Experiences of restrictive interventions in psychiatric health care from the perspectives of patients and health care professionals: Meta-synthesis of qualitative evidence.

WHAT IS KNOWN ON THE SUBJECT: Following their experience, patients with physical restraints often experienced traumatic sensations. The experiences of healthcare professionals' (HCPs') are primarily concerned with moral distress or conflicts between loyalty to the treatment and oppression of the patient's freedom when implementing RIs. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Improving the competency of HCPs can help establish therapeutic relationships rooted in compassionate care and facilitate appropriate assessments to determine whether and how often RIs are necessary. Furthermore, fostering an environment that guarantees patient safety and dignity, assuring a sufficient staffing ratio, and providing opportunities to share RI experiences can help improve the quality of care and build safe environments for RIs. WHAT ARE THE IMPLICATIONS FOR PRACTICE: Effective interaction between HCPs and patients, thorough patient assessment, and compassionate patient care may improve competency of HCPs intervene RIs procedures. Creating a safe therapeutic environment, including improvements to structural environments, increasing the staff-to-patient ratio, establishing organizational policies that guarantee staff debriefing, provide emotional support, provide appropriate training programs to HCPs to their coping skills during RIs also reduce the use of RIs and improve the quality of mental health care. ABSTRACT: INTRODUCTION: Restrictive interventions (RIs) are used in psychiatric inpatient units for ensuring safety. However, few studies have comprehensively reviewed physical restraint and seclusion experiences from the perspectives of both patients and healthcare professionals' (HCPs'). This study aims to gain an in-depth understanding of the RI experiences of mental health inpatients and HCPs. METHODS: A meta-synthesis was undertaken of qualitative studies exploring the RI experiences. Five electronic databases were searched and additional manual searches were performed for studies published within the last decade. Twelve articles were included, and a thematic analysis was conducted. The Critical Appraisal Skills Program (CASP) checklist was used to assess data quality. FINDINGS: Two main subthemes were identified: 'Competency of HCPs' (three subthemes: interaction between patients and HCPs, assessment methods, and care) and 'systems' (three subthemes: environment, protocols with training, and debriefing), including both positive and negative experiences. DISCUSSION: The Competency of HCPs and the ward environment are critical factors related to patients' unmet needs. Effective interactions between HCPs and patients, thorough patient assessments, and compassionate patient care are important elements of RI implementation. CONCLUSION: An environment that guarantees safety and care with dignity, sufficient staffing ratios, and opportunities to share RI experiences may improve quality of care and create safe environments for RIs.

Adaptation and validation of the Physical Restraint-Theory of Planned Behaviour Questionnaire to the paediatric context.

OBJECTIVE: To create and test psychometrically a paediatric version of the Physical Restraint-Theory of Planned Behaviour Questionnaire to assess paediatric critical care nurses' intention to use physical restraint. DESIGN: A psychometric study. SETTING: Five medical-surgical Paeditric Intensive care Units from five hospitals in Spain. METHODS: The study took place in three phases. In phase 1, the questionnaire was adapted. In phase 2, the content validity of each item was determined, and a pilot test was conducted. In phase 3, we administered the questionnaire and determined its psychometric properties. RESULTS: The assessment of the intention to use physical restraint was extended to all critical paediatric patients, two items were eliminated from the initial questionnaire, four new items were included, and the clinical scenarios of the intention subscale were expanded from three to six. Overall content validity index for the full instrument of 0.96 out of 1. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is made up of four subscales (attitude, subjective norms (SN), perceived behavioural control (PBC), and intention) subdivided into 7 factors and 51 items. The internal consistency for the attitude subscale obtained a Cronbach's Alpha of 0.80 to 0.73, for the SN it was 0.72 to 0.89, for the PBC it was from 0.80 to 0.73 and for the intention subscale it was 0.75. CONCLUSIONS: The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire is an instrument composed of seven factors and 51 items that validly and reliably assesses the intention of paediatric nurses to apply PR in PICUs. RELEVANCE FOR CLINICAL PRACTICE: Having this instrument will help health centres move towards restraint-free care by allowing managers to assess professionals' attitudes, beliefs, and intentions around the use of PR in PICUs.

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments.

BACKGROUND: Physical restraint (PR) is used to ensure the safety of care recipients. However, this causes an ethical dilemma between the autonomy and dignity of the recipients and the provision of effective treatment by health workers. This study aimed to analyze legal and ethical situations related to the use of PR using written judgments. METHODS: This study uses a qualitative retrospective design. Qualitative content analysis was performed on South Korean written judgments. A total of 38 cases from 2015 to 2021 were categorized. The types of court decisions and ethical dilemma situations were examined according to the four principles of bioethics, and the courts' judgments were compared. RESULTS: Written judgments related to PR were classified into three types according to the appropriateness of PR use, the presence or absence of duty of care, and legal negligence. Ethical dilemmas were categorized into three situations depending on whether the four principles of bioethics were followed. The courts' decisions regarding the ethical dilemmas differed depending on the situational factors before and after the use of PR and the conflicting conditions of the ethical principles. CONCLUSIONS: Health workers should consider legal and ethical requirements when determining whether to use PR to provide the care recipient with the necessary treatment.

Exposure to patient aggression and health outcomes for forensic mental health nurses: A cross-sectional survey.

AIMS: The aims of the study were to determine the types and prevalence of forensic mental health nurse exposure to patient aggression and explore the impact of these exposures on their physical and mental health and work absences. DESIGN: Cross-sectional survey conducted January to April 2020. METHODS: All 205 nurses working in an Australian high-security inpatient forensic mental health hospital were invited to participate. An online survey included the Perception of Prevalence of Aggression Scale to measure respondent exposure to types of patient aggression, and the SF-36v2 to measure mental and physical health. Absence from work and other work and individual characteristics were also explored. RESULTS: Sixty-eight respondents completed the survey. Verbal abuse was the most experienced aggression type, followed by physical violence and observing violence, patient self-harming behaviours and sexual violence. Nurses who worked in acute units experienced significantly more exposure to overall aggression than nurses in non-acute units. Higher level of aggression was associated with number of days sick leave taken and days off due to aggression or violence. Higher level of aggression was associated with poorer mental health, and patient self-harming behaviour was associated with poorer physical health. CONCLUSIONS: Nurses in acute units experience higher levels of inpatient aggression and are therefore at increased risk of being impacted by the exposure. Findings indicate a psychological impact of exposure to frequent aggression and potential for an accumulative effect of exposure to traumatic events on nurse well-being. Nurses who are victim of, or witness, physical violence are most likely to take time off work. IMPACT: This study provides further evidence that forensic mental health nurses are frequently exposed to various forms of patient aggression. For some nurses, this exposure to patient aggression negatively impacted their mental and physical health. Employing organizations should therefore prioritize provision of formal support for nurses. No patient or public contribution.

Dispositivos anticaídas en cuidados intensivos pediátricos: descripción de una experiencia exitosa de innovación liderada por enfermería en un hospital de cuidado terciario en Colombia / Anti Falls Device in Pediatric Intensive Care: Description of a Successful Innovative Experience Led by Nursing Personnel in Tertiary Hospital Care in Colombia / Dispositivo antiqueda em terapia intensiva pediátrica: descrição de uma experiência bemsucedida de inovação liderada pela enfermagem em um hospital de cuidado terciário na Colômbia

Introducción. Las caídas son eventos adversos que ponen en riesgo la integridad de quien las sufre. A pesar de la evidencia limitada sobre su efectividad, se han implementado algunos dispositivos de limitación de movimiento restrictivos y no restrictivos para prevenir caídas en niños críticamente enfermos en cuidados intensivos. Este artículo tiene como objetivo describir el diseño de un arnés preventivo y no restrictivo de movimiento para caídas intrahospitalarias en niños denominado "canguro-anticaídas", creado por profesionales de enfermería en una unidad de cuidados intensivos cardiovasculares pediátricos de la Fundación Cardioinfantil ­ Instituto de Cardiología. Tema de reflexión. A través de un enfoque reflexivo se presenta una descripción del dispositivo, los materiales, el método de uso, el personal que lo administra, los criterios de elegibilidad, la implementación del dispositivo, el alcance y la percepción del personal y los familiares respecto a su uso. Conclusiones. La prevención de caídas en población pediátrica hospitalizada en unidades de cuidados intensivos es uno de los pilares de la seguridad del paciente. La construcción de un dispositivo anticaída aplicado a esta población es una estrategia novedosa diseñada por el personal de enfermería para responder a la mejora continua de la calidad de la atención institucional. Palabras clave: Niños; Accidentes por Caídas; Prevención de Accidentes; Profesionales de Enfermería Pediátrica; Restricción Física; Difusión de Innovaciones; Unidades de Cuidado Intensivo Pediátrico

Introduction. Falls are adverse events that risk the integrity of those who suffer from them. Despite the limited evidence of its effectiveness, some restrictive and non-restrictive movement limitation devices have been implemented to prevent falls in critically ill children in intensive care. This article aims to describe the design of a preventive and non-restrictive movement harness for intra-hospital falls in children called "kangaroo- antifall", created by nursing professionals in a pediatric cardiovascular intensive care unit at the Cardioinfantil Foundation-Cardiology Institute. Reflection topics. Through a reflective approach, a description of the device materials, method of use, personnel who administer it, eligibility criteria, implementation of the device, scope, and perception of personnel and family members regarding its use are presented. Conclusions. One pillar of patient safety is fall prevention in pediatric populations hospitalized in intensive care units. The construction of an anti-fall device applied to this population is an innovative strategy designed by nursing staff to answer the continuous quality improvement of institutional care. Keywords: Child; Accidental Falls; Accident Prevention; Pediatric Nurse Practitioners; Restraint, Physical; Diffusion of Innovation; Intensive Care Units, Pediatric

Introdução. As quedas são eventos adversos que colocam em risco a integridade de quem sofre. A pesar das evidências limitadas sobre a sua eficácia, alguns dispositivos restritivos e não restritivos de limitação de movimento foram implementados para prevenir quedas em crianças gravemente doentes em cuidados intensivos. Este manuscrito tem como objetivo descrever o desenho de um arnês preventivo e sem restrição de movimento para quedas intra-hospitalares em crianças denominado "canguru-proteção contra quedas", criado por profissionais de enfermagem de uma unidade de terapia intensiva cardiovascular pediátrica da Fundação Cardioinfantil ­ Instituto de Cardiología. Tema de reflexão. Através de uma abordagem reflexiva, são apresentadas a descrição do dispositivo, materiais, método de uso, pessoal que o administra, critérios de elegibilidade, implementação do dispositivo, abrangência e percepción do pessoal e familiares sobre seu uso. Conclusões. A prevenção de quedas em populações pediátricas internadas em unidades de cuidados intensivos é um dos pilares da segurança do paciente. A construção de um dispositivo anti-queda aplicado a esta população é uma nova estratégia desenhada pela equipe de enfermagem para responder à melhoria contínua na qualidade do atendimento institucional. Palavras-chave: Crianças; Acidentes por Quedas; Prevenção de Acidentes; Profissionais de Enfermagem Pediátrica; Restrição Física; Difusão de Inovações; Unidades de Terapia Intensiva Pediátrica

A contenção mecânica na pessoa idosa em contexto hospitalar / Mechanical restraint in the elderly in a hospital context

A contenção mecânica pode ser definida como qualquer ação ou procedimento que impede os movimentos do corpo de uma pessoa através de qualquer método que lhe esteja adjacente ou anexado e que ela não consiga controlar ou remover facilmente. É uma medida que tem como objetivo otimizar a segurança do doente e de quem o rodeia, contudo a sua utilização é por vezes indevida, causando complicações físicas e psicológicas e comprometendo a dignidade, liberdade e autonomia das pessoas a ela submetidas. Alguns fatores de risco associados a uma maior predisposição para a colocação de medidas de contenção mecânica incluem a idade avançada, alterações cognitivas, incontinência e dependência nas atividades de vida diárias, tornando a população idosa particularmente vulnerável a ser submetida a estas medidas. Estes aspetos complexificam a tomada de decisão que no caso particular dos enfermeiros, é tida como um processo de deliberação ética que envolve a manutenção da integridade física, psicológica e moral da pessoa idosa. Deste modo, definiu-se como finalidade para este projeto contribuir para a melhoria dos cuidados de enfermagem à pessoa idosa submetida a contenção mecânica em contexto hospitalar. De forma a atingir esta finalidade e os objetivos propostos foram planeadas três atividades: a prestação de cuidados de enfermagem direta a pessoais idosas com fatores de risco para a contenção mecânica; a participação na elaboração e implementação do estudo de investigação com o objetivo estruturar um plano de melhoria que promova a segurança da pessoa idosa em risco de contenção mecânica em contexto hospitalar e a capacitação dos profissionais de saúde para a tomada de decisão em relação à utilização de medidas de contenção mecânica na pessoa idosa. Este relatório visa demonstrar o percurso realizado ao longo do estágio, que consistiu num processo de aprendizagem para a aquisição e desenvolvimento de competências especializadas, no que respeita às competências de enfermeiro mestre e especialista em enfermagem médico-cirúrgica.

Physical restraint can be defined as any action or procedure that impedes the movement of a person's body through any method that is adjacent or attached to it, and that the person cannot easily control or remove. It is a measure that aims to optimize patient's safety and those around him, however its use is at times inappropriate, causing physical and psychological complications and compromising the dignity, freedom and autonomy of the people subjected to it. Some risk factors associated with a greater predisposition to the placement of physical restraint measures include advanced age, cognitive alterations, incontinence and dependence in daily activities, making the elderly population particularly vulnerable to being subjected to these measures. These aspects complicate decision-making which, in the particular case of nurses, is seen as a process of ethical deliberation that involves maintaining the physical, psychological and moral integrity of the elderly patient. Thus, the purpose of this project was defined as contributing to the improvement of nursing care for the elderly subject to physical restraint in hospital context. In order to achieve this purpose and the proposed objectives, three activities were planned: the provision of direct nursing care to elderly people with risk factors for physical restraint; participation in the preparation and implementation of the research study with the goal of structuring an improvement plan that promotes the safety of the elderly at risk of physical restraint in the hospital context and training of health professionals to make decisions regarding the use of measures of physical restraint in the elderly. This report aims to demonstrate the path taken during the internship, which consisted of a learning process for the acquisition and development of specialized skills, with regard to the skills of master nurse and specialist in medical-surgical nursing.

Factors Associated With Physical Restraints in a Psychiatric Unit in Japan: a Retrospective Study.

OBJECTIVE: To identify factors associated with the use and duration of physical restraint (PR) in a psychiatric unit in Japan. METHODS: Medical records of 1308 patients admitted first time to the psychiatric emergency unit of Showa University Northern Yokohama Hospital between 1 January 2014 and 31 December 2021 were retrospectively reviewed. Data collected included patient age, sex, outpatient treatment, living arrangements, disability pension status, diagnosis (based on ICD-10), and psychotropic medication use at admission (chlorpromazine equivalent dose, imipramine equivalent dose, diazepam equivalent dose, and number of mood stabilisers administered). Logistic regression analysis and multiple regression analysis were used to identify factors associated with the use and duration of PR, respectively. RESULTS: Of 1308 patients, 399 (30.5%) were subjected to PR and 909 (69.5%) were not. Among the 399 patients subjected to PR, 54 were excluded from the multiple regression analysis for duration of PR as they remained subject to PR on the day of discharge. The remaining 345 patients were subject to PR for a median of 10 days. PR utilisation was associated with male sex (odds ratio [OR] = 1.420), treatment at our hospital (OR = 0.260), treatment at other hospitals (OR = 0.645), F3 diagnosis (depression) [OR = 0.290], F4-9 diagnosis (OR = 0.309), and imipramine equivalent dose at admission (unit OR = 0.994). The log-transformed duration of PR was independently associated with the age group of 50 to 69 years (ß = 0.248), the age group of ≥70 years (ß = 0.274), receiving a disability pension (ß = 0.153), an F1 diagnosis (ß = -0.187), an F4-9 diagnosis (ß = -0.182), chlorpromazine equivalent dose at admission (ß = 0.0004), and number of mood stabilisers administered at admission (ß = -0.270). CONCLUSION: Identifying factors associated with the use and duration of PR may lead to reduction in the use and duration of PR.

[Nursing Students' Experiences of Observing the Use of Physical Restraints: A Qualitative Study].

PURPOSE: The purpose of this study was to understand the experiences of final-year undergraduate nursing students in observing the use of physical restraints on patients in the course of clinical practice. METHODS: Three focus group interviews were conducted with 12 Korean nursing students who could provide sufficient information about their observation of physical restraints. The collected data was analyzed through conventional content analysis. RESULTS: The data were classified into four theme clusters, and nine themes. The four theme clusters included 'recognized as an unavoidable means,' 'experienced problems with the use of physical restraints,' 'realized the importance of the nurse's role and efforts,' and 'aspire to learn about correct use of physical restraints.' While nursing students recognized the necessities and problems of using physical restraints in clinical practice, and the importance of nurses' role and effort, the results found that education related to the use of physical restraints should be more systematic within the nursing curriculum. CONCLUSION: This study highlights the necessity of educating nursing students to ensure they acquire accurate knowledge and awareness regarding the use of physical restraints, and suggests the inclusion of systematic guidelines through simulation or extracurricular activities.

Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions.

OBJECTIVE: Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. METHODS: For coercive episodes reported to the national administrative register for the period 2011-16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. RESULTS: Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. CONCLUSION: The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults.

Nurses' knowledge, attitude and practices on use of restraints at State Mental health care setting: An impact of in-service education programme.

OBJECTIVES: To evaluate the effectiveness of short-term in-service education program in improving nurse's knowledge, attitude and self-reported practices related to physical restraint use. METHODS: A quasi-experimental one group pre-post study was conducted involving nurses working at a tertiary mental health care setting, Dharwad, India. We provided 3 consecutive days of intensive restraint management education (total 6 hours-two hours per day) with a follow-up assessment after one month. The standard questionnaires on knowledge, attitude and practice regarding physical restraints were used as tools for measuring the impact of in-service education program. The program was conducted for a group of five to six nurses at a time. Teaching was done using lecture method, group discussion and demonstrations. RESULTS: Of the 52 nurses who participated in the study, 52% were male, 58.5% had a baccalaureate degree. The mean age of respondents was 33.3 years, the mean work experience was 6.7 years. The findings of the study revealed that the mean scores on the knowledge regarding physical restraints increased after the in-service education from 6.4 to 8.2 (p<0.001). The mean attitude scores improved from 18.5 to 23.1 (p<0.001). There was a significant difference in mean practice scores between pre and post-intervention phases (23.7 versus 25.4; p<0.001). There was a significant correlation between post-test knowledge, attitude and practice scores. CONCLUSIONS: The in-service education program improved nurse's knowledge, attitude and self-reported practice scores. This may lead to more effective restraints management by psychiatric nurses.

Exposure to workplace trauma for forensic mental health nurses: A scoping review.

BACKGROUND: Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role. OBJECTIVES: To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses. DESIGN: A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool. METHODS: Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence. RESULTS: Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature. CONCLUSIONS: While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

Reducing the use of physical restraints in home care: development and feasibility testing of a multicomponent program to support the implementation of a guideline.

BACKGROUND: A validated evidence-based guideline was developed to reduce physical restraint use in home care. However, the implementation of guidelines in home care is challenging. Therefore, this study aims to systematically develop and evaluate a multicomponent program for the implementation of the guideline for reducing the use of physical restraints in home care. METHODS: Intervention Mapping was used to develop a multicomponent program. This method contains six steps. Each step comprises several tasks towards the design, implementation and evaluation of an intervention; which is theory and evidence informed, as well as practical. To ensure that the multicomponent program would support the implementation of the guideline in home care, a feasibility study of 8 months was organized in one primary care district in Flanders, Belgium. A concurrent triangulation mixed methods design was used to evaluate the multicomponent program consisting of a knowledge test, focus groups and an online survey. RESULTS: The Social Cognitive Theory and the Theory of Planned Behavior are the foundations of the multicomponent program. Based on modeling, active learning, guided practice, belief selection and resistance to social pressure, eight practical applications were developed to operationalize these methods. The key components of the program are: the ambassadors for restraint-free home care (n = 15), the tutorials, the physical restraint checklist and the flyer. The results of the feasibility study show the necessity to select uniform terminology and definition for physical restraints, to involve all stakeholders from the beginning of the process, to take time for the implementation process, to select competent ambassadors and to collaborate with other home care providers. CONCLUSIONS: The multicomponent program shows promising results. Prior to future use, further research needs to focus on the last two steps of Intervention Mapping (program implementation plan and developing an evaluation plan), to guide implementation on a larger scale and to formally evaluate the effectiveness of the multicomponent program.

Validação do módulo "Strategies to end seclusion restraint/Estratégias para acabar com o isolamento e a contenção" do ToolKit QualityRights / Validation of the "Strategies to end seclusion restraint/Estratégias para acabar com o isolamento e a contenção" module of the QualityRights ToolKit

Introdução: Os transtornos mentais e uso de substâncias ilícitas representam causa importante de incapacidade em todo o mundo. O número de pessoas com transtornos mentais aumenta cada vez mais, e a carga mundial é agravada pela falta de tratamento de saúde mental. No Brasil, os serviços de saúde mental ainda são insuficientes. Como resultado dessas limitações, pessoas com transtornos mentais têm alto nível de sofrimento e incapacidade física, emocional, econômica e social, além de experiência de contenção física ou outras formas de privação de liberdade, discriminação e abuso. Diante destes desafios, a OMS desenvolveu iniciativa denominada QualityRights, que promove os direitos humanos das pessoas com deficiências psicossociais, intelectuais e cognitivas, por meio de um kit de ferramentas para avaliação dos serviços de saúde e um kit de treinamento e capacitação de profissionais de saúde e população em geral. Locais que já utilizaram o QualityRights enfatizam que constitui ferramenta importante para alcançar a mudança de atitude em linha com os padrões de direitos humanos relativos à coerção e capacidade legal em saúde mental e deficiência relacionada aos serviços. Objetivos: Adaptar culturalmente para a cultura brasileira e validar o módulo "Strategies to end seclusion restraint" do toolkit QualityRights da Organização Mundial da Saúde sobre transtornos mentais para a capacitação de profissionais de saúde no Brasil. Percurso metodológico: Trata-se de estudo metodológico, dividido em três etapas. Na primeira etapa, foi realizada tradução dos módulos, da língua original (inglês) para a língua alvo (português brasileiro). Na segunda etapa a tradução e adaptação cultural foram realizadas por um Comitê de Juízes especialistas no assunto. Na terceira etapa, foi realizada a avaliação por profissionais de saúde mental. Resultados: Compuseram a etapa de análise pelo Comitê de Juízes 07 especialistas no assunto e na etapa de análise pelos Profissionais de Saúde 07 profissionais de saúde mental. Em relação à avaliação realizada por cada especialista, a porcentagem de aprovação variou por item, sendo que os itens com maior porcentagem de aprovação tiveram 100% de aprovação e os itens com menor porcentagem de aprovação tiveram 71% de aprovação em cada. A porcentagem de aprovação total do módulo foi de 92%. Em relação à avaliação realizada por cada profissional de saúde, a porcentagem de aprovação variou por item, sendo que dois itens tiveram aprovação máxima 100% e os demais itens tiveram aprovação de 86% cada. A porcentagem de aprovação total do módulo foi de 88%. Conclusão: Com base nos resultados, considera-se que este módulo está validado e adaptado para a cultura brasileira, podendo ser utilizado para capacitação de profissionais de saúde brasileiros

Introduction: Mental disorders and the use of illegal substances represent an important cause of disability worldwide. The number of people with mental disorders is increasing, and the global burden is compounded by the lack of mental health treatment. In Brazil, mental health services are still insufficient. As a result of these limitations, people with mental disorders have a high level of physical, emotional, economic and social suffering and disability, in addition to experiencing physical restraint or other forms of deprivation of liberty, discrimination and abuse. Faced with these challenges, the WHO developed an initiative called QualityRights, which promotes the human rights of people with psychosocial, intellectual and cognitive disabilities, through a toolkit for the assessment of health services and a training and qualification kit for health professionals and general population. Sites who have used QualityRights emphasize that it is an important tool to achieve attitudinal change in line with human rights standards regarding enforcement and legal capacity in mental health and service-related disability. Objective: Culturally adapt to Brazilian culture and validate the module "Strategies to end seclusion restraint" from the World Health Organization's QualityRights toolkit on mental disorders for the training of health professionals in Brazil. Methodology: This is a methodological study, divided into three stages. In the first stage, the modules were translated from the original language (English) to the target language (Brazilian Portuguese). In the second stage, the translation and cultural adaptation were carried out by a Committee of Judges who are experts on the subject. In the third stage, the evaluation was carried out by mental health professionals. Results: The analysis stage by the Committee of Judges comprised 07 experts on the subject and the analysis stage by the Health Professionals 07 mental health professionals. Regarding the evaluation performed by each expert, the percentage of approval varied by item, with the items with the highest percentage of approval having 100% approval and the items with the lowest percentage of approval having 71% approval in each. The total pass percentage for the module was 92%. Regarding the assessment carried out by each health professional, the percentage of approval varied by item, with two items having a maximum approval of 100% and the other items having an approval of 86% each. The total pass percentage for the module was 88%. Conclusion: Based on the results, it is considered that this module is validated and adapted to the Brazilian culture, and can be used for training Brazilian health professionals

Research progress of nursing training about physical restraint / 中国实用护理杂志

To know the status of nursing training about physical restraint among nurses in the domestic and overseas. Summarized the forms, content and the appraise tools of the results of physical restraint nursing at home and abroad so as to provide reference of nursing training about the physical restraint among nurses in the domestic.

Factors influencing critical care nurses' intentions to use physical restraints adopting the theory of planned behaviour: A cross-sectional multicentre study.

BACKGROUND: Studies addressing critical care nurses' practices regarding physical restraints have focused on individual nurses' knowledge and attitudes but lack the understanding of other social influences that could affect nurses' intentions to use them. OBJECTIVE: The objective of this study was to determine critical care nurses' attitudes, subjective norms, perceived behavioural control, and intentions to use physical restraints in intubated patients and the relationship between them and sociodemographic, professional, and contextual factors using a survey approach. METHODS: A cross-sectional, multicentre study was conducted in a convenience sample of 12 intensive care units from eight hospitals in Spain (n = 354). The Physical Restraint-Theory of Planned Behaviour questionnaire and a researcher-developed survey were used to collect structural and clinical data from each unit. Multilevel model analysis was used. RESULTS: Critical care nurses showed a moderate level of intention to use physical restraints 12.52 (standard deviation = 3.81) [3-21]. More than a half (52%) agreed restraints were safe. The highest perceived barrier against physical restraint use was patient cooperation. Although nurses did not feel that others expected them to use restraints, they did not perceive high levels of disapproval of such practice. Nurses who had received previous training on restraints and who worked in units with a flexible family visitation policy, an informed consent form for restraint use, analgosedation and restraint protocols, and nurse-driven analgosedation management reported lower levels of intention to use restraints. Working in smaller units (beta -1.81; 95% confidence interval [CI]: -0.18, -3.44) and working in units with a consent form for restraint use (beta -4.82; 95% CI: -2.80, -6.85) were the variables with the highest impact on nurses' intentions to use restraints. CONCLUSIONS: Critical care nurses' intentions to use physical restraints are moderate and are influenced by intrapersonal, patient, and contextual factors. Nurses who work in units with organisational policies and alternatives to restraints demonstrated lower levels of intention to use them.

'Only ever as a last resort': Mental health nurses' experiences of restrictive practices.

Nurses play a crucial role in the implementation of restrictive practices such as seclusion and restraint. Restrictive practices have been widely recognized as harmful practices and efforts to reduce their use have been in place for several years. While some reductions have been achieved, more information and insight into the perspectives and experiences of front-line mental health nursing staff is required if further changes are to be realized. Sixty-five respondents participated in an online survey to investigate Australian mental health nurses' personal experiences and opinions regarding restrictive practices. Analysis revealed restrictive practices as a complex, contested and challenging area of practice. Analysis of data revealed five main ways that restrictive practices were framed by respondents. These were as follows: as a response to fear; to maintain safety for all; a legacy of time and place; the last resort; and, a powerful source of occupational distress. In addition, findings revealed the need to support staff involved in restrictive practices. This need could be satisfied through the implementation of procedures to address post-restrictive distress at all levels of the organization. Ensuring an optimal work environment that includes appropriate staffing, availability of supportive education and structured routine debriefing of all episodes of restrictive practice is critical in achieving further reductions in seclusion and restraint.

Physical restraint in critical care units from the experience of doctors and nursing assistants: In search of an interdisciplinary interpretation. / La contención mecánica en unidades de cuidados críticos desde la experiencia de los médicos y técnicos en cuidados auxiliares de enfermería: buscando una lectura interdisciplinar.

OBJECTIVES: The study aim was to explore the experience of doctors and nursing assistants in the management of physical restraint (PR) in critical care units. METHOD: A multicentre phenomenological study that included 14 critical care units (CCU) in Madrid (Spain). The CCU were stratified according to their use of physical restraint: "frequently used" versus "seldom used". Three focus groups were formed: the first comprised nursing assistants from CCUs that frequently used physical restraint, the second comprised nursing assistants from CCUs that seldom used physical constraint, and the final group comprised doctors from both CCU subtypes. Sampling method: purposive. DATA ANALYSIS: thematic content analysis. Data saturation was achieved. RESULTS: Four principle themes emerged: 1) concept of safety and risk (patient safety versus the safety of the professional), 2) types of restraint, 3) professional responsibilities (prescription, recording, and professional roles) and 4) "zero restraint" paradigm. The conceptualisation regarding the use of physical contentions shows differences in some of the principal themes, depending on the type of CCU, in terms of policies, use and management of physical constraint (frequently used versus seldom used). CONCLUSIONS: The real reduction in the use of physical restraint in CCU must be based on one crucial point: acceptance of the complexity of the phenomenon. The use of physical restraint observed in the different CCU is influenced by individual, group and organisational factors. These factors will determine how doctors and nursing assistants interpret safety and risk, the centre of care (patient or professional-centred care), the concept of restraint, professional responsibilities and interventions, interactions of the team and the leadership.

Factors associated with the use of physical restraint in intensive care patients / Factores asociados con la utilización de restricción mecánica en pacientes de cuidados intensivos / Fatores associados à utilização de restrição mecânica em pacientes de terapia intensiva

Abstract Objective: To verify the frequency of physical restraint in patients and the factors associated with its use in the intensive care unit. Method: 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. Results: 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. Conclusion: 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.

Resumen Objetivo: Verificar la frecuencia de restricción mecánica en los pacientes y los factores asociados con su empleo en la Unidad de Cuidados Intensivos. Método: Estudio observacional y prospectivo acerca del uso de la restricción en pacientes, observados en dos días, considerando las variables: edad y sexo, características personales y clínicas, dispositivos, evento adverso y empleo de restricción. La frecuencia fue verificada en tres grupos de pacientes con distintas condiciones, aplicándose las pruebas Chi cuadrado o Razón de Verosimilitud o Kruskal-Wallis. La asociación de las variables fue verificada con la Regresión Logística Multinomial. Resultados: Participaron 84 pacientes. La restricción fue observada en el 77,4% de los 84 pacientes analizados y fue más frecuente en la presencia de sedación, agitación y dispositivos invasivos. La probabilidad de estar restricto fue por lo menos cinco veces mayor en las condiciones de sedación, ya sea en la reducción gradual de la medicación o despertar diario, reducción gradual de la ventilación mecánica, agitación y presencia de dispositivos invasivos. Conclusión: El empleo de la restricción fue elevado y se asoció con el sexo femenino, sedación, agitación y vía aérea invasiva. Se subraya la importancia de aplicación de políticas para reducción de la restricción en cuidados intensivos.

Resumo Objetivo: Verificar a frequência de restrição mecânica nos pacientes e os fatores associados ao seu uso na Unidade de Terapia Intensiva. Método: Estudo observacional e prospectivo sobre uso da restrição em pacientes, observados em dois dias, considerando as variáveis: idade e sexo, características pessoais e clínica, dispositivos, evento adverso e uso de restrição. A frequência foi verificada em três grupos de pacientes com diferentes condições aplicando-se os testes Qui-Quadrado ou Razão de Verossimilhança ou Kruskal-Wallis. A associação das variáveis foi verificada com a Regressão Logística Multinomial. Resultados: Participaram 84 pacientes. A restrição foi observada em 77,4% dos 84 pacientes analisados e foi mais frequente na presença de sedação, agitação e dispositivos invasivos. A chance de se estar restrito foi cerca de pelo menos cinco vezes maior nas condições de sedação, seja em desmame ou despertar diário, desmame da ventilação mecânica, agitação e presença de dispositivos invasivos. Conclusão: O uso da restrição foi elevado e associou-se ao sexo feminino, sedação, agitação e via aérea invasiva. Ressalta-se a importância de aplicação de políticas para redução da restrição em terapia intensiva.

Mechanical Restraint in Nursing Homes in Brazil: a cross-sectional study / Contención Mecánica en Hogares para Ancianos: studio transversal / Contenção mecânica em instituição de Longa Permanência para Idosos: estudo transversal

ABSTRACT Objective: to estimate the mechanical restraint prevalence in Nursing Homes in Brazil and the factors associated with its performance. Methods: this cross-sectional study was carried out in 14 institutions, with a final sample of 443 elderly people. Mechanical restraint was considered as a dependent variable. Results: there was a 7.45% prevalence of mechanical restraint considering bed rails and 3.84% without considering bed rails. Main justification for restraint use was risk of falls (66.7%), and restraint duration was 24 hours (84.8%). The factors associated with the dependent variable were: wandering (p=0.000); MMSE, with cognitive loss (p=0.000); Katz Index, with dependence for Activities of Daily Living (p=0.000); and Alzheimer's comorbidity (p=0.001) Conclusion: prevalence was lower than international studies, but there was an association with worsening of wandering, dependence, cognitive worsening, and Alzheimer's Disease, showing the need for alternative interventions to mechanical restraint.

RESUMEN Objetivo: estimar la prevalencia de la contención mecánica en Hogares para Ancianos y los factores asociados con su realización. Métodos: estudio transversal, realizado en 14 instituciones, con una muestra final de 443 personas mayores. La ocurrencia de contención mecánica se consideró como una variable dependiente. Resultados: hubo una prevalencia del 7,45% para la contención mecánica considerando las barandas de la cama y el 3,84% sin considerar las barandas de la cama. La principal justificación para usar la restricción fue el riesgo de caídas (66.7%), y la duración de la restricción fue de 24 horas (84.8%). Los factores asociados con la variable dependiente fueron: caminar (p = 0.000); MEEM, con pérdida cognitiva (p=0.000); Índice de Katz, con dependencia para las actividades de la vida diaria (p=0.000); y comorbilidad de Alzheimer (p=0.001). Conclusión: la prevalencia fue menor que los estudios internacionales, pero hubo una asociación con el empeoramiento de la marcha, la dependencia, el empeoramiento cognitivo y la enfermedad de Alzheimer, lo que demuestra la necesidad de intervenciones alternativas a la restricción mecánica.

RESUMO Objetivo: estimar a prevalência da contenção mecânica em Instituições de Longa Permanência para Idosos e os fatores associados à sua realização. Métodos: estudo transversal, realizado em 14 instituições, com amostra final de 443 idosos. Considerou-se como variável dependente a ocorrência de contenção mecânica. Resultados: obteve-se prevalência de 7,45% de contenção mecânica considerando grades no leito e 3,84% sem considerar a grade no leito. Principal justificativa para a utilização da contenção foi o risco de quedas (66,7%), e a duração da contenção foi de 24 horas (84,8%). Os fatores associados à variável dependente foram: deambula (p=0,000); MEEM, com perda cognitiva (p=0,000); Índice de Katz, com dependência para Atividades de Vida Diária (p=0,000); e comorbidade Alzheimer (p=0,001). Conclusão: a prevalência foi menor que os estudos internacionais, porém houve associação com a piora na deambulação, dependência, piora cognitiva, e Doença de Alzheimer, demonstrando a necessidade de intervenções alternativas à contenção mecânica.

Reducing Injury During Restraint by Crisis Intervention in Psychiatric Wards in Singapore.

OBJECTIVE: The application of restraints during psychiatric crises is a serious adverse event. We aimed to reduce the number of injuries sustained by patients during the application of restraints. METHODS: Structured interviews were conducted with 10 staff to determine six root causes of patient injury during restraint. Three plan-do-study-act cycles were implemented: (1) reorganising shift rosters to pair trained staff with inexperienced staff, (2) holding monthly session for practising de-escalation and restraint techniques as a team in a supervised setting, and (3) rotating the responsibility for leading the de-escalation in real crises. RESULTS: Pre-intervention period was from January 2014 to December 2014 (28 251 inpatient bed days). Intervention period was from January 2015 to March 2015 (7121 inpatient bed days). Post-intervention period was from April 2015 to December 2016 (51 735 inpatient bed days). Data extracted included the dates and numbers of crises, activation of the crisis team, use of restraints, and injuries. During pre-intervention and intervention periods, only two minor and three moderate injuries were recorded. During post-intervention period, no injury was recorded and the number of restraints decreased gradually although the number of crisis team activations increased in the early phase. Eventually restraints were used only upon arrival of the crisis team. CONCLUSION: Our quality improvement project identified six root causes and implemented three plan-do-study-act cycles to successfully eliminated patient injuries during the use of restraints.