Skip to main content

Advertisement

SpringerLink
Log in

Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study

  • Original Paper
  • Published:
Psychiatric Quarterly Aims and scope Submit manuscript

Abstract

The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010–September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008–September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Knutzen M, Mjosund NH, Eidhammer G, Lorentzen S, Opjordsmoen S, Sandvik L, Friis S: Characteristics of psychiatric inpatients who experienced restraint and those who did not: A case-control study. Psychiatric Services 62(5):492–497, 2011.

    Article  PubMed  Google Scholar 

  2. Cornaggia CM, Beghi M, Pavone F, Barale F: Aggression in psychiatry wards: A systematic review. Psychiatry Research 189(1):10–20, 2011.

    Article  PubMed  Google Scholar 

  3. Borckardt JJ, Madan A, Grubaugh DC, Pelic C, Hardesty, S, Hanson R, Herbert J, Cooney H, Benson A, Frueh, B: Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital. Psychiatric Services 62(5):477–483, 2011.

    Article  PubMed  Google Scholar 

  4. Huckshorn K: Building a better mental health work-force: 8 core elements. Journal of Psychosocial Nursing and Mental Health Services 45(8):24–34, 2007.

    PubMed  Google Scholar 

  5. Almvik R, Woods P, Rasmussen K: The Brøset Violence Checklist: Sensitivity, specificity, and interrater reliability. Journal of Interpersonal Violence 15(12):1284–1296, 2000.

    Article  Google Scholar 

  6. Linaker OM, Busch-Iversen H: Predictors of imminent violence in psychiatric inpatients. Acta Psychiatrica Scandanavica 92(4):250–254, 1995.

    Article  CAS  Google Scholar 

  7. Woods P, Almvik R: The Brøset Violence Checklist (BVC). Acta Psychiatrica Scandanavica Supplementum 106(412):103–105, 2002.

    Article  Google Scholar 

  8. Almvik R, Rasmussen K,Woods P: Challenging behaviour in the elderly-monitoring violent incidents. International Journal of Geriatric Psychiatry 21(4):368–74, 2006.

    Article  PubMed  Google Scholar 

  9. Clarke DE, Brown AM, Griffith P: The Broset Violence Checklist: clinical utility in a secure psychiatric intensive care setting. Journal of Psychiatric and Mental Health Nursing 17(7):614–20, 2010.

    Article  CAS  PubMed  Google Scholar 

  10. Barton SA, Johnson MR, Price LV: Achieving restraint-free on an inpatient behavioral health unit. Journal of Psychosocial Nursing and Mental Health Services 47(1):34–40, 2009.

    Article  PubMed  Google Scholar 

  11. Huckshorn K: Six core strategies for reducing seclusion and restraint use ©, National Association of State Mental health Program Directors, 2006. http://www.nasmhpd.org/docs/NCTIC/Consolidated_Six_Core_Strategies_Document.pdf. Accessed 24 Oct 2014.

  12. Knox DK, Holloman GH Jr: Use and avoidance of seclusion and restraint: Consensus statement of the American Association for Emergency Psychiatry project Beta seclusion and restraint workgroup. Western Journal of Emergency Medicine 13(1):35–40, 2012.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Delaney KR, Johnson ME: Keeping the unit safe: Mapping psychiatric nursing skills. Journal of the American Psychiatric Nurses Association 12(4):198–207, 2006.

    Article  Google Scholar 

  14. Bjorkdahl A, Olsson D, Palmstierna T: Nurses’ short-term prediction of violence in acute psychiatric intensive care. Acta Psychiatrica Scandanavica 13(3):224–229, 2006.

    Article  Google Scholar 

  15. Livingston G, Kelly, L Lewis-Holmes E, Baio G, Morris S, Patel N, Omar R, Katona C, Cooper C: Non-pharmacological interventions for agitation in dementia: A systematic review of randomised controlled trials. British Journal of Psychiatry 205(6):436–442, 2014.

    Article  PubMed  Google Scholar 

  16. Wong SCP, Gordon A, Gu D: Assessment and treatment of violence-prone forensic clients: An integrated approach. British Jouranl of Psychiatry 49:66–74, 2007.

    Article  Google Scholar 

  17. Donat DC: An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatric Services 54(8):1119–1123, 2003.

    Article  PubMed  Google Scholar 

  18. Heinze C, Dassen T, Grittner U: Use of physical restraints in nursing homes and hospitals and related factors: A cross-sectional study. Journal of Clinical Nursing 21(7–8):1033–40, 2012.

    Article  PubMed  Google Scholar 

  19. Johnson ME, Delaney KR: Keeping the unit safe: The anatomy of escalation. Journal of the American Psychiatric Nurses Association 13(1):42–52, 2007.

    Article  Google Scholar 

  20. Nolan KA, Citrome L: Reducing inpatient aggression: Does paying attention pay off? Psychiatric Quarterly 79(2):91–5, 2008.

    Google Scholar 

  21. Roley SS, Clark GF, Bissell J, Brayman SJ, Commission on Practice: Applying sensory integration framework in educationally related occupational therapy practice (2003 statement). American Journal of Occupational Therapy 57(6):652–9, 2003.

    Article  PubMed  Google Scholar 

  22. Nackley VL: Sensory diet application and environmental modifications: A winning combination. Sensory Integration Special Interest Section Quarterly 24(1):1–4, 2001.

    Google Scholar 

  23. Muskett C: Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing 23(1):51–9, 2014.

    Article  PubMed  Google Scholar 

  24. Janner, M, Delaney, KR: Safety issues on British mental health wards. Journal of the American Psychiatric Nurses Association 18(2):104–11, 2012.

    Article  PubMed  Google Scholar 

  25. Yao, X Li Z, Arthur D, Hu L, An F, Cheng G: Acceptability and psychometric properties of Brøset Violence Checklist in psychiatric care settings in China. Journal of Psychiatric and Mental Health Nursing 21(9):848–855, 2014.

    CAS  PubMed  Google Scholar 

  26. Stewart D, Van der Merwe M, Bowers L, Simpson A, Jones J: A review of interventions to reduce mechanical restraint and seclusion among adult psychiatric inpatients. Issues in Mental Health Nursing 31(6):413–424, 2010.

    Article  PubMed  Google Scholar 

  27. Smith, G, Davis, R, Bixler, E, Lin, H, Altenor, A, Alternor, R, Hardentstine, B, Kopchick, G: Pennsylvania state hospital system’s seclusion and restraint reduction program. Psychiatric Services 56(9):1115–1122, 2005.

    Article  PubMed  Google Scholar 

  28. Bader S, Evans SE, Welsh E: Aggression among psychiatric inpatients: The relationship between time, place, victims and severity ratings. Journal of the American Psychiatric Nurses Association 20(3):179–86, 2014.

    Article  PubMed  Google Scholar 

  29. van de Sande R, Nijman HLI, Noorthoorn, EO Wierdsma AI, Hellendoom E, van der Staak C, Mulder CL: Aggression and seclusion on acute psychiatric wards: Effect of short-term risk asessment. British Journal of Psychiatry 199(6):473–478, 2011.

    Article  PubMed  Google Scholar 

  30. Benedictis L, Dumais A, Sieu N, Mailhot M, Letourneau G, Tran M, Stikarovska I, Bilodeau M, Brunelle S, Cote G, Lesage A: Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. Psychiatric Services 62(5):484–491, 2011.

    Article  PubMed  Google Scholar 

  31. Goulet MH, Larue C, Stafford MC, Durnais A: Profiles of patients admitted to a psychiatric intensive care unit: Secluded with or without restraint. Canadian Journal of Psychiatry 58(9):546–550, 2013.

    Article  PubMed  Google Scholar 

  32. Johnson ME: Violence on inpatient psychiatric units: State of the science. Journal of the American Psychiatric Nurses Association 10(3):113–121, 2004.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA

    Ellen W. Blair, Bonnie L. Szarek, Theodore F. Mucha, Olga Dutka & Harold I. Schwartz

  2. Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA

    Stephen Woolley, Jeff Wisniowski & John W. Goethe

Authors
  1. Ellen W. Blair
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Woolley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bonnie L. Szarek
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Theodore F. Mucha
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olga Dutka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Harold I. Schwartz
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jeff Wisniowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. John W. Goethe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ellen W. Blair.

Ethics declarations

Conflict of Interest

We have no potential conflict of interest.

Ethical Approval

This article does not contain any studies with human participants performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Blair, E.W., Woolley, S., Szarek, B.L. et al. Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study. Psychiatr Q 88, 1–7 (2017). https://doi.org/10.1007/s11126-016-9428-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11126-016-9428-0

Keywords

Search

Navigation