Alternatives to use of restraint: A path toward humanistic care

A systematic review of interventions to reduce mechanical restraint in adult mental health inpatient settings

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.

Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence and Justice in the Use of Physical Restraints

In intensive care units, patients are often restrained to ensure their safety, with physical restraints being the most commonly used method. However, physical restraints compromises the patient's freedom, health and comfort, and nurses often face moral dilemmas when deciding whether to use physical restraints. This article examines physical restraints through the four universal principles of autonomy, beneficence, non-maleficence and justice. Through these principles, the authors will critically explore whether the physical restraints of patients by nurses is ethical in practice and what moral issues exist. This paper also explores conflicts and moral dilemmas for nurses in this context. Finally, suggestions are made on changes to education and clinical practice.

Standardized training nurses's humanistic care practice ability: A cross-sectional survey in western China during COVID-19

AIM

This study aims to investigate the current status and determinants of humanistic care practice abilities among standardized training nurses in China during the post-COVID-19 era, as well as to propose management strategies.

DESIGN

A cross-sectional study.

METHODS

Deliberately chosen were 517 standardized training nursing students from a provincial-level training facility in western China.

RESULTS

The respondents had a mean ± SD age of 21.23 ± 1.34 years, and 92.0% of them voluntarily opted for the nursing profession. Almost all (99.8%) respondents had at least a college degree. The standardized training nurses scored an average of (130.31 ± 14.18) on humanistic care ability, which was significantly related to some sociodemographic variables. The average scores for the five dimensions of nursing communication ability, psychological adjustment ability, moral and legal application ability, nursing aesthetic ability, and care practice ability were 30.78, 17.61, 32.23, 18 and 31.67, respectively. All these dimensions showed positive correlations with the overall score of humanistic care practice ability.

Risk factors for coercion length at psychiatric hospitals in Israel: Relationship with staff

Background

Coercive interventions continue to be applied frequently in psychiatric care when patients are at imminent risk of harming themselves and/or others.

Aim

The purpose of this study was to demonstrate the relationship between the length of coercion and a variety of factors, including the sociodemographic background of patients, their diagnoses and the characteristics of hospital staff.

Methods

This is a one-year cross-sectional retrospective study, including records of 298 patients who underwent restraint and/or seclusion interventions in male acute, closed wards in two psychiatric hospitals in Israel.

Results

A higher proportion of academic nurses to nonacademic nurses on duty leads to a shorter coercion time (P < 0.000). The number of male staff on duty, without any relation to their level of education, also leads to the shortening of the coercion time.

Conclusion

The presence of registered, academic female nurses, male staff on duty and the administration of medication before coercive measures can reduce the length of restriction.

District nurses' experiences with involuntary treatment in dementia care at home: a qualitative descriptive study

BACKGROUND

Research shows that half of person(s) living with dementia (PLWD) receive care which they resist and/or have not given consent to, defined as involuntary treatment. District nurses play a key role in providing this care. Knowledge about how district nurses experience involuntary treatment is lacking. Therefore, the aim of this study was to describe the experiences of district nurses who used involuntary treatment for PLWD at home.

METHODS

A qualitative descriptive design using semi-structured interviews. Sixteen district nurses with experience in involuntary treatment for PLWD were recruited through purposive sampling. Data were analysed using the Qualitative Analysis Guide of Leuven.

RESULTS

District nurses' experiences with involuntary treatment were influenced by their involvement in the decision-making process. When they were involved, they considered involuntary treatment use to be appropriate care. However, at the moment that involuntary treatment use was started, district nurses were worried that its use was unjust since they wished to respect the wishes of the PLWD. Eventually, district nurses found, from a professional perspective, that involuntary treatment use was necessary, and that safety outweighed the autonomy of the PLWD. District nurses experienced dealing with this dilemma as stressful, due to conflicting values. If district nurses were not involved in the decision-making process regarding the use of involuntary treatment, family caregivers generally decided on its use. Often, district nurses perceived this request as inappropriate dementia care and they first tried to create a dialogue with the family caregivers to reach a compromise. However, in most cases, family caregivers stood by their request and the district nurse still provided involuntary treatment and found this difficult to tolerate.

CONCLUSIONS

Our results show that district nurses experience involuntary treatment use as stressful due to dealing with obverse values of safety versus autonomy. To prevent involuntary treatment use and obverse values, we need to increase their ethical awareness, communication skills, knowledge and skills with person-centred care so they can deal with situations that can evolve into involuntary treatment use in a person-centred manner.

Comprehensive Reform Urgently Needed in Hospital Shackling Policy for Incarcerated Patients in the United States

Approximately 2.2 million people are incarcerated in the United States. The carceral population is aging due to strict sentencing laws, which has increased the frequency and acuity of off-site medical care. Inpatient providers must follow departments of correction procedures when treating incarcerated patients, which often prevents adherence to standards of care and puts the health of patients at risk. Shackling is a common requirement during hospitalization and is associated with increased risk for complications. Current state and federal policies regarding shackling lack specifics to prevent patient harm. Incarcerated people have a constitutionally protected right to health care, but with current policy, we are not meeting this essential responsibility. Updates to policy are needed to ensure that patients receive compassionate, safe, and constitutionally mandated health care.

Effectiveness of a Home Based Training Program on Caregivers Knowledge in Managing Aggressive Behavior of Patients With Mental Illness

In India, more than 90% of the patient with chronic mental illness stayed with their family members. Approximately 77.4% of caregivers experience moderate to severe levels of aggression. The purpose of this study was to evaluate the effectiveness of caregiver-training program on knowledge in managing aggressive behavior of mentally ill at home. Research design was pre-experimental. Seventy two caregivers were recruited using purposive sampling technique. The caregivers knowledge was assessed at 3 time points with regard to training program; before, immediately (post-test 1), and after 1 month (±1 week; post-test 2). The baseline knowledge was reflective of the deficiencies existing in the management of aggression of the mentally ill by caregivers. The knowledge of caregivers regarding the management of aggressive behavior of mentally ill, increased after caregiver training program, from the pre-test score of 17.63 ± 3.3 to post-test 1 score of 23.26 ± 2.9, and slightly decreased post-test 2 score of 21.01 ± 3.3 at p < .05. Repeated measure analysis of variance (ANOVA) was done to compare the differences in knowledge score over time with Bonferroni adjustment. This home based caregiver training program helped caregivers to identify etiological factors of aggression, warning signs of aggression and use of de-escalation strategies to manage aggressive behavior of mentally ill. Training caregivers regarding aggression management will make caregiver proficient in practicing safe approach during handling of aggressive patient which will ensure the physical safety of the caregiver as well as of the patient and let the patient stay at home.

An Educational Intervention to Decrease the Number of Emergency Incidents of Restraint and Seclusion on a Behavioral Health Unit

BACKGROUND

The objective of this study was to implement an educational intervention on an inpatient, behavioral health care unit with the goal of reducing the number of crisis interventions of seclusion or restraint.

METHOD

A quasi-experimental pretest and posttest design using De-escalate Anyone, Anywhere, Anytime training was employed with a focus of an increased understanding of a range of de-escalation techniques to use instead of restraint and seclusion.

RESULTS

A convenience sample of 21 mental health employees participated in the training. The rates of restraint declined from a mean of 6 preintervention to 2 postintervention. The number of seclusions on the designated unit declined from a mean of 4.33 preintervention to a mean of 1.667 postintervention.

CONCLUSION

These data suggest that an educational intervention to increase the knowledge of direct care staff in a broad range of de-escalation techniques resulted in a reduction in the use of restraint and seclusion. Ongoing training for nursing staff may reassure them of the efficacy of alternative methods for dealing with aggressive patients. [J Contin Educ Nurs. 2022;53(2):70-76.].

Technical Tips: Restraint Use in Healthcare - What Neurodiagnostic Technologists Need to Know

In healthcare, it is not uncommon for neurodiagnostic technologists to provide care and testing for patients who are in restraints or in need of restraints. When properly used, restraints ensure patient safety and the safety of others while allowing the continuation of life saving tests and treatments. Oversight for restraint use is provided by outside agencies such as the Centers for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC). Improper use of restraints can lead to serious sanctions by both organizations and can negatively impact patients, leaving them with emotional and psychological trauma. The process of restraint management such as ordering, implementing, or monitoring restrained patients is not within the scope of practice for neurodiagnostic technologists. Restraints should only be utilized as a last resort for the safety of the patient to receive proper care. This paper seeks to inform Technologists on what does and does not constitute a restraint, and the factors that should be considered before making the decision to request use of restraints in order to perform neurodiagnostic testing.