Physical Restraint Research Articles

Prediction of resilience based on parenting and coping strategies in patients with psychosomatic disorders.

The present research was conducted aiming at predicting the resilience based on parenting and coping strategies in patients with psychosomatic disorders. The statistical population of the present research consisted of all patients suffering from psychosomatic disorders who had visited medical clinics related to Medical Sciences (University) of Arak County in 2019-20. The statistical sample includes 347 women, aged 18 to 55 years-old, who were selected by available sampling. Data collection tool included Young parenting, Moss and Billings coping strategies questionnaire and Connor and Davidson resilience questionnaire. Pearson's correlation coefficient and multiple regression analysis were used to analyze the data. The findings showed that parenting (dependency, preoccupied/untransformed self) have a negative and significant relationship with resilience. Coping strategies focused on emotion, coping focused on physical restraint or physicalization of problems have a negative and significant relationship with resilience and have a positive and significant relationship with coping strategies focused on problem-solving and coping focused on cognitive evaluation. According to the findings, it can be concluded that it is possible to pave the way for increasing resilience and preventing the development of psychosomatic disorders by creating suitable conditions during the childhood, improving parent-child relationships, and by strengthening coping strategies focused on problem-solving and coping focused on cognitive evaluation.

Advanced paramedics' restraint decision-making when managing acute behavioural disturbance (ABD) in the UK pre-hospital ambulance setting: A qualitative investigation.

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.

Virtual reality vs. tablet for procedural comfort using an identical game in children undergoing venipuncture: a randomized clinical trial.

Recent research has explored the effectiveness of interactive virtual experiences in managing pain and anxiety in children during routine medical procedures, compared to conventional care methods. However, the influence of the specific technology used as an interface, 3-dimensions (D) immersive virtual reality (VR) vs. 2D touch screens, during pediatric venipuncture, remains unexamined. This study aimed to determine if immersive VR is more effective than a tablet in reducing pain and anxiety during short procedures. An interactive game was designed by clinicians and psychologists, expert in pain theory, hypnosis, and procedural pain and anxiety relief, and was tailored for both VR and tablet use. Fifty patients were randomly assigned to either the Tablet or VR group. The primary outcome measures were pain and anxiety levels during the procedure. Secondary outcome measures included the need for physical restraint, duration of the procedure, enjoyment levels, and satisfaction ratings from both parents and nurses. Participants, in both groups, had low levels of pain and anxiety. Physical restraint was infrequently used, procedures were brief, and high satisfaction levels were reported by patients, parents, and nurses. This study suggests that the type of technology used as a support for the game has a minimal effect on the child's experience, with both groups reporting low pain and anxiety levels, minimal physical restraint, and high enjoyment. Despite immersive VR's technological advancements, this study underscores the value of traditional tablets with well-designed interactive games in enhancing children's wellbeing during medical procedures. [ClinicalTrials.gov], identifier [NCT05065307].

Perceptions of the use of restraint with children and young adults with disabilities and mental health disorders: A review of the literature

Physical and mechanical restraint are reactive procedures implemented to maintain the safety of individuals. Physical and mechanical restraint are most frequently used on children and young adults with disabilities and mental health disorders who exhibit an imminent threat of physical harm to themselves or others. However, the current body of research on the use of restraint is limited, especially when examining the synthesis of perceptions of the use of restraint. There has only been one review conducted within the past three decades examining attitudes on the use of restraint on individuals with intellectual disabilities. The current review synthesizes the body of literature by investigating the attitudes, perceptions, and experiences of those receiving and implementing physical and mechanical restraint, including caregivers, service providers, medical professionals, and children and young adults with disabilities and mental health disorders. We also examine attitudes, perceptions, and experiences of the use of restraint across time and barriers to eliminating the use of restraint. Recommendations for future research and practitioners are discussed.

A toolbox for transitioning from student to veterinarian: Setting yourself up for success and reframing failure in your first year of practice

The transition from veterinary student to private practice vet­erinarian is difficult. As a practitioner, one must put into action what was learned in veterinary school. Being a mixed large ani­mal veterinarian poses additional challenges due to the ambu­latory nature of the job. Clinical skills are important to master, and they will develop over time; but it is important to also con­sider intangible skills, such as cultivating fingertip facts, un­derstanding appropriate applications of chemical and physical restraint, honing one’s planning abilities, communicating with clients, maintaining relationships with mentors, and refram­ing failure. This presentation will highlight the experience of Dr. Dayna Locitzer as a recent graduate in mixed large animal practice and illustrate how she used these intangible skills to help with the transition from student to practitioner.

Physical restraint intervention in the intensive care unit: An observational pilot study.

Physical restraint (PR) is applied for patients' safety and to prevent the removal of inserted devices. No matter how well applied, PR causes undesired effects and discomfort to patients. Because PR-Guidelines are not yet implemented in Turkey, an observational study was performed to get baseline data on the type and number of PR-activities and on patients' complications in intensive care unit (ICU) patients. An observational pilot study was conducted in anesthesia and reanimation adult ICUs in a midsized general hospital in Turkey. Included were 31 patients and two data collection tools: a basic form (patient demographics, medical information, and complications) and a PR observation guide on nurses' PR-activities. Descriptive statistics (frequencies, percentages, and mean and standard deviation) were used for data evaluation. Most patients (61.3%) were male, and 74.2% were aged 60-79 years. Almost a third was unconscious (Glasgow Coma Scale <9) and at risk for falling. Of the total 33 activities of the Nursing Interventions Classification (NIC), 13 were never applied in 33% of patients. The most applied activity was "provide sufficient staff to assist with the safe application of physical restraining devices or manual restraints" (96.8%). Least applied were "explain inpatient and significant others the behaviors necessary for the termination of the intervention," "Provide the dependent patient with a means of summoning help" (6.5%), and "Teach family the risks and benefits of restraint reduction" (3.2%). Overall, 58.1% of patients had PR complications. For the first time, PR NIC activities were evaluated in a Turkish ICU. Findings show low performance of NIC activities and a high complication rate. The findings provide the basis to implement a PR-Guideline in Turkish ICUs to enhance patients' safety and comfort.

Stress-impaired reward pathway promotes distinct feeding behavior patterns.

Although dietary behaviors are affected by neuropsychiatric disorders, various environmental conditions can have strong effects as well. We found that mice under multiple stresses, including social isolation, intermittent high-fat diet, and physical restraint, developed feeding behavior patterns characterized by a deviated bait approach (fixated feeding). All the tested stressors affected dopamine release at the nucleus accumbens (NAcc) shell and dopamine normalization reversed the feeding defects. Moreover, inhibition of dopaminergic activity in the ventral tegmental area that projects into the NAcc shell caused similar feeding pattern aberrations. Given that the deviations were not consistently accompanied by changes in the amount consumed or metabolic factors, the alterations in feeding behaviors likely reflect perturbations to a critical stress-associated pathway in the mesolimbic dopamine system. Thus, deviations in feeding behavior patterns that reflect reward system abnormalities can be sensitive biomarkers of psychosocial and physical stress.

A Nursing Process for Shared Decision-Making for Patients with Severe Mental Illness Receiving Treatment Involving Long-Term Coercive Measures: A Modified Grounded Theory Approach.

The use of shared decision-making (SDM) has recently attracted attention for building recovery-oriented therapeutic relationships with patients with severe mental illness (SMI). The purpose of this study was to describe a nursing process for SDM for psychiatric patients with SMI being treated via long-term coercive measures, such as seclusion and physical restraint, in the "seclusion room" of a psychiatric ward. The study used a modified grounded theory approach. The participants were 17 psychiatric nurses. Data were collected via semi-structured interviews. Concepts and categories were generated from verbatim transcripts, and their relationships were illustrated using a diagram and by generating a storyline. The nursing process for SDM was based on sensing the response to triggering stimuli, and the nurse-led preventive measures compensated for the patients' lack of coping skills. Because of the patients' persistent instability in response to certain stimuli, in our process, nurses are involved in creating opportunities for self-understanding and self-selection while also taking proactive preventative measures. Patients' reactions to surrounding stimuli were evaluated by nurses, who then determined whether they (or the patient) should take the lead in terms of decision-making.

ПСИХОЛОГІЧНІ ОСОБЛИВОСТІ АДАПТАЦІЇ ВІЙСЬКОВОПОЛОНЕНИХ ДО УМОВ ПОЛОНУ

The article theoretically analyzes the psychological features of the adaptation of war prisoners to the conditions of captivity. Captivity is always a condition of forced isolation, which has a certain negative impact on the individual’s psyche, which destroys value orientations and affects the future life of a war prisoner. The degree of deformation of the consciousness of war prisoners depends on many factors, among which several main ones can be distinguished: the circumstances under which the prisoner was taken prisoner, the conditions of keeping the prisoner of war in captivity; physical restraint (handcuffs; lack of individual space; dissatisfaction of physiological needs; uncomfortable conditions of detention; humiliation, insults. Captivity carries with it certain consequences for a war prisoner, which are manifested in physiological, somatic, psychological, social changes, which are reflected in social and personal factors, which constitute the essence of the prisoner’s identity. The individual characteristics of the war prisoner, which have certain changes in his basic mental processes and phenomena, are also revealed. Key words: captivity, war prisoner, adaptation, maladaptation, mental states, phases of captivity, stages of captivity, personality, behavior.

Predictive Value of Social-cognitive Function in Physical Restraint Use in Older Patients:

Predictive Value of Social-cognitive Function in Physical Restraint Use in Older Patients:

Understanding carceral mobilities in and through lived experiences of incarceration.

Recent scholarship on carceral mobilities critiques conceptualizations of carceral spaces as fixed and stable, and movements within or around sites of confinement as linear and horizontal. According to this critique, criminological studies of imprisonment have typically embraced what Turner and Peters (2017) ['Rethinking mobility in criminology', Punishment & Society 19(1), 96-114] term a 'sedentarist ontology' by failing to consider the complexities of prisoner mobilities in the lived experiences of the carceral. We draw on qualitative interview data from the Prison Transparency Project, a multiyear study initially across four research sites in Canada focused on former prisoners' narratives of their carceral experiences, to identify and analyze the multifaceted mobilities that characterize prison life. We focus on three aspects of carceral mobilities: the use of psychotropic medications to produce docility, the coercive (im)mobilities of physical restraints and the 'prison on wheels' (i.e., prisoner transport vehicles). Using the concept of 'kinetic immobility', in which prisoners' bodies are immobilized so they can be coercively moved (or not) through space and time, we consider the degree to which the theoretical work on carceral mobilities aligns with lived experiences of incarceration, as narrated by research participants.

Dynamic neuroreceptor positron emission tomography in non-anesthetized rats using point source based motion correction: A feasibility study with [11C]ABP688

To prevent motion artifacts in small animal positron emission tomography (PET), animals are routinely scanned under anesthesia or physical restraint. Both may potentially alter metabolism and neurochemistry. This study investigates the feasibility of fully awake acquisition and subsequent absolute quantification of dynamic brain PET data via pharmacokinetic modelling in moving rats using the glutamate 5 receptor radioligand [11C]ABP688 and point source based motion correction. Five male rats underwent three dynamic [11C]ABP688 PET scans: two test-retest awake PET scans and one scan under anesthesia for comparison. Specific radioligand binding was determined via the simplified reference tissue model (reference: cerebellum) and outcome parameters BPND and R1 were evaluated in terms of stability and reproducibility. Test-retest measurements in awake animals gave reliable results with high correlations of BPND (y = 1.08 × −0.2, r = 0.99, p < 0.01) and an acceptable variability (mean over all investigated regions 15.7 ± 2.4%). Regional [11C]ABP688 BPNDs under awake and anesthetized conditions were comparable although in awake scans, absolute radioactive peak uptakes were lower and relative blood flow in terms of R1 was higher. Awake small animal PET with absolute quantification of neuroreceptor availability is technically feasible and reproducible thereby providing a suitable alternative whenever effects of anesthesia are undesirable, e.g. in sleep research.

The effect of common paralytic agents used for fluorescence imaging on redox tone and ATP levels in Caenorhabditis elegans.

One aspect of Caenorhabditis elegans that makes it a highly valuable model organism is the ease of use of in vivo genetic reporters, facilitated by its transparent cuticle and highly tractable genetics. Despite the rapid advancement of these technologies, worms must be paralyzed for most imaging applications, and few investigations have characterized the impacts of common chemical anesthetic methods on the parameters measured, in particular biochemical measurements such as cellular energetics and redox tone. Using two dynamic reporters, QUEEN-2m for relative ATP levels and reduction-oxidation sensitive GFP (roGFP) for redox tone, we assess the impact of commonly used chemical paralytics. We report that no chemical anesthetic is entirely effective at doses required for full paralysis without altering redox tone or ATP levels, and that anesthetic use alters the detected outcome of rotenone exposure on relative ATP levels and redox tone. We also assess the use of cold shock, commonly used in combination with physical restraint methods, and find that cold shock does not alter either ATP levels or redox tone. In addition to informing which paralytics are most appropriate for research in these topics, we highlight the need for tailoring the use of anesthetics to different endpoints and experimental questions. Further, we reinforce the need for developing less disruptive paralytic methods for optimal imaging of dynamic in vivo reporters.

A Multicenter randomized comparative study of dementia nursing practice skills development programs for nurses in acute care hospitals: A Comparison of person-centered care and dementia-type-specific programs

The present multicenter randomized controlled trial explored the effectiveness of a person-centered care program (intervention group) and a dementia-type-specific program (control group) for nurses in acute-care hospitals. Seven hospitals in Prefecture A were randomly allocated to two groups (an intervention group and a control group), and a study of these groups was conducted from July 2021 to January 2022. A total of 158 participants were included in the study: 58 in the control group and 100 in the intervention group. In a comparison of assessment values immediately after the course, three months later, and six months later for both the intervention and control groups, "expertise in dementia nursing," "medical expertise in dementia, " and "confidence in nursing older people with dementia" were all significantly higher than before the course. Significant improvements in the intervention group's "knowledge of dementia" and "sense of dignity" on the ethical sensitivity scale were found immediately after the course compared to baseline, three months later, and six months later and were also significantly greater than the control group in terms of the amount of change. In the control group's "unique care tailored to cognitive function and the person," there were significant improvements in the ratings immediately after the course and three and six months after the course compared to baseline, with significantly greater amounts of change than in the intervention group. The person-centered care program for nurses led to improvements in the knowledge about dementia and awareness of the dignity of ethical sensitivity. In addition, the type of dementia program had a significant influence on medical knowledge and unique care tailored to the cognitive function and the individual patient. Further outcome evaluations of physical restraint rates as a quality of care in nursing practice are needed.

PENGETAHUAN PERAWAT TENTANG PENANGANAN RESTRAIN DALAM KEGAWATDARURATAN PSIKIATRI : DESKRIPTIF KUANTITATIF SURVEY

Background: Mental health crisis is a major issue for ODGJ and can endanger others and the environment. In handling psychiatric emergencies, the expertise of nurses is very important and needed. In the process, nurses have personal traits or qualities that can influence knowledge. Objective: The purpose of this study was to find the effect of age and education on the knowledge of health center nurses on how to handle patients with psychiatric emergencies. Methods: Using a sample of 91 respondents selected by cluster sampling technique. The research method used a cross-sectional approach. Demographic survey and knowledge assessment test (The Phisical Restraint Questionare) on how to handle psychiatric emergencies in patients were used to collect data. Results: Ordinal logistic regression analysis of the model fitting data provided results in the form of an association between the variables of age and education with knowledge and the degree of nurse expertise as indicated by a decrease in the value of -2 log Like hood decreased from 73.99 (Intercept Only) to 61.52 (Final) with p=0.029 (&lt;0.05). Conclusion: The variables show that the model fits the data, meaning that the variables of age and education level together affect the level of knowledge of nurses about handling restraints in psychiatric emergency patients. Suggestion: Training programs for nurses on physical restraints need to be carried out continuously so that the quality of care provided by nurses when physically restraining psychiatric patients is getting better. Keywords: Knowledge, Restraint, Psychiatric Emergency

Fewer emergency department alarms is associated with reduced use of medications for acute agitation

Background and objectivesPatient monitoring systems provide critical information but often produce loud, frequent alarms that worsen patient agitation and stress. This may increase the use of physical and chemical restraints with implications for patient morbidity and autonomy. This study analyzes how augmenting alarm thresholds affects the proportion of alarm-free time and the frequency of medications administered to treat acute agitation. MethodsOur emergency department's patient monitoring system was modified on June 28, 2022 to increase the tachycardia alarm threshold from 130 to 150 and to remove alarm sounds for several arrhythmias, including bigeminy and premature ventricular beats. A pre-post study was performed lasting 55 days before and 55 days after this intervention. The primary outcome was change in number of daily patient alarms. The secondary outcomes were alarm-free time per day and median number of antipsychotic and benzodiazepine medications administered per day. The safety outcome was the median number of patients transferred daily to the resuscitation area. We used quantile regression to compare outcomes between the pre- and post-intervention period and linear regression to correlate alarm-free time with the number of sedating medications administered. ResultsBetween the pre- and post-intervention period, the median number of alarms per day decreased from 1332 to 845 (−37%). This was primarily driven by reduced low-priority arrhythmia alarms from 262 to 21 (−92%), while the median daily census was unchanged (33 vs 32). Median hours per day free from alarms increased from 1.0 to 2.4 (difference 1.4, 95% CI 0.8–2.1). The median number of sedating medications administered per day decreased from 14 to 10 (difference − 4, 95% CI −1 to −7) while the number of escalations in level of care to our resuscitation care area did not change significantly. Multivariable linear regression showed a 60-min increase of alarm-free time per day was associated with 0.8 (95% CI 0.1–1.4) fewer administrations of sedating medication while an additional patient on the behavioral health census was associated with 0.5 (95% CI 0.0–1.1) more administrations of sedating medication. ConclusionA reasonable change in alarm parameter settings may increase the time patients and healthcare workers spend in the emergency department without alarm noise, which in this study was associated with fewer doses of sedating medications administered.

The importance of individualised care, good communication and trust for reducing nasogastric tube feeding under physical restraint: qualitative multi-informant study.

Nasogastric tube (NGT) feeding against a patient's consent is an intervention that clinicians working in specialist mental health in-patient units may need to implement from time to time. Little research has explored clinician, patient and carer perspectives on good practice. To use qualitative data from people with lived experience (PWLE), parents/carers and clinicians, to identify components of best practice when this intervention is required. PWLE and parents/carers were recruited via BEAT UK's eating disorder charity. Clinicians were recruited via a post on The British Eating Disorders Society's research page. Semi-structured interviews were administered, transcribed and thematically analysed. Thirty-six interviews took place and overlapping themes were identified. Participants spoke in relation to three themes: first, the significance of individualised care; second, the importance of communication; third, the impact of staff relationships. Sub-themes were identified and explored. Good care evolved around positive staff relationships and individualised care planning rather than standard processes. The centrality of trust as an important mediator of outcome was identified, and this should be acknowledged in any service that delivers this intervention.

Envisioning a safety paradigm in inpatient mental health settings: Moving beyond zero-risk approaches

A zero-risk paradigm currently dominates the organization and delivery of mental health care within inpatient settings, giving rise to a proliferation of risk management strategies that are ineffective and produce harms. Drawing on Foucault's confinement and grounded in a comprehensive analysis of the extant literature, we identify three central processes that constitute this paradigm, including: risk is situated within the patient; eliminating risk is a foundational aim; and mental health professionals lead decision-making. Responding to the zero-risk paradigm, this paper proposes a novel safety paradigm comprised of four intersecting components, undertaken collectively by mental health professionals to guide practice: i) holding risk, ii) building capacity, iii) prioritizing relationships, and iv) re-envisioning environments. Foundationally underlying these commitments is direct action toward reducing coercive practices and structures, such as chemical and physical restraints, seclusion, and door locking. Mental health professionals are encouraged to challenge the zero-risk paradigm and its resultant risk management approaches, and embrace a safety paradigm to meaningfully re-orient care toward enhancing patients' safety and well-being during and following hospitalization.

Use of Electronic Health Record-Based Measures to Assess Quality of Care for Pediatric Agitation.

Acute agitation during pediatric mental health emergency department (ED) visits presents safety risks to patients and staff. We previously convened multidisciplinary stakeholders who prioritized 20 proposed quality measures for pediatric acute agitation management. Our objectives were to assess feasibility of evaluating performance on these quality measures using electronic health record (EHR) data and to examine performance variation across 3 EDs. At a children's hospital and 2 nonchildren's hospitals, we assessed feasibility of evaluating quality measures for pediatric acute agitation management using structured EHR data elements. We retrospectively evaluated measure performance during ED visits by children 5 to 17 years old who presented for a mental health condition, received medication for agitation, or received physical restraints from July 2020 to June 2021. Bivariate and multivariable regression were used to examine measure performance by patient characteristics and hospital. We identified 2785 mental health ED visits, 275 visits with medication given for agitation, and 35 visits with physical restraints. Performance was feasible to measure using EHR data for 10 measures. Nine measures varied by patient characteristics, including 4.87 times higher adjusted odds (95% confidence interval 1.28-18.54) of physical restraint use among children with versus without autism spectrum disorder. Four measures varied by hospital, with physical restraint use varying from 0.5% to 3.3% of mental health ED visits across hospitals. Quality of care for pediatric acute agitation management was feasible to evaluate using EHR-derived quality measures. Variation in performance across patient characteristics and hospitals highlights opportunities to improve care quality.

Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care

BackgroundAgitation and/or aggression affect up to 60% of persons living with dementia in long-term care (LTC). It can be treated via non-pharmacological and pharmacological interventions, but the former are underused in clinical practice. In the literature, there is currently a lack of understanding of the challenges to caring for agitation and/or aggression among persons living with dementia in LTC. This study assesses what barriers and facilitators across the spectrum of care exist for agitation and/or aggression among people with dementia in LTC across stakeholder groups.MethodsThis was a qualitative study that used semi-structured interviews among persons involved in the care and/or planning of care for people with dementia in LTC. Participants were recruited via purposive and snowball sampling, with the assistance of four owner-operator models. Interviews were guided by the Theoretical Domains Framework and transcribed and analyzed using Framework Analysis.ResultsEighteen interviews were conducted across 5 stakeholder groups. Key identified barriers were a lack of agitation and/or aggression diagnostic measures, limited training for managing agitation and/or aggression in LTC, an overuse of physical and chemical restraints, and an underuse of non-pharmacological interventions. Facilitators included using an interdisciplinary team to deliver care and having competent and trained healthcare providers to administer non-pharmacological interventions.ConclusionsThis study advances care for persons living with dementia in LTC by drawing attention to unique and systemic barriers present across local and national Canadian LTC facilities. Findings will support future implementation research endeavours to eliminate these identified barriers across the spectrum of care, thus improving care outcomes among people with dementia in LTC.