Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis
Accessible Summary What is already known about the topic? Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous stud...
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Veröffentlicht in: | Journal of psychiatric and mental health nursing 2021-12, Vol.28 (6), p.1052-1064 |
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creator | Pérez‐Revuelta, Jose I. Torrecilla‐Olavarrieta, Rocío García‐Spínola, Edgar López‐Martín, Ángela Guerrero‐Vida, Rafael Mongil‐San Juan, Jose M. Rodríguez‐Gómez, Carmen Pascual‐Paño, Juan M. González‐Sáiz, Francisco Villagrán‐Moreno, Jose M. |
description | Accessible Summary
What is already known about the topic?
Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized.
Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long‐term plan for reducing the use of mechanical restraint.
What this paper adds to existing knowledge?
We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework.
Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long‐term plan for the reduction in mechanical restraint can be targeted with long‐lasting positive effects.
What are the implications for practice?
Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint.
Introduction
Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long‐term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation.
Aim/Question
To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8‐year period and previous observation of 5 years.
Methods
Cross‐sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure.
Results
Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly redu |
doi_str_mv | 10.1111/jpm.12749 |
format | Article |
fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2497076999</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2597823714</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3539-fe9161d06359a0ba09f78b82936bfac4fdc641ed746031c0dffc3edfc500175e3</originalsourceid><addsrcrecordid>eNp1kc1u1TAQha2qiJbCoi-ALHVTFmntOLHj7qqK8qMiWMA6muuMFV_l59Z2Wl1WfQSekSdhyi0skJiNZ-zvHHl0GDuW4kxSna8345ksTWX32KFUui7Kphb7j30tCyFLfcBepLQWQlSVEs_ZgSLIaFMesodrcHmOiUNKswuQseP3Ifc898iXhHz2fETXwxQcDDxiyhHClHmYONDLlOm2RxhI0s9pE2gO3yGHeeLLFPIFb34-_NgiRNLmSAS6HO6QwwTDNoX0kj3zMCR89XQesW_Xb79evS9uPr_7cHV5UzhVK1t4tFLLTmhVWxArENabZtWUVumVB1f5zulKYmcqLZR0ovPeKey8q4WQpkZ1xE53vps43y60RjuG5HAYYMJ5SW1ZWSOMttYSevIPup6XSP8lqramKZWRFVFvdpSjrVJE325iGCFuWynax1haiqX9HQuxr58cl9WI3V_yTw4EnO-A-zDg9v9O7ccvn3aWvwCvQpnc</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2597823714</pqid></control><display><type>article</type><title>Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis</title><source>Wiley Journals</source><creator>Pérez‐Revuelta, Jose I. ; Torrecilla‐Olavarrieta, Rocío ; García‐Spínola, Edgar ; López‐Martín, Ángela ; Guerrero‐Vida, Rafael ; Mongil‐San Juan, Jose M. ; Rodríguez‐Gómez, Carmen ; Pascual‐Paño, Juan M. ; González‐Sáiz, Francisco ; Villagrán‐Moreno, Jose M.</creator><creatorcontrib>Pérez‐Revuelta, Jose I. ; Torrecilla‐Olavarrieta, Rocío ; García‐Spínola, Edgar ; López‐Martín, Ángela ; Guerrero‐Vida, Rafael ; Mongil‐San Juan, Jose M. ; Rodríguez‐Gómez, Carmen ; Pascual‐Paño, Juan M. ; González‐Sáiz, Francisco ; Villagrán‐Moreno, Jose M.</creatorcontrib><description>Accessible Summary
What is already known about the topic?
Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized.
Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long‐term plan for reducing the use of mechanical restraint.
What this paper adds to existing knowledge?
We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework.
Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long‐term plan for the reduction in mechanical restraint can be targeted with long‐lasting positive effects.
What are the implications for practice?
Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint.
Introduction
Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long‐term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation.
Aim/Question
To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8‐year period and previous observation of 5 years.
Methods
Cross‐sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure.
Results
Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01).
Discussion
Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation.
Implications for Practice
Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.</description><identifier>ISSN: 1351-0126</identifier><identifier>EISSN: 1365-2850</identifier><identifier>DOI: 10.1111/jpm.12749</identifier><identifier>PMID: 33657672</identifier><language>eng</language><publisher>England: Wiley Subscription Services, Inc</publisher><subject>acute mental health ; Behavior disorders ; emergency psychiatry ; Mental health ; Mental institutions ; Nursing ; Nursing care ; Personality disorders ; Physical restraints ; risk assessment ; Risk factors ; seclusion and restraint ; service management and planning</subject><ispartof>Journal of psychiatric and mental health nursing, 2021-12, Vol.28 (6), p.1052-1064</ispartof><rights>2021 John Wiley & Sons Ltd</rights><rights>2021 John Wiley & Sons Ltd.</rights><rights>Copyright © 2021 John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3539-fe9161d06359a0ba09f78b82936bfac4fdc641ed746031c0dffc3edfc500175e3</citedby><cites>FETCH-LOGICAL-c3539-fe9161d06359a0ba09f78b82936bfac4fdc641ed746031c0dffc3edfc500175e3</cites><orcidid>0000-0002-0047-9387 ; 0000-0002-4163-7812 ; 0000-0001-6020-0686 ; 0000-0001-9526-0355 ; 0000-0003-3033-3298 ; 0000-0003-0451-4909 ; 0000-0001-7257-6314</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fjpm.12749$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fjpm.12749$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,780,784,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33657672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Pérez‐Revuelta, Jose I.</creatorcontrib><creatorcontrib>Torrecilla‐Olavarrieta, Rocío</creatorcontrib><creatorcontrib>García‐Spínola, Edgar</creatorcontrib><creatorcontrib>López‐Martín, Ángela</creatorcontrib><creatorcontrib>Guerrero‐Vida, Rafael</creatorcontrib><creatorcontrib>Mongil‐San Juan, Jose M.</creatorcontrib><creatorcontrib>Rodríguez‐Gómez, Carmen</creatorcontrib><creatorcontrib>Pascual‐Paño, Juan M.</creatorcontrib><creatorcontrib>González‐Sáiz, Francisco</creatorcontrib><creatorcontrib>Villagrán‐Moreno, Jose M.</creatorcontrib><title>Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis</title><title>Journal of psychiatric and mental health nursing</title><addtitle>J Psychiatr Ment Health Nurs</addtitle><description>Accessible Summary
What is already known about the topic?
Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized.
Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long‐term plan for reducing the use of mechanical restraint.
What this paper adds to existing knowledge?
We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework.
Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long‐term plan for the reduction in mechanical restraint can be targeted with long‐lasting positive effects.
What are the implications for practice?
Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint.
Introduction
Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long‐term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation.
Aim/Question
To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8‐year period and previous observation of 5 years.
Methods
Cross‐sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure.
Results
Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01).
Discussion
Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation.
Implications for Practice
Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.</description><subject>acute mental health</subject><subject>Behavior disorders</subject><subject>emergency psychiatry</subject><subject>Mental health</subject><subject>Mental institutions</subject><subject>Nursing</subject><subject>Nursing care</subject><subject>Personality disorders</subject><subject>Physical restraints</subject><subject>risk assessment</subject><subject>Risk factors</subject><subject>seclusion and restraint</subject><subject>service management and planning</subject><issn>1351-0126</issn><issn>1365-2850</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNp1kc1u1TAQha2qiJbCoi-ALHVTFmntOLHj7qqK8qMiWMA6muuMFV_l59Z2Wl1WfQSekSdhyi0skJiNZ-zvHHl0GDuW4kxSna8345ksTWX32KFUui7Kphb7j30tCyFLfcBepLQWQlSVEs_ZgSLIaFMesodrcHmOiUNKswuQseP3Ifc898iXhHz2fETXwxQcDDxiyhHClHmYONDLlOm2RxhI0s9pE2gO3yGHeeLLFPIFb34-_NgiRNLmSAS6HO6QwwTDNoX0kj3zMCR89XQesW_Xb79evS9uPr_7cHV5UzhVK1t4tFLLTmhVWxArENabZtWUVumVB1f5zulKYmcqLZR0ovPeKey8q4WQpkZ1xE53vps43y60RjuG5HAYYMJ5SW1ZWSOMttYSevIPup6XSP8lqramKZWRFVFvdpSjrVJE325iGCFuWynax1haiqX9HQuxr58cl9WI3V_yTw4EnO-A-zDg9v9O7ccvn3aWvwCvQpnc</recordid><startdate>202112</startdate><enddate>202112</enddate><creator>Pérez‐Revuelta, Jose I.</creator><creator>Torrecilla‐Olavarrieta, Rocío</creator><creator>García‐Spínola, Edgar</creator><creator>López‐Martín, Ángela</creator><creator>Guerrero‐Vida, Rafael</creator><creator>Mongil‐San Juan, Jose M.</creator><creator>Rodríguez‐Gómez, Carmen</creator><creator>Pascual‐Paño, Juan M.</creator><creator>González‐Sáiz, Francisco</creator><creator>Villagrán‐Moreno, Jose M.</creator><general>Wiley Subscription Services, Inc</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>ASE</scope><scope>FPQ</scope><scope>K6X</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-0047-9387</orcidid><orcidid>https://orcid.org/0000-0002-4163-7812</orcidid><orcidid>https://orcid.org/0000-0001-6020-0686</orcidid><orcidid>https://orcid.org/0000-0001-9526-0355</orcidid><orcidid>https://orcid.org/0000-0003-3033-3298</orcidid><orcidid>https://orcid.org/0000-0003-0451-4909</orcidid><orcidid>https://orcid.org/0000-0001-7257-6314</orcidid></search><sort><creationdate>202112</creationdate><title>Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis</title><author>Pérez‐Revuelta, Jose I. ; Torrecilla‐Olavarrieta, Rocío ; García‐Spínola, Edgar ; López‐Martín, Ángela ; Guerrero‐Vida, Rafael ; Mongil‐San Juan, Jose M. ; Rodríguez‐Gómez, Carmen ; Pascual‐Paño, Juan M. ; González‐Sáiz, Francisco ; Villagrán‐Moreno, Jose M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3539-fe9161d06359a0ba09f78b82936bfac4fdc641ed746031c0dffc3edfc500175e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>acute mental health</topic><topic>Behavior disorders</topic><topic>emergency psychiatry</topic><topic>Mental health</topic><topic>Mental institutions</topic><topic>Nursing</topic><topic>Nursing care</topic><topic>Personality disorders</topic><topic>Physical restraints</topic><topic>risk assessment</topic><topic>Risk factors</topic><topic>seclusion and restraint</topic><topic>service management and planning</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Pérez‐Revuelta, Jose I.</creatorcontrib><creatorcontrib>Torrecilla‐Olavarrieta, Rocío</creatorcontrib><creatorcontrib>García‐Spínola, Edgar</creatorcontrib><creatorcontrib>López‐Martín, Ángela</creatorcontrib><creatorcontrib>Guerrero‐Vida, Rafael</creatorcontrib><creatorcontrib>Mongil‐San Juan, Jose M.</creatorcontrib><creatorcontrib>Rodríguez‐Gómez, Carmen</creatorcontrib><creatorcontrib>Pascual‐Paño, Juan M.</creatorcontrib><creatorcontrib>González‐Sáiz, Francisco</creatorcontrib><creatorcontrib>Villagrán‐Moreno, Jose M.</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of psychiatric and mental health nursing</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Pérez‐Revuelta, Jose I.</au><au>Torrecilla‐Olavarrieta, Rocío</au><au>García‐Spínola, Edgar</au><au>López‐Martín, Ángela</au><au>Guerrero‐Vida, Rafael</au><au>Mongil‐San Juan, Jose M.</au><au>Rodríguez‐Gómez, Carmen</au><au>Pascual‐Paño, Juan M.</au><au>González‐Sáiz, Francisco</au><au>Villagrán‐Moreno, Jose M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis</atitle><jtitle>Journal of psychiatric and mental health nursing</jtitle><addtitle>J Psychiatr Ment Health Nurs</addtitle><date>2021-12</date><risdate>2021</risdate><volume>28</volume><issue>6</issue><spage>1052</spage><epage>1064</epage><pages>1052-1064</pages><issn>1351-0126</issn><eissn>1365-2850</eissn><abstract>Accessible Summary
What is already known about the topic?
Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized.
Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long‐term plan for reducing the use of mechanical restraint.
What this paper adds to existing knowledge?
We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework.
Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long‐term plan for the reduction in mechanical restraint can be targeted with long‐lasting positive effects.
What are the implications for practice?
Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint.
Introduction
Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long‐term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation.
Aim/Question
To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8‐year period and previous observation of 5 years.
Methods
Cross‐sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure.
Results
Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01).
Discussion
Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation.
Implications for Practice
Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.</abstract><cop>England</cop><pub>Wiley Subscription Services, Inc</pub><pmid>33657672</pmid><doi>10.1111/jpm.12749</doi><tpages>0</tpages><orcidid>https://orcid.org/0000-0002-0047-9387</orcidid><orcidid>https://orcid.org/0000-0002-4163-7812</orcidid><orcidid>https://orcid.org/0000-0001-6020-0686</orcidid><orcidid>https://orcid.org/0000-0001-9526-0355</orcidid><orcidid>https://orcid.org/0000-0003-3033-3298</orcidid><orcidid>https://orcid.org/0000-0003-0451-4909</orcidid><orcidid>https://orcid.org/0000-0001-7257-6314</orcidid></addata></record> |
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source | Wiley Journals |
subjects | acute mental health Behavior disorders emergency psychiatry Mental health Mental institutions Nursing Nursing care Personality disorders Physical restraints risk assessment Risk factors seclusion and restraint service management and planning |
title | Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis |
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