract
OBJECTIVES Children with behavioral health conditions often experience agitation when admitted to children's hospitals. Physical restraint should be used only as a last resort for patient agitation because it endangers the physical and psychological safety of patients and employees. At the medical behavioral unit (MBU) in our children's hospital, we aimed to decrease the weekly rate of physical restraint events per 100 MBU patient-days, independent of patient race, ethnicity, or language, from a baseline mean of 14.0 to <10 within 12 months. METHODS Using quality improvement methodology, a multidisciplinary team designed, tested, and implemented interventions including a series of daily deescalation huddles led by a charge behavioral health clinician that facilitated individualized planning for MBU patients with the highest behavioral acuity. We tracked the weekly number of physical restraint events per 100 MBU patient-days as a primary outcome measure, weekly physical restraint event duration as a secondary outcome measure, and MBU employee injuries as a balancing measure. RESULTS Our cohort included 527 consecutive patients hospitalized in the MBU between January 2021 and January 2023. Our 2021 baseline mean of 14.0 weekly physical restraint events per 100 MBU patient-days decreased to 10.0 during our 2022 intervention period from January through July and 4.1 in August, which was sustained through December. Weekly physical restraint event duration also decreased from 112 to 67 minutes without a change in employee injuries. CONCLUSIONS Multidisciplinary huddles that facilitated daily deescalation planning safely reduced the frequency and duration of physical restraint events in the MBU.
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Affiliation(s)
- Evan M. Dalton
- Department of Pediatrics, Baylor College of Medicine, Texas Children’s Hospital, Houston, Texas
| | | | | | - Kristin Vespe
- Child and Adolescent Psychiatry and Behavioral Sciences
| | | | | | | | | | - Emily Kane
- Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
- University of Pennsylvania, Philadelphia, Pennsylvania
| | - Gabriela Andrade
- Child and Adolescent Psychiatry and Behavioral Sciences
- University of Pennsylvania, Philadelphia, Pennsylvania
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19
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O'Donoghue J, Young M. Impact of a high observation ward on seclusion and restraint episodes. Ir J Psychol Med 2024; 41:159-160. [PMID: 36081189 DOI: 10.1017/ipm.2022.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- J O'Donoghue
- Basic Specialist Training with University College Cork Deanery, Cork, Ireland
| | - M Young
- Kerry Mental Health Services, Tralee, Kerry, Ireland
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20
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Lalrinawma TSK, Sangma JT, Renthlei Z, Trivedi AK. Restraint stress-induced effects on learning, memory, cognition, and expression of transcripts in different brain regions of mice. Mol Biol Rep 2024; 51:278. [PMID: 38319482 DOI: 10.1007/s11033-024-09224-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/08/2024] [Indexed: 02/07/2024]
Abstract
BACKGROUND Stress is one of the prevalent factors influencing cognition. Several studies examined the effect of mild or chronic stress on cognition. However, most of these studies are limited to a few behavioral tests or the expression of selected RNA/proteins markers in a selected brain region. METHODS This study examined the effect of restraint stress on learning, memory, cognition, and expression of transcripts in key learning centers. Male mice were divided into three groups (n = 6/group)-control group, stress group (adult stressed group; S), and F1 group (parental stressed group). Stress group mice were subjected to physical restraint stress for 2 h before light offset for 2 weeks. The F1 group comprised adult male mice born of stressed parents. All animals were subjected to different tests and were sacrificed at the end. Transcription levels of Brain-Derived Neurotrophic Factor (Bdnf), Tyrosine kinase (TrkB), Growth Associated Protein 43 (Gap-43), Neurogranin (Ng), cAMP Response Element-Binding Protein (Creb), Glycogen synthase kinase-3β (Gsk3β), Interleukine-1 (IL-1) and Tumour necrosis factor-α (Tnf-α) were studied. RESULTS Results show that both adult and parental stress negatively affect learning, memory and cognition, as reflected by taking longer time to achieve the task or showing reduced exploratory behavior. Expression of Bdnf, TrkB, Gsk3β and Ng was downregulated, while IL-1 and Tnf-α were upregulated in the brain's cortex, thalamus, and hippocampus region of stressed mice. These effects seem to be relatively less severe in the offspring of stressed parents. CONCLUSIONS The findings suggest that physical restraint stress can alter learning, memory, cognition, and expression of transcripts in key learning centers of brain.
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Affiliation(s)
| | - James T Sangma
- Department of Zoology, Mizoram University, Aizawl, Mizoram, 796004, India
| | | | - Amit K Trivedi
- Department of Zoology, Mizoram University, Aizawl, Mizoram, 796004, India.
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21
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Moell A, Rozental A, Buchmayer S, Kaltiala R, Långström N. Effects of stricter legislation on coercive measures in child and adolescent psychiatric care: a qualitative interview study with staff. BMC Psychiatry 2024; 24:102. [PMID: 38317134 PMCID: PMC10845720 DOI: 10.1186/s12888-024-05553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 01/23/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Legislators often want to positively affect psychiatric inpatient care and reduce coercion by a stricter judicial regulation. However, staff experiences and comprehension of such legal changes are largely unknown, yet essential in obtaining the intended outcomes. We examined staff understanding and implementation of a July 1, 2020 legal change in Sweden regarding the use of coercive measures (e.g., restraint, seclusion, and forced medication) in child and adolescent psychiatric inpatient care. METHODS During 2021, semi-structured interviews were conducted with nine child and adolescent psychiatric inpatient staff (nurses, senior consultants, and head of units). Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We used an implementation outcomes framework to relate data to a wider implementation science context. RESULTS The legislative change was viewed as both positive and negative by participating staff. They reported mixed levels of preparedness for the legislative change, with substantial challenges during the immediate introduction, including insufficient preparations and lack of clear guidelines. A knowledge hierarchy was evident, affecting various professional roles differently. While the law was positively viewed for its child-centred approach, we found notable distrust in legislators' understanding of the clinical reality, leading to practical difficulties in implementation. Care practices after the legal change varied, with some participants reporting little change in the use of coercive measures, while others noted a shift towards more seclusion and sedative medication usage. The work environment for consultants was described as more challenging due to increased bureaucratic procedures and a heightened pressure for accuracy. CONCLUSIONS The study highlights the complexities and challenges in implementing legislative changes in psychiatric care, where stricter legislation does not necessarily entail reduced use of coercion.
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Affiliation(s)
- Astrid Moell
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Alexander Rozental
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Susanne Buchmayer
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Riittakerttu Kaltiala
- Faculty of Medicine and Health Technology, and Tampere University Hospital, Department of Adolescent Psychiatry, Tampere University, Tampere, Finland
| | - Niklas Långström
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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22
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Chang-Sing E, Smith CM, Gagliardi JP, Cramer LD, Robinson L, Shah D, Brinker M, Jivalagian P, Hu Y, Turner NA, Wong AH. Racial and Ethnic Disparities in Patient Restraint in Emergency Departments by Police Transport Status. JAMA Netw Open 2024; 7:e240098. [PMID: 38381433 PMCID: PMC10882414 DOI: 10.1001/jamanetworkopen.2024.0098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 01/03/2024] [Indexed: 02/22/2024] Open
Abstract
Importance Black patients are more likely than White patients to be restrained during behavioral crises in emergency departments (EDs). Although the perils of policing mental health for Black individuals are recognized, it is unclear whether or to what extent police transport mediates the association between Black race and use of physical restraint in EDs. Objective To evaluate the degree to which police transport mediates the association between Black race and use of physical restraint in EDs. Design, Setting, and Participants This retrospective, cross-sectional study used electronic health record data from ED visits by adults (aged ≥18 years) to 3 hospitals in the southeastern US and 10 in the northeastern US between January 1, 2015, and December 31, 2022. Data were analyzed from September 1, 2022, to May 30, 2023. Exposures Race, ethnicity, and police transport to the hospital. Main Outcomes and Measures The primary outcome variable was the presence of an order for restraints during an ED visit. Results A total of 4 263 437 ED visits by 1 257 339 patients (55.5% of visits by female and 44.5% by male patients; 26.1% by patients 65 years or older) were included in the study. Black patients accounted for 27.5% of visits; Hispanic patients, 17.6%; White patients, 50.3%; and other or unknown race or ethnicity, 4.6%. In models adjusted for age, sex, site, previous behavioral or psychiatric history, and visit diagnoses, Black patients were at increased odds of experiencing restraint compared with White patients (adjusted odds ratio [AOR], 1.33 [95% CI, 1.28-1.37]). Within the mediation analysis, Black patients had higher odds of being brought to the hospital by police compared with all other patients (AOR, 1.38 [95% CI, 1.34-1.42]). Patients brought to the ED under police transport had increased odds of experiencing restraint compared with all other modes of transport (AOR, 5.51 [95% CI, 5.21-5.82]). The estimated proportion of use of restraints for Black patients mediated by police transport was 10.70% (95% CI, 9.26%-12.53%). Conclusions and Relevance In this cross-sectional study of ED visits across 13 hospitals, police transport may have mediated the association between Black race and use of physical restraint. These findings suggest a need to further explore the mechanisms by which transport to emergency care may influence disparate restrictive interventions for patients experiencing behavioral emergencies.
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Affiliation(s)
| | - Colin M. Smith
- Hubert-Yeargan Center for Global Health, Duke University, Durham, North Carolina
| | - Jane P. Gagliardi
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Laura D. Cramer
- Yale National Clinician Scholars Program, New Haven, Connecticut
| | - Leah Robinson
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Dhruvil Shah
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | | | - Patelle Jivalagian
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yue Hu
- Yale School of Public Health, New Haven, Connecticut
| | - Nicholas A. Turner
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Ambrose H. Wong
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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23
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Chen Y, Zhou X, Chu B, Xie Q, Liu Z, Luo D, Zhang J. Restraint Stress, Foot Shock and Corticosterone Differentially Alter Autophagy in the Rat Hippocampus, Basolateral Amygdala and Prefrontal Cortex. Neurochem Res 2024; 49:492-506. [PMID: 37955816 DOI: 10.1007/s11064-023-04048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023]
Abstract
Autophagy is a conserved lysosomal degradation process that has recently been found to be associated with stress-related psychological diseases. However, previous studies have yielded inconsistent results regarding the effects of various stress patterns on autophagy in different brain regions. This discrepancy may arise from differences in autophagy flux across nuclei, the type of stress experienced, and the timing of autophagy assessment after stress exposure. In this study, we assessed autophagy flux in the rat hippocampus (HPC), medial prefrontal cortex (mPFC), and basal lateral amygdala (BLA) by quantifying protein levels of p-ULK1, LC3-I, LC3-II, and p62 via Western blot analysis at 15 min, 30 min, and 60 min following various stress paradigms: restraint stress, foot shock, single corticosterone injection, and chronic corticosterone treatment. We found that: (1) hippocampal autophagy decreased within 1 h of restraint stress, foot shock, and corticosterone injection, except for a transient increase at 30 min after restraint stress; (2) autophagy increased 1 h after restraint stress and corticosterone injection but decreased 1 h after foot shock in mPFC; (3) In BLA, autophagy increased 1 h after foot shock and corticosterone injection but decreased 1 h after restraint stress; (4) Chronic corticosterone increased autophagy in mPFC and BLA but had no effects in HPC. These findings suggest that stress regulates autophagy in a brain region- and stressor-specific manner within 1 h after stress exposure, which may contribute to the development of stress-related psychological disorders.
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Affiliation(s)
- Yanmei Chen
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China.
| | - Xiaotao Zhou
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China
- Clinical Research Institute, Nanhua University Affiliated Nanhua Hospital, Hengyang, 421001, Hunan, People's Republic of China
| | - Boling Chu
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China
| | - Qunqun Xie
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China
| | - Zhenkun Liu
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China
| | - Di Luo
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China
| | - Jichuan Zhang
- Department of Basic Medicine, Medical School, Kunming University of Science and Technology, # 727 Jinmingnanlu Street, Kunming, 650550, Yunnan, People's Republic of China.
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24
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Wolfe C, McCoin N. Management of the Agitated Patient. Emerg Med Clin North Am 2024; 42:13-29. [PMID: 37977745 DOI: 10.1016/j.emc.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
The acutely agitated patient should be managed in a step-wise fashion, beginning with non-coercive de-escalation strategies and moving on to pharmacologic interventions and physical restraints as necessary. Face-to-face examination, monitoring, and documentation by the physician are essential. The emergency physician should be familiar with multiple pharmaceutical options, tailored to the individual patient. Use of ketamine, benzodiazepines and antipsychotics should be considered. Patient autonomy, safety, and medical well-being are paramount.
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Affiliation(s)
- Carmen Wolfe
- Department of Emergency Medicine, Tristar Skyline Medical Center, 3443 Dickerson Pike, Suite 230, Nashville, TN 37207, USA.
| | - Nicole McCoin
- Department of Emergency Medicine, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
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25
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Kong EH, Kim S, Kim M, Lee K, Choi H. Nursing students' experiences regarding physical restraint use in long-term care facilities: A qualitative descriptive study. Nurse Educ Today 2024; 133:106086. [PMID: 38154216 DOI: 10.1016/j.nedt.2023.106086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 11/27/2023] [Accepted: 12/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Despite many harmful effects, physical restraints are still used in long-term care facilities. Most existing studies have focused on staff. Nursing students observe staff's use of restraints during gerontological nursing practicums, but there are few studies on nursing students' experiences regarding restraint use in long-term care settings. OBJECTIVE This study aimed to explore nursing students' experiences with physical restraint use in order to enhance nursing education and improve care quality in long-term care facilities. METHODS Using convenience sampling method, three nursing schools from three provinces were recruited. Twenty-six senior undergraduate nursing students who had taken a gerontological nursing practicum course participated in this study. A qualitative descriptive method was utilized to provide a clear account of the students' experiences. In-depth interviews were conducted using a semi-structured interview guide. Thematic analysis was used for data analysis. RESULTS Four themes were identified, which included overuse of restraints, ambivalent response to restraints, becoming accustomed to restraints, and lack of education regarding restraints. Students frequently observed the use of various restraints, which elicited both negative and positive responses, ultimately leading to their desensitization to the overuse of restraints. They expressed a lack of knowledge and educational needs regarding restraint reduction. CONCLUSION Nursing students encountered the overuse of various restraints, exhibited ambivalent responses, and became desensitized to this practice in long-term care facilities. They perceived a lack of education and educational needs regarding restraint reduction. This study adds important new knowledge to existing literature and provides important insights into restraint use in long-term care facilities. Future studies need to develop and evaluate educational programs for restraint-free and person-centered care targeting nursing students. Long-term care facilities should offer organizational support and implement continuous mandatory training to promote restraint-free care.
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Affiliation(s)
- Eun-Hi Kong
- Gachon University, College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea.
| | - Seonho Kim
- Chungbuk National University, Department of Nursing, Chungdae-ro 1, Seowon-Gu, Cheongju-si, Chungbuk 28644, Republic of Korea.
| | - Myoungsuk Kim
- Kangwon National University, College of Nursing, 1 Gangwondaehakgil, Chuncheon-Si, Gangwon-Do 24341, Republic of Korea
| | - Kayoung Lee
- Gachon University, College of Nursing, 191 Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea.
| | - Heeseung Choi
- Seoul National University, College of Nursing and Research Institute of Nursing, 103 Daehak-ro, Jongno-Gu, #512, Seoul 03080, Republic of Korea.
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Robinson AE, Driver BE, Cole JB, Miner JR, Dreyfuss AP, Strom AW, Brodt ER, Wyatt TE. Factors Associated With Physical Restraint in an Urban Emergency Department. Ann Emerg Med 2024; 83:91-99. [PMID: 37725022 DOI: 10.1016/j.annemergmed.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 08/01/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023]
Abstract
STUDY OBJECTIVE To determine what patient characteristics were associated with the application of physical restraints in our emergency department (ED). METHODS This was a retrospective analysis of encounters in the ED of an urban, Level I academic trauma center. We included ED encounters of adult patients (aged ≥18 years) during a 5-year period starting in 2017. We evaluated the independent association of restraint application during an encounter using a generalized estimating equation model. RESULTS There were 464,031 ED encounters during the time period from 162,244 unique patients, including 34,798 (7.5%) with restraint application, comprising 18,166 unique patients. Several variables were associated with an increased likelihood of restraint use during an encounter. The variable with the highest odds ratio was intoxication with drugs or alcohol (adjusted odds ratio [aOR] 8.29; 95% confidence interval (CI) 7.94 to 8.65). American Indian race was associated with increased odds of restraint application (aOR 1.42; 95% CI 1.31 to 1.54) compared to the reference value of White race. Black race (aOR 0.58; 95% CI 0.55 to 0.61) and Hispanic ethnicity (aOR 0.42; 95% CI 0.37 to 0.48) were associated with lower odds of restraint application. CONCLUSIONS Drug and alcohol intoxication were most closely associated with restraint. Encounters in which the patient was American Indian had higher odds of restraint, but this study does not replicate prior findings regarding other racial disparities in restraint.
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Affiliation(s)
- Aaron E Robinson
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Menominee Indian Tribe of Wisconsin, Keshena, WI, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA.
| | - Brian E Driver
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Jon B Cole
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - James R Miner
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Andrea P Dreyfuss
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Aida W Strom
- Department of Health Equity, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Erik R Brodt
- Department of Family Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Thomas E Wyatt
- Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA; Department of Emergency Medicine, University of Minnesota, Minneapolis, MN, USA; Loyal Shawnee Tribe and Quapaw Nation, OK, USA
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Conteh E, Alorda A, Lebowitz D, MacIntosh T. Disparities in the Use of Chemical and Physical Restraints in the Emergency Department by Race/Ethnicity. J Racial Ethn Health Disparities 2024; 11:132-136. [PMID: 36622570 DOI: 10.1007/s40615-022-01504-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Restraints are often utilized in the emergency department (ED) to prevent patients from injuring themselves or others while managing their agitation in order to deliver appropriate medical care. Chemical and physical restraints are ordered at the discretion of the medical provider and typically employed after reasonable verbal de-escalation has been attempted. While health inequities and racial bias in medicine and healthcare have been well-established, information on the differences in the selection and use of restraints by race and ethnicity are scarce. METHODS This retrospective cohort study utilized national data from HCA Healthcare ED and inpatient database with patient visits from 2016 to 2019 to evaluate the relationships between race and ethnicity and the utilization of restraints in the ED. Associations are reported using linear and logistic regression analyses. RESULTS The study population included 12,229 unique ED admissions for patients 16 and older with diagnoses of aggression or agitation who had either chemical or physical restraints used. There was no statistically significant difference when comparing Black or other race to White patients and the type of restraint used. Hispanic patients received 0.206 fewer doses of chemical restraints compared to White patients (p = 0.008, 95% C.I. [-0.359, -0.053]) and were slightly less likely to receive physical restraints compared with White patients (p = 0.044, 95% C.I. [0.467, 0.989]), but there was no difference between use of physical restraint and Black or other patients compared to White patients. CONCLUSIONS In this national sample of agitated and/or aggressive ED patients who were restrained, Hispanic patients were slightly less likely to receive physical restraints and received fewer doses of chemical restraints than White patients. There were no differences between Black or other patients compared to White patients in restraint type, number of doses of chemical restraint or time to application of either restraint type. This suggests that physicians apply the use of chemical restraints to agitated and aggressive ED patients based on factors that are not associated with race and ethnicity.
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Affiliation(s)
- Etta Conteh
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
| | - Abigail Alorda
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
- University of Central Florida/HCA Healthcare GME (Greater Orlando), HCA Florida Osceola Hospital, Orlando, USA
| | - David Lebowitz
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA
- University of Central Florida/HCA Healthcare GME (Greater Orlando), HCA Florida Osceola Hospital, Orlando, USA
| | - Tracy MacIntosh
- University of Central Florida College of Medicine, 6850 Lake Nona Blvd, Orlando, FL, 32827, USA.
- University of Central Florida/HCA Healthcare GME (Greater Orlando), HCA Florida Osceola Hospital, Orlando, USA.
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Matsumoto K, Nohara Y, Sakaguchi M, Takayama Y, Yamashita T, Soejima H, Nakashima N. Development of Machine Learning Prediction Models for Self-Extubation After Delirium Using Emergency Department Data. Stud Health Technol Inform 2024; 310:1001-1005. [PMID: 38269965 DOI: 10.3233/shti231115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Delirium is common in the emergency department, and once it develops, there is a risk of self-extubation of drains and tubes, so it is critical to predict delirium before it occurs. Machine learning was used to create two prediction models in this study: one for predicting the occurrence of delirium and one for predicting self-extubation after delirium. Each model showed high discriminative performance, indicating the possibility of selecting high-risk cases. Visualization of predictors using Shapley additive explanation (SHAP), a machine learning interpretability method, showed that the predictors of delirium were different from those of self-extubation after delirium. Data-driven decisions, rather than empirical decisions, on whether or not to use physical restraints or other actions that cause patient suffering will result in improved value in medical care.
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Affiliation(s)
- Koutarou Matsumoto
- Biostatistics Center, Kurume University, Japan
- Institute for Medical Information Research and Analysis, Saiseikai Kumamoto Hospital, Japan
| | - Yasunobu Nohara
- Institute for Medical Information Research and Analysis, Saiseikai Kumamoto Hospital, Japan
- Big Data Science and Technology, Faculty of Advanced Science and Technology, Kumamoto University, Japan
| | | | - Yohei Takayama
- Institute for Medical Information Research and Analysis, Saiseikai Kumamoto Hospital, Japan
- Department of Nursing, Saiseikai Kumamoto Hospital, Japan
| | | | - Hidehisa Soejima
- Institute for Medical Information Research and Analysis, Saiseikai Kumamoto Hospital, Japan
| | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Japan
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Cortinhal VSJ, Correia ASC, Deodato Fernandes SJ. Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review. Int J Environ Res Public Health 2024; 21:75. [PMID: 38248539 PMCID: PMC10815796 DOI: 10.3390/ijerph21010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/03/2023] [Accepted: 12/13/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE to map the existing knowledge on nursing ethical decision making in the physical restraint of hospitalised adults. (1) Background: physical restraint is a technique that conditions the free movement of the body, with risks and benefits. The prevalence of physical restraint in healthcare suffers a wide variation, considering the environment or pathology, and it raises ethical issues that hinders decision making. This article intends to analyse and discuss this problem, starting from a literature review that will provoke a grounded discussion on the ethical and legal aspects. Inclusion criteria are: studies on physical restraint (C) and ethical nursing decision making (C) in hospitalized adults (P); (2) methods: a three-step search strategy was used according to the JBI. The databases consulted were CINAHL Plus with Full Text (EBSCOhost), MEDLINE Full Text (EBSCOhost), Nursing and Allied Health Collection: Comprehensive and Cochrane Database of Systematic Reviews (by Cochrane Library, RCAAP and Google Scholar. All articles were analysed by two independent reviewers; (3) results: according to the inclusion criteria, 18 articles were included. The categories that influence ethical decision in nursing are: consequence of the decision, the context, the nature of the decision in terms of its complexity, the principles of the ethical decision in nursing, ethical issues and universal values; (4) conclusions: the findings of this review provide evidence that there is extensive knowledge regarding nursing ethical decision making in adult physical restriction, also, it is considered an ethical issue with many associated assumptions. In this article we aim to confront all these issues from a legal perspective.
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Affiliation(s)
- Vanessa Sofia Jorge Cortinhal
- Centro Hospitalar Barreiro Montijo, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Ana Sofia Castro Correia
- Centro Hospitalar de Lisboa Ocidental, EPE, Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
| | - Sérgio Joaquim Deodato Fernandes
- School of Nursing, Institute of Health Sciences, Universidade Católica Portuguesa,1649-023 Lisbon, Portugal
- Center for Interdisciplinary Research in Health (CIIS), Institute of Health Sciences, Universidade Católica Portuguesa, 1649-023 Lisboa, Portugal
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30
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Cho E, Min D. Use of physical restraints on older adults in South Korean nursing homes: a multicenter study. Sci Rep 2024; 14:394. [PMID: 38172205 PMCID: PMC10764948 DOI: 10.1038/s41598-023-50897-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 12/27/2023] [Indexed: 01/05/2024] Open
Abstract
In this study, we aimed to examine the current status of physical restraint use and ascertain factors affecting the rate of usage of physical restraints on older adults in South Korean nursing homes. For this purpose, we conducted a secondary analysis of data from 190 registered nurses employed at 62 nursing homes. Logistic regression analysis was used to identify the factors affecting the use of restraints in nursing homes. The rate of using physical restraints was 79.5%. Nursing homes were found to use 90.7% and 91.3% less restraint when the work environment was better (odds ratio [OR]: 0.093, 95% confidence interval [CI]: 0.023-0.368) and mixed (OR: 0.087, 95% CI: 0.087-0.100), respectively. Nursing homes owned by corporations were 9.796 times more likely to use physical restraints than those owned by local governments (OR: 9.796, 95% CI: 1.473-65.158). Therefore, improving nurses' work environment and introducing regulations and education that enable the entrusted doctors or nurses to make decisions regarding restraint use, monitoring, and removal, regardless of nursing home ownership type, are necessary.
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Affiliation(s)
- Eunhee Cho
- Yonsei University College of Nursing & Mo-Im Kim Nursing Research Institute, Seoul, Republic of Korea
| | - Deulle Min
- Department of Nursing, College of Medicine, Wonkwang University, 460, Iksandae-ro, Iksan, Jeonbuk, 54538, Republic of Korea.
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31
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Minguell C, Gassó AM, Martin‐Fumadó C, Gómez‐Durán EL, Arimany‐Manso J. Physical restraints in nursing homes: A qualitative study with multiple stakeholders. Nurs Open 2024; 11:e2078. [PMID: 38268245 PMCID: PMC10777331 DOI: 10.1002/nop2.2078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 09/14/2022] [Accepted: 11/30/2023] [Indexed: 01/26/2024] Open
Abstract
AIM This study aims to understand the perceptions regarding physical restraints of the elder-care professional's stakeholders. DESIGN A qualitative methodology was employed. METHODS Semi-structured interviews were conducted with a convenient sample of 19 participants, which included nursing homes' managers, nurses and physicians; law, ethics, quality or patient rights' protection experts in care and public servers with responsibilities in the field. The data were collected, recorded and verbatim transcribed. A thematic analysis approach was used to analyse the data. RESULTS Three main themes emerged: the use of restraints, organizational issues and regulation. Although professionals involved in nursing care agree that improvements have been made, they highlight the negative impact of restraints and the need for a change in culture about their use. Yet, they have concerns about the 'zero restraints' feasibility, with divergent views on the need for a stronger regulatory framework.
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Affiliation(s)
- Cristina Minguell
- Praxis Area. Barcelona's Official College of PhysiciansBarcelonaSpain
- Chair of Legal Medicine and Professional Liabity and Clinical SafetyUniversitat de BarcelonaBarcelonaSpain
| | - Aina M. Gassó
- School of MedicineUniversitat Internacional de CatalunyaBarcelonaSpain
| | - Carles Martin‐Fumadó
- Praxis Area. Barcelona's Official College of PhysiciansBarcelonaSpain
- Chair of Legal Medicine and Professional Liabity and Clinical SafetyUniversitat de BarcelonaBarcelonaSpain
| | - Esperanza L. Gómez‐Durán
- School of MedicineUniversitat Internacional de CatalunyaBarcelonaSpain
- Fundación Galatea, Clínica GalateaBarcelonaSpain
| | - Josep Arimany‐Manso
- Praxis Area. Barcelona's Official College of PhysiciansBarcelonaSpain
- Chair of Legal Medicine and Professional Liabity and Clinical SafetyUniversitat de BarcelonaBarcelonaSpain
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32
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Lefèvre-Utile J. [Restraint in child psychiatry]. Soins 2024; 69:31-33. [PMID: 38296417 DOI: 10.1016/j.soin.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.
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Affiliation(s)
- Jean Lefèvre-Utile
- Service de psychiatrie de l'enfant et de l'adolescent, hôpital Pitié-Salpêtrière, AP-HP, 47-83 boulevard de l'Hôpital, 75013 Paris, France; Équipe de recherches en éthique et épistémologie, Université Paris-Saclay, CESP, U1018, Inserm, hôpital Paul-Brousse, 16 avenue Paul-Vaillant-Couturier, 94800 Villejuif, France; Ingram School of Nursing McGill University, 680 Sherbrooke West, Suite 1800, Montréal, Canada.
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Abstract
The practice of medicine frequently involves the unconsented restriction of liberty. The reasons for unilateral liberty restrictions are typically that being confined, strapped down, or sedated are necessary to prevent the person from harming themselves or others. In this paper, we target the ethics of chemical restraints, which are medications that are used to intentionally restrict the mental states associated with the unwanted behaviors, and are typically not specifically indicated for the condition for which the patient is being treated. Specifically, we aim to identify the conditions under which chemical restraints are ethically permissible. It is wrong to assume that what is morally true of physical restraints is also true of chemical restraints. Our aim is thus to identify the conditions under which chemical restraints are permissible while distinguishing these conditions from those of the application of physical restraints.
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Affiliation(s)
| | - Michael Redinger
- Western Michigan University Homer Stryker M.D. School of Medicine
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Lombart B, Bouchart C, Annequin D, Caron A, Tourniaire B, Galinski M. [Measuring the intensity of restraint during care in children: Validation of the Pric scale]. Soins 2024; 69:20-24. [PMID: 38296415 DOI: 10.1016/j.soin.2023.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
Restraint is used relatively often during pediatric care. However, no scale has yet been validated to assess its intensity. The study presented here did this for the Procedural Restraint Intensity in Children tool in metrological terms (with some limitations). In the absence of a reference scale in this area, the reliability of this tool was studied under experimental conditions. It is nevertheless the first scale with metrological validation, measuring the intensity of physical constraint. Other work is underway to validate it in real clinical situations.
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Affiliation(s)
- Bénédicte Lombart
- Hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr Arnold-Netter, 75012 Paris, France; Laboratoire interdisciplinaire d'études du politique Hannah-Arendt, UR 7373, Université Paris-Est Créteil, 61 avenue du Général-de-Gaulle, 94010 Créteil cedex, France.
| | - Céline Bouchart
- Centre d'étude et de traitement de la douleur de l'enfant, hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Daniel Annequin
- Centre d'étude et de traitement de la douleur de l'enfant, hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Anne Caron
- Hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Barbara Tourniaire
- Centre d'étude et de traitement de la douleur de l'enfant, hôpital Armand-Trousseau, AP-HP, 26 avenue du Dr Arnold-Netter, 75012 Paris, France
| | - Michel Galinski
- Pôle Urgences adultes-Samu, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33000 Bordeaux, France; Inserm U1219-Équipe "Épidémiologie des traumatismes transport occupation", Université de Bordeaux II, 33076 Bordeaux cedex, France
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Birks D. Chemical Restraints and the Basic Liberties. AJOB Neurosci 2024; 15:22-24. [PMID: 38207186 DOI: 10.1080/21507740.2023.2292498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
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Ravaglia IC, Jasodanand V, Bhatnagar S, Grafe LA. Sex differences in body temperature and neural power spectra in response to repeated restraint stress. Stress 2024; 27:2320780. [PMID: 38414377 PMCID: PMC10989713 DOI: 10.1080/10253890.2024.2320780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
Repeated stress is associated with an increased risk of developing psychiatric illnesses such as post-traumatic stress disorder (PTSD), which is more common in women, yet the neurobiology behind this sex difference is unknown. Habituation to repeated stress is impaired in PTSD, and recent preclinical studies have shown that female rats do not habituate as fully as male rats to repeated stress, which leads to impairments in cognition and sleep. Further research should examine sex differences after repeated stress in other relevant measures, such as body temperature and neural activity. In this study, we analyzed core body temperature and EEG power spectra in adult male and female rats during restraint, as well as during sleep transitions following stress. We found that core body temperature of male rats habituated to repeated restraint more fully than female rats. Additionally, we found that females had a higher average beta band power than males on both days of restraint, indicating higher levels of arousal. Lastly, we observed that females had lower delta band power than males during sleep transitions on Day 1 of restraint, however, females demonstrated higher delta band power than males by Day 5 of restraint. This suggests that it may take females longer to initiate sleep recovery compared with males. These findings indicate that there are differences in the physiological and neural processes of males and females after repeated stress. Understanding the way that the stress response is regulated in both sexes can provide insight into individualized treatment for stress-related disorders.
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Affiliation(s)
- IC Ravaglia
- Bryn Mawr College, Department of Psychology, Bryn Mawr, PA, USA
| | - V Jasodanand
- Bryn Mawr College, Department of Psychology, Bryn Mawr, PA, USA
| | - S Bhatnagar
- Department of Anesthesiology and Critical Care, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - LA Grafe
- Bryn Mawr College, Department of Psychology, Bryn Mawr, PA, USA
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Picquet G. [Addressing the issue of seclusion and restraint in psychiatry]. Soins Psychiatr 2024; 45:33-37. [PMID: 38218621 DOI: 10.1016/j.spsy.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2024]
Abstract
In an ever-changing environment, the question of the meaning of care within a caring, ethical framework is of paramount importance. The development of a patient-centred approach relies on an understanding of the Other. Caring and empathy are the essential foundations of this approach. An attempt to analyze practices through a few notions of ethics can be proposed.
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Affiliation(s)
- Grégory Picquet
- EPSM de l'agglomération lilloise, 1 rue de Lommelet, 59871 Saint-André-lez-Lille cedex, France.
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Alostaz Z, Rose L, Mehta S, Johnston L, Dale CM. Interprofessional intensive care unit (ICU) team perspectives on physical restraint practices and minimization strategies in an adult ICU: A qualitative study of contextual influences. Nurs Crit Care 2024; 29:90-98. [PMID: 36443064 DOI: 10.1111/nicc.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/12/2022] [Accepted: 11/14/2022] [Indexed: 12/03/2022]
Abstract
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.
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Affiliation(s)
- Ziad Alostaz
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sangeeta Mehta
- Medical Surgical Intensive Care Unit, Mount Sinai Hospital, Sinai Health, Toronto, Canada
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada
| | - Linda Johnston
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Craig M Dale
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Canada
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39
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Renouf T, Lapoussin S, Peyronnin B, Toullier C, Hansotte C, Raynal PA. [Patient restraint in the emergency department: a daily challenge]. Soins 2024; 69:37-40. [PMID: 38296419 DOI: 10.1016/j.soin.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The context of the emergency department particularly exposes professionals to situations where the question of restraint arises. This article describes the indications and modalities of physical restraint. Physical restraint should be considered as a last resort, and requires systematic ethical questioning.
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Affiliation(s)
- Thomas Renouf
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Sandra Lapoussin
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Baptiste Peyronnin
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Cendrine Toullier
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Caroline Hansotte
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France
| | - Pierre-Alexis Raynal
- Service d'accueil des urgences, Hôpital Saint-Antoine, AP-HP, 184 rue du Faubourg-Saint-Antoine, 75012 Paris, France.
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40
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Pino EC, Gonzalez F, Nelson KP, Jaiprasert S, Lopez GM. Disparities in use of physical restraints at an urban, minority-serving hospital emergency department. Acad Emerg Med 2024; 31:6-17. [PMID: 37597262 DOI: 10.1111/acem.14792] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Recent reports have identified associations between patient race and ethnicity and use of physical restraint while receiving care in the emergency department (ED). However, no study has assessed this relationship in hospitals primarily treating patients of color and underserved populations. The primary objective of this study was to evaluate the association between race/ethnicity and the use of restraints in an ED population at a minority-serving, safety-net institution. METHODS For this cross-sectional study, chart review identified all adult patients presenting to the Boston Medical Center ED between January 2018 and April 2021. Generalized estimating equation logistic regression modeling was conducted to evaluate associations between race and use of restraints. RESULTS Of 348,384 ED visits (22.9% White, 46.7% Black, 23.1% Hispanic), 1852 (0.5%) had an associated physical restraint order. Multivariable models showed significant interactions (p = 0.02) between race/ethnicity, behavioral health diagnosis, and sex on the primary outcome of physical restraint. Stratified analysis revealed that among patients with no behavioral health diagnoses, Black (odds ratio [OR] 0.50, 95% confidence interval [CI] 0.34-0.72, p = 0.0003) and Hispanic (OR 0.35, 95% CI 0.20-0.63, p = 0.0004) patients had lower odds of restraint than White patients. Among female patients with a mental health and/or substance use disorder diagnosis, Black (OR 1.95, 95% CI 1.49-2.54, p < 0.0001) and Hispanic (OR 2.13, 95% CI 1.49-3.03, p < 0.0001) patients had higher odds of restraint than White patients. Similar trends were observed for Black male patients (OR 1.60, 95% CI 1.34-1.91, p < 0.0001) but not for Hispanic male patients (OR 0.96, 95% CI 0.73-1.26, p = 0.77) with behavioral health diagnoses who had similar odds of restraint to White patients. Additional factors associated with physical restraint include younger age, public or lack of insurance, and ED visits during the pandemic. CONCLUSIONS Racial disparities exist in restraint utilization at this minority-serving safety-net hospital; however, these disparities are modified by sex and by behavioral health diagnoses. The reasons for these disparities may be multifactorial and warrant further investigation.
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Affiliation(s)
- Elizabeth C Pino
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Felisha Gonzalez
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kerrie P Nelson
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sorraya Jaiprasert
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
| | - Gina M Lopez
- Department of Emergency Medicine, Boston Medical Center and Boston University School of Medicine, Boston, Massachusetts, USA
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41
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Lombart B. [Using restraint during treatment: Definitions, contexts and benchmarks]. Soins 2024; 69:10-15. [PMID: 38296413 DOI: 10.1016/j.soin.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
The clinical practice of nursing sometimes leads to physically restraining the patient while carrying out a therapeutic or diagnostic procedure. This laconic observation says little about the many questions raised by the use of restraint on a person during treatment. The questions are professional, institutional, philosophical, ethical, legal and deontological. The role of the nurse in the decision to use coercion to provide care is preponderant, and the moral dilemmas that this decision provokes are most often carried out individually by the professionals.
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Affiliation(s)
- Bénédicte Lombart
- Hôpital Saint-Antoine, AP-HP, GH Sorbonne université, 84 rue du Faubourg Saint-Antoine, 75012 Paris, France; Laboratoire interdisciplinaire d'études du politique Hannah-Arendt, UR 7373, Université Paris-Est Créteil, 61 avenue du Général-de-Gaulle 94010 Créteil cedex, France.
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42
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Souppart V, Zafrani L. [Restraint in intensive care: between patient safety and respect for autonomy]. Soins 2024; 69:51-53. [PMID: 38296422 DOI: 10.1016/j.soin.2023.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The use of physical restraint in the context of medical resuscitation is relatively frequent. Although temporary or prolonged physical restraint is justified by patient safety (possibility of self-extubation, etc.), this practice is itself a source of risk, leads to suffering on the part of the patient, and raises dilemmas and ethical questions within teams. Inherent to the working conditions and training of professionals, restraint must nevertheless be balanced and lead to the search for alternatives.
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Affiliation(s)
- Virginie Souppart
- Médecine intensive réanimation, hôpital Saint-Louis, AP-HP, 1 avenue Claude-Vellefaux, 75010 Paris, France
| | - Lara Zafrani
- Médecine intensive réanimation, hôpital Saint-Louis, AP-HP, 1 avenue Claude-Vellefaux, 75010 Paris, France.
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43
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Dumont M. [Restraint, a clinical philosophy of body-to-body combat?]. Soins 2024; 69:25-30. [PMID: 38296416 DOI: 10.1016/j.soin.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Restraint is an extremely controversial practice, symbol of crucial debates on developments in care. This is about trying to think about this painful reality where care is at its limit and carries many dangers. The ethical issues raised by restraint will thus be described, and the responses that can be provided to them.
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Affiliation(s)
- Martin Dumont
- Université Paris-Est Créteil, 61 avenue Général-de-Gaulle, 94010 Créteil cedex, France.
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44
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Perez EC, Gehm KH, Lobo VG, Olvera M, Leasure JL. Adulthood effects of developmental exercise in rats. Dev Psychobiol 2024; 66:e22444. [PMID: 38131238 DOI: 10.1002/dev.22444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 10/11/2023] [Accepted: 11/06/2023] [Indexed: 12/23/2023]
Abstract
Exercise is known to promote efficient function of stress circuitry. The developing brain is malleable and thus exercise during adolescence could potentially exert lasting beneficial effects on the stress response that would be detectable in adulthood. The current study determined whether adolescent wheel running was associated with reduced stress response in adulthood, 6 weeks after cessation of exercise. Male and female adolescent rats voluntarily ran for 6 weeks and then were sedentary for 6 weeks prior to 10 days of chronic restraint stress in adulthood. Fecal corticosterone levels were measured during stress, and escape from the restraint tube was assessed on the final day as a proxy for depressive-like behavior. Anxiety-like behavior was measured 24 h later with the elevated plus maze and locomotor behaviors with the open field. Brain and body measurements were taken immediately following behavioral testing. Developmental exercise and adulthood stress both exerted independent effects on physiological and behavioral outcomes in adulthood. Exercise history increased the odds ratio of escape from restraint stress in males, but did not influence other stress-induced behaviors. In summary, exercise early in life exerted lasting effects, but did not substantially alter the adulthood response to restraint stress.
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Affiliation(s)
- Emma C Perez
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Kevin H Gehm
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - Valeria Gaume Lobo
- Department of Biology & Biochemistry, University of Houston, Houston, Texas, USA
| | - Marcelle Olvera
- Department of Psychology, University of Houston, Houston, Texas, USA
| | - J Leigh Leasure
- Department of Psychology, University of Houston, Houston, Texas, USA
- Department of Biology & Biochemistry, University of Houston, Houston, Texas, USA
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45
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Atdjian S, Huckshorn KA. Toward the Cessation of Seclusion and Mechanical Restraint Use in Psychiatric Hospitals: A Call for Regulatory Action. Psychiatr Serv 2024; 75:64-71. [PMID: 37461820 DOI: 10.1176/appi.ps.202100538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2024]
Abstract
The use of seclusion and mechanical restraints (S-R) in psychiatric hospitals remains widespread despite the traumatizing effects and risk for lethality associated with these practices. Neither the Centers for Medicare and Medicaid Services (CMS) nor The Joint Commission (TJC) have updated their guidelines on the use of S-R since 2005. Their regulations do not include current best practices, such as the evidence-based six core strategies (6CS) or other trauma-informed approaches, despite robust data on their effectiveness in preventing violence and S-R use. The authors describe Pennsylvania State hospitals' nearly 10-year cessation of S-R use via their continuous adherence to 6CS. In contrast, the authors describe the significant decrease in S-R use during the implementation of 6CS at a public psychiatric hospital while under U.S. Department of Justice (DOJ) monitoring and the resumption of high S-R use after DOJ monitoring and adherence to 6CS ended. The authors emphasize the importance of external regulatory oversight and mandates to safely achieve and sustain the cessation of S-R use in psychiatric hospitals. Urging CMS and TJC to update their regulations, the authors offer a roadmap to more effectively mandate the reduction and eventual cessation of S-R use in psychiatric hospitals.
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Affiliation(s)
- S Atdjian
- Johns Hopkins University, Baltimore (Atdjian); Kevin Huckshorn & Associates Inc., Chapel Hill, North Carolina (Huckshorn)
| | - K A Huckshorn
- Johns Hopkins University, Baltimore (Atdjian); Kevin Huckshorn & Associates Inc., Chapel Hill, North Carolina (Huckshorn)
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46
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De Marco G, Douglas T, Forsberg L, Savulescu J. On the Relative Intrusiveness of Physical and Chemical Restraints. AJOB Neurosci 2024; 15:26-28. [PMID: 38207188 DOI: 10.1080/21507740.2023.2292499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Affiliation(s)
| | | | - Lisa Forsberg
- Oxford University
- University of Oxford Somerville College
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47
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Villemont P, Lombart B. [How do parents perceive their child's restraint during emergency care?]. Soins 2024; 69:41-47. [PMID: 38296420 DOI: 10.1016/j.soin.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Restraint during care in pediatrics is a professional practice that is beginning to be studied. However, few studies explore this phenomenon from the point of view of the parents of children who are firmly restrained during care. Guided by the caregiver's perspective, care remains a priority for them. Some perceive the violence of the situation, while others focus on the benevolence of the professionals. In all cases, this practice implies the need for professionals to support the parents and children concerned, in order to safeguard the best interests of the young patient.
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Affiliation(s)
- Pauline Villemont
- Pôle enfant, centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay-Rocquencourt, France.
| | - Bénédicte Lombart
- Hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Laboratoire interdisciplinaire d'études du politique Hannah-Arendt, UR 7373, Université Paris-Est Créteil, 61 avenue du Général-de-Gaulle, 94010 Créteil cedex, France
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48
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Wasser T, Strockbine B, Uyanwune Y, Kapoor R. Restraint and Seclusion Practices and Policies in U.S. Forensic Psychiatric Hospitals. J Am Acad Psychiatry Law 2023; 51:566-574. [PMID: 38065618 DOI: 10.29158/jaapl.230099-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Over the last 30 years, there have been significant efforts to reduce the use of restraint and seclusion in psychiatric hospitals. Although authors have previously described restraint policies and practices in general psychiatry settings across the United States, this study is the first to attempt to describe policies regarding those practices in forensic hospital settings. We review the history of restraint and seclusion use in the United States, placing it within an international context. We then describe the results of a national survey of state forensic services directors regarding restraint modalities and policies in forensic hospital facilities. Twenty-nine respondents representing 25 states completed the survey. The results indicate that physical holds are the most frequently available method of restraint and that restraint chairs are the least frequently available. Most respondents reported having a policy regulating the use of restraint in their facilities, most commonly at the institutional level.
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Affiliation(s)
- Tobias Wasser
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT.
| | - Bentley Strockbine
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Yvonne Uyanwune
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Reena Kapoor
- Dr. Wasser is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Strockbine is the Chief Medical Officer, Whiting Forensic Hospital, Middletown, CT. Dr. Uyanwune is a Psychiatry Resident, Yale School of Medicine, New Haven, CT. Dr. Kapoor is an Associate Professor of Psychiatry, Yale School of Medicine, New Haven, CT
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Kelly AM, Eburn M, Cockburn T, Senthi A. Review article: Detaining patients against their will: Can duty of care be used to justify detention and restraint in emergency departments? Emerg Med Australas 2023; 35:896-902. [PMID: 37638384 DOI: 10.1111/1742-6723.14299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
Every day in EDs, clinicians are faced with situations where they need to decide whether to detain a patient for assessment and treatment. For patients who meet the relevant criteria, provisions of mental health legislation can be used. For other patients, clinicians often rely on so-called 'duty of care'. This article briefly explores this complex area of law, including the relevant legislation, common law principles and grey areas. It also proposes an approach to decision-making in this area.
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Affiliation(s)
- Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | | | - Tina Cockburn
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Anand Senthi
- Rural Clinical School of Western Australia, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Bunbury Hospital and St John of God Midland Hospital, Perth, Western Australia, Australia
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50
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Ma D, Wang H, Zhao Y, Li Y, Zhang X, Nu E, Sun J. Physical restraints applied to people diagnosed with dementia in home care from the perceptions of family caregivers: A qualitative study in China. J Psychiatr Ment Health Nurs 2023; 30:1082-1093. [PMID: 37208843 DOI: 10.1111/jpm.12934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 03/04/2023] [Accepted: 05/02/2023] [Indexed: 05/21/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Physical restraint is widely used in the elderly at home, and cognitive impairment is an important risk factor. Family caregivers of people with dementia are the main decision makers and implementers of physical restraint at home. Most people with dementia in China receive home care, and family caregivers face enormous care and moral pressures influenced by Confucian culture. Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. There is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Many family caregivers face approach - avoidance conflict and moral dilemmas when making decisions to restrain, and they make difficult choices in these dilemmas. In China, family caregivers are influenced by many unique factors, including traditional Confucian culture, family affection, and rural home environment. Inadequate laws and policies provide the ground for abuse of physical restraints, and family caregivers rarely consider legal and policy restrictions when using physical restraints. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With limited medical resources, nurse-led dementia management is the hope to reduce physical restraints in home. Mental health nurses need to assess for the appropriateness of physical restraints associated with psychiatric symptoms in people with dementia. At both organizational and community levels, improving effective communication and relationships between professionals and family caregivers are important to address. Improvements in this context require education and time for staff to develop skills and experience which is necessary to provide family caregivers with ongoing information and psychological support within their communities. Considering Confucian culture will be of value for mental health nurses working in other countries where there are Chinese communities to better understand perceptions of family caregivers. ABSTRACT INTRODUCTION: The use of physical restraints is a common practice in home care. Family caregivers face care-related and moral pressures due to the influence of Confucian culture in China. The use of physical restraints in the Chinese cultural environment may differ from the use of such restraints in other cultures. SCIENTIFIC RATIONALE Current research on physical restraints focuses on quantitative analysis of its prevalence and reasons within the institutions. However, there is little research on how family caregivers perceive physical restraints in home care context, especially under Chinese culture. AIM To explore the perceptions of family caregivers on physical restraints in people diagnosed with dementia receiving home care. METHOD A descriptive, qualitative study of Chinese family caregivers of people diagnosed with dementia in home care. Framework method analysis was adopted using the multilevel socio-ecological model. RESULTS Beliefs about benefit lead to a dilemma for family caregivers. Cherishing family's affection encourages caregivers to reduce physical restraints, but lack of help from family members, professionals and the community forces them to restrain their loved ones. DISCUSSION Future research should explore the complex issue of culturally specific physical restraints decisions. IMPLICATIONS FOR PRACTICE Mental health nurses must receive education regarding the negative outcomes of the use of physical restraints for family members of people diagnosed with dementia. A more liberal approach to mental health and relevant legislation, which is an emerging global phenomenon that is currently in an early phase of development in China, grants human rights to people diagnosed with dementia. Effective communication and relationships between professionals and family caregivers can contribute to the establishment of a dementia-friendly community in China.
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Affiliation(s)
- Dongfei Ma
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
| | - Hong Wang
- Bethune First Hospital of Jilin University, Changchun, Jilin, China
| | - Yingnan Zhao
- The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Yijing Li
- Evidence-based Nursing Center, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xu Zhang
- Nursing Department, Peking Union Medical College Hospital, Beijing, Dongcheng, China
| | - Eradili Nu
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
| | - Jiao Sun
- Basic Nursing Department, School of Nursing, Jilin University, Changchun, Jilin, China
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