Physical restraint reduction in the acute rehabilitation setting: a quality improvement study.

A prospective, continuous quality improvement study was implemented at a hospital on two rehabilitation units: stroke and brain injury. The purpose of the study was to decrease restraint use by 25% and to maintain fall rates no greater than 10% over baseline. A multi-component restraint reduction program was implemented that focused on administrative support, education, consultation, and feedback. Monthly restraint rates and fall rates were monitored and compared to the previous year's rates. Both units reduced restraint use. Importantly, this reduction was accomplished at the same time as a decline in fall rates.     

The movement of physical restraint‐free care for the elderly in Japan and Japanese culture

Abstract For a long time in Japan, there was no legal control or guidelines in the use of physical restraints at both acute and long‐term care facilities. Keeping the elderly in bed or binding them in beds, wheel chairs or geriatric‐chairs was commonly done. This seems to be related to a chief characteristic of the Japanese.     

身体约束不良影响及减少约束的策略

本文通过对身体约束的不良影响和各国减少约束的措施进行综述,提出应营造减少约束的环境,制定并有效实施基于循证的指南,加强对约束执行人员的教育培训,通过影响其知识、态度和行为改进约束实践。     

Medicate,restrain or seclude? Strategies for dealing with violent and threatening behaviour in a Norwegian university psychiatric hospital

The aim of this study was to examine staff strategies for applying emergency procedures with patients who were violent or threatening. The study addressed those situations where verbal intervention, voluntary medication, and other interventions had been tried unsuccessfully and where staff found it necessary to apply emergency procedures in the shape of forced emergency medication (pharmacological restraint), physical restraint, and seclusion. The study was conducted in a 100-bed Norwegian university psychiatric hospital. By retrospectively examining hospital records we found there were 797 episodes of physical restraint, 384 episodes of pharmacological restraint, and 88 episodes of seclusion during a five and a half year period. The preferred emergency procedures varied significantly with patients' sex, age, and diagnoses. Physical restraint was preferred more often with male, younger, and nonpsychotic patients. Pharmacological restraint was preferred more often with female patients and older patients with a nonorganic psychotic disorder. Seclusion was preferred more often with older male patients with an organic psychotic disorder.     

Perspectives on the experience of being physically restrained: an integrative review of the qualitative literature

Publications providing information on the safe use of physical restraints, guidelines for restraint use, and journal articles on the care of mental health patients are frequently devoid of information regarding patients' perspectives on physical restraint. As physical restraint is a common procedure in many settings, the purpose of this review is to examine and summarize the qualitative literature on patients' perspectives on being physically restrained, from 1966 through to 2009. A formal integrative review of existing qualitative literature on patients' perspectives of physical restraint was conducted. Studies were critiqued, evaluated for their strength, and analysed for key themes and meanings. Twelve studies were ultimately identified and included in the review. Four themes emerged from the review, including negative psychological impact, retraumatization, perceptions of unethical practices, and the broken spirit. While little qualitative research on patients' perceptions of physical restraint exists, findings within the current literature reveal serious implications for patients and nurses alike. Additional research into physical restraint implications for the patient-nurse dyad is needed, and nurses should approach the use of physical restraint with caution and awareness of their potential psychological impact.     

ICU住院病人身体约束实施的现况调查

[目的]调查ICU住院病人身体约束的实施现况,为制定ICU身体约束实践指南提供依据。[方法]采用便利抽样法抽取国内12个省/直辖市的3055名ICU护士,采用自行编制的"临床护士对住院患者身体约束现状调查问卷"进行调查。[结果]24.3%的护士约束前不使用约束评估工具,16.0%的护士告知时未使用知情同意书,43.1%的护士实施约束后导致投诉或其他不良后果,24.9%的护士不知道具体的约束替代措施,62.5%的护士遇见被约束的病人发生过约束相关并发症,10.3%的护士实施身体约束后未进行护理记录。[结论]ICU病人身体约束评估、约束告知、约束器具使用、约束记录等存在不规范,需制定统一的身体约束标准以规范指导临床实践。     

An exploratory account of registered nurses'' experience of patient aggression in both mental health and general nursing settings

Until relatively recently, aggression and violence in nursing has been an area of little discussion (Poster & Ryan 1993). Today, concerns are rising about escalating levels of violence towards nurses (Wykes 1994, Whittington 1997). In response, this paper explores registered nurses' experiences of patient aggression encountered in the acute inpatient general and mental health settings. Critical incidents from registered nurses in both areas are examined and analyzed in relation to existing literature. The aim of the research is to ascertain if differences exist or similarities prevail. Findings reveal that the two areas have similar problems in terms of types of aggression. Verbal and 'minor' types of aggression are the most problematic. Also, the 'biomedical model' of care is evident in both settings and possibly underpins chosen approaches to aggression management. The repeated use of chemical and physical restraint is apparent. The main comparison identified between the two groups relates to nursing control over situations involving violent patients. Mental health nurses seem to consistently take control of aggressive situations whilst general nurses tend to rely more heavily upon the input of others (medical staff, mental health teams and the police) when intervening. These two nursing specialties therefore have much to learn from each other in terms of nursing experience and possible future approaches to the management of aggressive patients.     

精神科患者保护性约束中知情同意的相关问题及对策

本文分析了精神科患者保护性约束中知情同意存在的问题和原因,并对我院实践方法进行了介绍,提出在保护性约束中只有遵循患者充分知情、理解、同意的原则,才能保证知情同意的实现。     

Dilemmas facing Japanese nurses regarding the physical restraint of elderly patients

Aim: The purpose of this study was to clarify the meaning of “dilemma” regarding the use of physical restraint on elderly persons as described by nurses in general wards at community hospitals. The questions asked included: to what extent has the dilemma of nurses regarding the restraint of elderly persons in the general ward been clarified?, which factor/s compose the dilemma?, what are the psychometric properties of the factors?, and how should nurses deal with the dilemma with regard to restraining elderly persons? Methods: The participants were 1477 nurses (12 male, 1463 female, and two: no answer) at 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units). The dilemma was measured by using a questionnaire consisting of 20 items previously developed by the author. Results: An explanatory factor analysis revealed four dilemma factors among 17 items investigated. These were “execution of treatment and security”, “characteristics in nursing of elderly patients”, “a cooperative relationship”, and “priorities in nursing”. The cumulative contribution ratio was 68.3%. In respect to the dilemma where nurses are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: “execution of treatment and security”, “characteristic features in nursing”, “a cooperative relationship in nursing”, and “priorities in nursing”. Conclusions: Based on the psychometric properties, the Dilemma scale is a valid and reliable tool. The construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to communicate with comedical workers in order to reach a consensus about the elderly’s care, avoid restraining the elderly by allocating care specialists to the elderly, establish institutional policies and safety standards that establish the nurses’ responsibilities for patients’ decision‐making, and receive continuous and timely ethical education.     

住院患者身体约束方法的研究进展

本文对身体约束的分类、器械约束装置的改良、患者活动监管装置以及约束的辅助方法进行综述,以期为身体约束的合理使用提供参考,从而降低住院患者身体约束的使用率和使用时间,减少伤害的发生。     

Views of nursing staff on the use of physical restraint

A postal questionnaire survey was employed in regional secure and psychiatric intensive care units in England and Wales, in respect of mental health nurses' training in the use of physical restraint. The nurses' views were sought relating to their last experience of implementing the procedure. Whilst most nurses (n = 259, 96.3%) reported positive outcomes in so far that the incident was brought under control, the views of the aftereffects of the procedure were of concern and ambivalence. The literature suggests that service users did not necessarily hold the same positive views. A range of alternatives, which were consistent with the literature, was made by staff to improve intervention in the management of violence. Negative aspects relating to the use of physical restraint were also highlighted. They included procedural, injury, clinical and management issues. Some respondents also expressed concerns about the negative attitudes of their colleagues. The findings of this aspect of the survey highlights that the therapeutic value of physical restraint can only be achieved with appropriate monitoring and with emphasis on psychological intervention in the prevention and management of violence.     

Factors associated with the use of intrusive measures at a tertiary care facility for children and youth with mental health and developmental disabilities

This study seeks to identify some of the explanatory factors associated with the use of intrusive measures among children with mental health and developmental disabilities in psychiatric facilities. Intrusive intervention data were collected using an organizational database that was developed internally at a tertiary care facility. The sample was composed of 338 children/youth aged between 6 and 18 years (mean = 12.33, standard deviation = 2.70) admitted within a 2‐year period. Logistic regression was used to examine the relationship between chemical restraint, physical restraint and secure isolation, and programme type after controlling for demographic and other relevant client characteristics. The study found that the number of chemical restraints and secure isolations was higher for clients with developmental disabilities than for clients with mental health, whereas the number of physical restraints was lower for clients with developmental disabilities than clients with mental health issues. Demographic variables also predicted specific types of intrusive measures. The results of this study outline the differential factors associated with specific types of intrusive measures to control aggressive and self‐harm behaviours. The paper also outlines cultural change initiatives, organizational interventions, and policy implications for best practice services for children/youth in psychiatric facilities to further reduce intrusive measures.     

国外住院患者身体约束使用指征的研究进展

本文通过对国外身体约束使用指征进行综述,为制定适用于我国的身体约束使用规范提供参考,从而降低患者身体约束的使用率。     

身体约束在老年病人护理中使用的研究进展

综述了老年护理中身体约束的使用情况,使用身体约束对被约束者的影响,影响老年护理中身体约束使用的因素以及减少身体约束使用的方法。     

身体约束在老年病人护理中使用的研究进展

综述了老年护理中身体约束的使用情况，使用身体约束对被约束者的影响，影响老年护理中身体约束使用的因素以及减少身体约束使用的方法。     

Case study approach to removing physical restraint

The pathway to discarding the use of restraints on older people with a dementing illness is cluttered with misinformation. While exploring the reasons restraints are used as an intervention on an older person with a dementing illness, we find duty of care is an important aspect. This paper presents the process that occurred when an aged care facility used an education and consultation approach in an attempt to remove the need for physical and chemical restraint. This case involved the family of an older person with a dementing illness and staff of the aged care facility.     

An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings

In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five‐stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness.     

Experiencing restraint: A dialogic narrative inquiry from a service user perspective

In recent decades concerns about violence and programs for the minimization of physical restraint, amongst other restrictive practices, have proliferated within mental health policy and practice. Whilst nurses are often called upon when violence occurs within mental health care settings, they often find themselves having the conflicting roles of caring and controlling. Within such situations it is service users, who are experts by experience, who perhaps can offer more meaningful insight into being restrained and thus provide a more appropriate approach in dealing with mental distress. This paper presents the findings of a narrative study of individuals' experiences of physical restraint within the mental health care system. In total 11 mental health service users, who had experienced physical restraint, were interviewed. Frank's (2010, Letting stories breathe: a socio-narratology) guiding questions were used to undertake a dialogical narrative analysis of each story. For the purpose of this paper, four of the 11 stories are presented as these are representative of Frank's ‘quest narrative’. However, whilst studies from the service user perspective regarding restraint are scarce, findings are discussed in relation to the grand narrative of restraint. The dialogical relationship between individual stories and the dominant grand narrative implies that the former has the capacity to shape and review the latter within mental health care. Adding to the growing body of evidence of restraint from service users' perspectives could enable nurses to provide more appropriate and meaningful mental health care in times of mental distress. [238].