Frequency Of Physical Restraint Research Articles

Prevalence and correlates of restrictive interventions in an Irish child and adolescent psychiatric unit: a 4-year retrospective study

BackgroundThere has been a global effort to reduce the use of restrictive interventions (RIs) in healthcare settings. In order to reduce unnecessary RIs, it is essential to understand their use in mental health settings. To date, there have been few studies examining the use of RIs in child and adolescent mental health settings, with no such studies in Ireland.AimsThe purpose of this study is to examine the prevalence and frequency of physical restraints and seclusion and to identify any associated demographic and clinical characteristics.MethodsThis is a 4-year retrospective study of the use of seclusion and physical restraint in an Irish child and adolescent psychiatric inpatient unit from 2018 to 2021. Computer-based data collection sheets and patient records were retrospectively reviewed. Eating disorder and non-eating disorder samples were analysed.ResultsOf 499 hospital admissions from 2018 to 2021, 6% (n = 29) had at least one episode of seclusion and 18% (n = 88) had at least one episode of physical restraint. Age, gender and ethnicity were not significantly associated with rates of RI. Unemployment, prior hospitalization, involuntary legal status and longer length of stay were significantly associated with higher rates of RIs in the non-eating disorder group. Involuntary legal status was associated with higher rates of physical restraint in the eating disorder group. Patients with a diagnosis of eating disorder and psychosis had the highest prevalence of physical restraints and seclusions respectively.ConclusionsIdentifying youth who are at greater risk of requiring RIs may allow early and targeted intervention and prevention.

Essential oils for agitation in dementia [rELOAD]: A pragmatic, cluster-randomized, placebo-controlled, pilot feasibility trial

BackgroundClinical guidelines recommend non-pharmacological interventions as the first line of treatment for agitation in dementia. One intervention that shows some promise as a treatment for agitation is essential oils. The objective of this study was to provide preliminary evidence of the effectiveness and feasibility of using topically-administered, individualized essential oil preparations for the alleviation of agitation in persons with dementia. MethodsWe conducted a 10-week pragmatic, cluster-randomized, placebo-controlled, pilot feasibility trial to compare the effectiveness of topically-administered, individualized essential oil preparations to control (placebo) preparations. Outcomes included frequency and severity of agitation, quality of life, frequency of antipsychotic medication use and physical restraint, incidence of adverse events, and trial feasibility. Participants with dementia and clinically significant agitation were recruited from five residential aged-care facilities across regional South Australia. ResultsThirty-eight participants were randomized from five sites. Accounting for random effects, we found statistically significant differences between the intervention and control groups in Pittsburgh Agitation Scale (PAS) aberrant vocalization sub score, Cohen Mansfield Agitation Inventory (CMAI) verbally agitated sub score and CMAI total score at week 4, but not at weeks 8 (post-intervention) or 10 (follow-up). No significant time-group interactions were observed for other PAS/CMAI scores or sub scores, quality of life - Alzheimer's disease total score, or frequency of physical restraint or as-needed antipsychotic medication. No adverse events were reported in any group. ConclusionsThe study findings highlight some promising effects of topically-administered, individualized essential oil preparations for agitation in dementia, and indicate that a large multi-center, cluster-randomized controlled trial of this treatment is feasible. Trial registrationAustralian New Zealand Clinical Trial Registry [ACTRN12617001159347].

Physical restraint during inpatient treatment of adolescent anorexia nervosa: frequency, clinical correlates, and associations with outcome at five-year follow-up

BackgroundStudies of the use and effects of physical restraint in anorexia nervosa (AN) treatment are lacking. The purpose of this study was to describe the frequency of physical restraint in a specialized program for adolescents with AN, and to examine if meal-related physical restraint (forced nasogastric tube-feeding) was related to 5-year outcome.MethodThirty-eight (66% of 58) patients with AN (mean age 15.9, SD = 1.9) admitted to a regional, specialized adolescent eating disorders (ED) inpatient unit. Patient data, including restraint episodes, were obtained from hospital records, and outcome was assessed at a 5-year follow-up.ResultsA total of 201 restraint episodes occurred over 5513 days of inpatient treatment, including 109 meal-related episodes and 56 episodes to avoid self-harm. Twelve (32%) patients experienced at least one restraint episode during the admission, of which eight (21%) experienced meal-related restraint. Four patients represented 91% of all restraint episodes, experiencing 10 or more episodes during admission. Meal-related restraint was significantly associated with a higher rate of persisting ED diagnosis, but not with weight gain during admission, EDE-Q global score or BMI at follow-up.ConclusionsRestraint episodes occurred rather infrequently. A small number of patients (n = 4) accounted for a high proportion of episodes (91%). More knowledge is important to reduce the need for restraint in treatment for AN.

Factors associated with the use of physical restraint in intensive care patients.

To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. An observational and prospective study on the use of restraint in patients observed over two days, considering the variables: age and gender, personal and clinical characteristics, devices, adverse event and restraint use. The frequency was verified in three groups of patients with different conditions by applying the Chi-Squared, Likelihood Ratio or Kruskal-Wallis tests. The association of the variables was verified with the Multinomial Logistic Regression. Eighty-four (84) patients participated. Restraint was observed in 77.4% of the 84 analyzed patients, and was more frequent in the presence of sedation, agitation and invasive devices. The chance of being restrained was at least five times higher in sedation conditions, whether in weaning or daily awakening, mechanical ventilation weaning, agitation or the presence of invasive devices. Restraint use was high and was associated with female gender, sedation, agitation and invasive airway. It is emphasized and important to apply policies to reduce restraint use in intensive care.

Application of project management to reduce the effects of physical restraint for psychiatric inpatients

Objective To explore the effects of project management to reduce the rate of physical restraint for psychiatric inpatients. Methods From October 2014 to December 2015, 160 nurses was selected for the study in the hospital by whole group sampling method. Through the perfect system, processes and guide construction for physical restraint, as well as more training, implement and supervision, we observed the rate, duration and frequency of physical restraint, the achieved rate of physical restraint nursing quality and the adverse event incidences before (October to December in 2014) and after (October to December in 2015) project management. Results After the project management, the restraint rate was 53.42%, the duration of restraint (4.07±0.50) h, and the restraint's times for patients (2.35±1.25) , which were all lower than that before the intervention (P 0.05) . Conclusions Project management not only provides advanced management methods for nurse administrators, but also reduces the rate of physical restraint for psychiatric inpatients, and improves the quality of physical restraint nursing. Key words: Mental disorder; Project management; Hospitalization; Rate of physical restraint; Nursing quality

Frequency of Physical Restraint and Its Associations With Demographic and Clinical Characteristics in a Chinese Psychiatric Institution

Physical restraint (PR) is a highly controversal topic in psychiatry. Little is known about PR among psychiatric inpatients in China. This study examined the frequency of PR and its relationships with demographic and clinical characteristics among a large psychiatric institution in the Hunan Province, China. The study included a consecutively assessed sample of 160 psychiatric inpatients. Sociodemographic and clinical data including use of PR were collected from the medical records using a form designed for this study and confirmed via interview. The frequency of PR was 51.3% in the whole sample; 63.2% among female and 39.2% among male patients. In multiple logistic regression analysis PR was independently associated with male gender (p = 0.001, odds ratio [OR] = 0.2, 95% confidence interval [CI] 0.1-0.6), less outpatient treatment prior to admission (p = 0.03, OR = 0.3, 95% CI 0.1-0.9), more frequent use of mood stabilizers (p = 0.002, OR = 5.6, 95% CI 1.9-16.7), more aggressive behavior prior to admission (p = 0.002, OR = 1.1, 95% CI 1.04-1.2), and younger age (p = 0.04, OR = 0.97, 95% CI 0.93-0.99). PR is very common in clinical practice in China. Its demographic and clinical correlates are similar to findings in Western settings.

A significant association between physical restraint and the development of venous thromboembolism in psychiatric patients

Recently, the systematic review about venous thromboembolism (VTE) prophylaxis in hospitalized adult nonsurgical patients has been reported [1], bringing lively and controversial discussions. The prophylaxis of VTE is a very important subject for also hospitalized psychiatric patients. We have certified that we comply with the Principles of Ethical Publishing in the International Journal of Cardiology [2]. To elucidate the risk factors for the development of VTE in hospitalized psychiatric patients, we analyzed patients who developed VTE which was confirmed by ultrasound and/or contrast enhanced computed tomography during recent five years (from April 2007 to September 2011) in our hospital, using the inpatient medical records. We studied age, sex, and frequency of the existence of reported risk factors for VTE [3] and physical restraint in VTE patients with and without psychiatric diseases. We detected 48 VTE patients. There were 31 patients with psychiatric diseases and 17 patients without psychiatric diseases. The differences in age, sex, and frequency of the existence of reported risk factors for VTE and physical restraint in VTE patients with and without psychiatric diseases were shown in Table 1 [3]. Age of VTE patients with psychiatric diseases was significantly lower than that of VTE patients without psychiatric diseases. There were no significant differences in frequency of reported risk factors for VTE between patients with and without psychiatric diseases. The frequencyof physical restraintwas significantly higher in VTE patients with psychiatric diseases than patients without psychiatric diseases. A number of studies have suggested a significant association between increasing age and elevated incidence of VTE [3]. Risk for VTE approximately doubles with each subsequent decade. In our study, VTE patients with psychiatric diseases were significantly younger than VTE patients without psychiatric diseases, suggesting that an association between aging and the development of VTE is weaker in patients with psychiatric diseases than patients without psychiatric diseases. Present study demonstrated a significantly higher frequency of physical restraint in patients with psychiatric diseases as compared with patients without psychiatric diseases, indicating a significant association between physical restraint and the development of VTE in psychiatric patients. Virchow R proposed that thrombosis was the result of at least 1 of 3 underlying etiologic factors: vascular endothelial damage, stasis of blood flow, and hypercoagulability. According to his description, there has been interest in the development of animal models of thrombosis to mimic the human condition. Therefore, the inferior vena cava (IVC) ligationmodel and the IVC stenosis model have been developed as the mouse models of VTE [4]. Studies in the IVC ligation rats suggest that after IVC ligation a combination of stasisinduced vein wall injury and enhanced tissue factor expression in endothelial cells and leukocytes produce thrombosis, and the IVC stenosis model combined external compression with a reduction in blood flow to produce laminar thrombosis [5,6]. Physical restraint may induce external compression and a reduction in blood flow of vein, and also a stasis-induced vein wall injury and enhanced tissue factor expression in endothelial cells, resulting in thrombosis formation. Physical restraint also leads to immobility strongly associated with the development of VTE [3]. In conclusion, physical restraint is significantly associated with the development of VTE in psychiatric patients.

Restraint use among nursing home residents: cross‐sectional study and prospective cohort study

To investigate (1) the prevalence of physical restraints and psychoactive medication, (2) newly administered physical restraints, frequency of application of the devices and frequency of psychoactive medication on demand during 12-month follow-up and (3) characteristics associated with restraint use in nursing homes. High quality data on restraint use in German nursing homes are lacking so far. Such information is the basis for interventions to achieve a restraint-free care. Cross-sectional study and prospective cohort study. Thirty nursing homes with 2367 residents in Hamburg, Germany. External investigators obtained prevalence of physical restraints by direct observation on three occasions on one day, psychoactive drugs were extracted from residents' records and prospective data were documented by nurses. Residents' mean age was 86 years, 81% were female. Prevalence of residents with at least one physical restraint was 26.2% [95% confidence interval (CI) 21.3-31.1]. Centre prevalence ranged from 4.4 to 58.9%. Bedrails were most often used (in 24.5% of residents), fixed tables, belts and other restraints were rare. Prevalence of residents with at least one psychoactive drug was 52.4% (95% CI 48.7-56.1). The proportion of residents with at least one physical restraint after the first observation week of 26.3% (21.3-31.3) cumulated to 39.5% (33.3-45.7) at the end of follow-up (10.4 SD 3.3 months). The relative frequency of observation days with at least one device ranged from 4.9-64.8% between centres. No characteristic was found to explain centre differences. The frequency of physical restraints and psychoactive drugs in German nursing homes is substantial. Pronounced centre variation suggests that standard care is possible without restraints. Effective restraint minimisation approaches are urgently warranted. An evidence-based guideline may overcome centre differences towards a restraint-free nursing home care.

Process of Care in General Hospital Psychiatric Units: National Survey In Italy

To investigate the process of care in Italian public acute inpatient facilities. Each facility's head psychiatrist (in all Italian regions except Sicily) completed a structured interview concerning provision of treatment and facility rules. Twenty-three university psychiatric clinics with 399 beds (mean=17.3 beds), 16 24 h community mental health centers with 98 beds (mean=6.1 beds), and 262 general hospital psychiatric units with 3431 beds (mean=13.1 beds) were surveyed. Mean length of stay was 18.5+/-7.1 days, 37.0+/-55.3 days and 12.0+/-3.4 days, respectively. Pharmacotherapy was ubiquitous. Approximately 80% of facilities held regular clinical evaluations, supportive talks, and counselling. Dynamic focused psychotherapy was available in 29% of the facilities; 24% provided cognitive behavioural therapy; 32% family therapy; and 39% structured rehabilitative intervention. Vocational training and activities targeted at helping patient integration into their local communities were uncommon. Most facilities did not allow the possession of cutting utensils (96%), personally possessed medication (96%), or lighters (72%), and most had locked doors (75%). Fewer facilities (37%) prohibited the use of mobile phones (32%) and metal knives during meal times (37%). Frequency of physical restraint was associated with number of internal rules. Delivery of psychotherapy was associated with nurse provision. The process of psychiatric inpatient care in Italy shows considerable variability. Future clinical practice guidelines should address the currently limited provision of evidence-based psychosocial intervention in these facilities. Efforts should also be devoted to improving the effectiveness of the hospital-community mental health service interface.

Behavioral intervention to reduce physical restraint of adolescents with developmental disabilities

Physical restraint procedures sometimes are approved for implementation in human service settings for children and adults who have developmental disabilities and seriously challenging behaviors. Although use of restraint may be clinically justified to manage behavior disorders and prevent injury to self and others, procedures should be evaluated to decrease, and possibly eliminate, such methods. This study addressed the effects of restraint-reduction procedures with two adolescents who had developmental disabilities and displayed severe aggression. Clinically significant reductions in the frequency of physical restraint were achieved through a treatment package that included the behavior-specific criterion for the application of restraint and antecedent control approaches. The implementation of strategic interventions to decrease physical restraint utilization is discussed. Copyright © 2000 John Wiley & Sons, Ltd.

Client Characteristics Contributing to the Frequency of Physical Restraints in Child Residential Treatment of Males

ABSTRACT The purpose of this study was to investigate client characteristics along with related milieu variables that contribute to the vulnerability of being physically restrained in child-residential settings. The relationships between eleven client characteristics: Full Scale IQ, Verbal IQ, Performance IQ, verbal comprehension, reading level, age, height, weight, externalizing behavior, length of institutionalized time, and history of abuse, with regard to the frequency of physical restraints, were examined through the use of a one-way multi-analysis of variance, and followed up with a discriminant function analysis and individual F-tests. The experience of direct-care staff was also examined with regard to the frequency of physical restraints, through the employment of a Pearson product-moment correlation.

The Use of Physical Restraint in Patients with Cerebral Contusion

Behavioral problems resulting in the use of physical restraint is a clinical problem seen in the acute phase of recovery from cerebral contusion. However, little is known about the frequency of physical restraint, factors that might predispose to its use, the pattern of adjunctive psychotropic drugs used or the outcome for patients needing this form of management. In order to examine these issues, a retrospective study of all patients (N = 34) admitted with cerebral contusion to a neurosurgical service over a one-year period was undertaken. Physical restraint was used in twelve patients (35%) for an average length of 4.3 days. The use of physical restraint was associated with presumptive evidence of alcohol abuse or dependence but not with level of consciousness on admission. Restrained patients were frequently prescribed psychotropic drugs during hospitalization. Patients requiring physical restraint stayed in hospital nearly twice as long as those not needing restraint. Close attention to the identification and treatment of alcohol problems and their complications in this population may reduce the need for physical restraint and shorten length of hospital stay.