ABSTRACT
BACKGROUND: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway. AIMS: To examine how presumed MR preventive factors of non-medical origin may explain the differing number of MR episodes between Denmark and Norway. METHODS: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors is evident between Denmark and Norway. RESULTS: Six MR preventive factors confounded [∆exp(B)> 10%] the difference in MR use between Denmark and Norway, including staff education (- 51%), substitute staff (- 17%), acceptable work environment (- 15%), separation of acutely disturbed patients (13%), patient-staff ratio (- 11%), and the identification of the patient's crisis triggers (- 10%). CONCLUSIONS: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor was not supported by earlier research, the identification of the patient's crisis triggers; therefore, more research on the mechanisms involved is needed. CLINICAL IMPLICATIONS: None of the six MR preventive factors presents any adverse effects; therefore, units in Denmark and Norway may consider investigating the effect of implementing, the identification of the patient's crisis triggers, an increased number of staff per patient, increased staff education, a better work environment and reduced use of substitute staff in practice.
Subject(s)
Cross-Cultural Comparison , Job Satisfaction , Nurse-Patient Relations , Psychiatric Department, Hospital/organization & administration , Psychiatric Nursing/organization & administration , Restraint, Physical/psychology , Restraint, Physical/statistics & numerical data , Social Environment , Adolescent , Adult , Aged , Cross-Sectional Studies , Dangerous Behavior , Denmark , Female , Humans , Male , Middle Aged , Norway , Utilization Review , Young AdultABSTRACT
PURPOSE: To examine how potential mechanical restraint preventive factors in hospitals are associated with the frequency of mechanical restraint episodes. DESIGN AND METHODS: This study employed a retrospective association design, and linear regression was used to assess the associations. FINDINGS: Three mechanical restraint preventive factors were significantly associated with low rates of mechanical restraint use: mandatory review (exp[B] = .36, p < .01), patient involvement (exp[B] = .42, p < .01), and no crowding (exp[B] = .54, p < .01). PRACTICE IMPLICATIONS: None of the three mechanical restraint preventive factors presented any adverse effects; therefore, units should seriously consider implementing these measures.
Subject(s)
Hospitals, Psychiatric/standards , Models, Nursing , Psychiatric Nursing/standards , Restraint, Physical/standards , Adult , Denmark , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Middle Aged , Norway , Psychiatric Nursing/methods , Restraint, Physical/statistics & numerical data , Retrospective StudiesABSTRACT
PURPOSE: To identify interventions preventing mechanical restraints. DESIGN AND METHODS: Systematic review of international research papers dealing with mechanical restraint. The review combines qualitative and quantitative research in a new way, describing the quality of evidence and the effect of intervention. FINDINGS: Implementation of cognitive milieu therapy, combined interventions, and patient-centered care were the three interventions most likely to reduce the number of mechanical restraints. PRACTICE IMPLICATIONS: There is a lack of high-quality and effective intervention studies. This leaves patients and metal health professionals with uncertainty when choosing interventions in an attempt to prevent mechanical restraints.
