Title: Effectiveness of non‐pharmacological interventions to reduce the use of physical restraint in mental health settings: a systematic review protocol
year: 2014
Journal: JBI Database of Systematic Reviews and Implementation Reports
Volume: 12
Issue: 6
Pages: 24-35
ISSN: 2202-4433
DOI: 10.11124/jbisrir-2014-1395
Accession Number: 01938924-201412060-00004
Abstract: Review question/objective: The objective of this review is to synthesize the best available evidence on the use of non‐pharmacological interventions to reduce the use of physical restraint in mental health settings in adults aged 21 to 65 years with acute or chronic mental illness including dementia. Background: Physical restraint (PR) is defined as, “any device, material, or equipment attached to or near a person's body that could not be controlled or easily removed by a patient and deliberately prevents or is intended to prevent free body movement to a position of choice.”1 (p.367) Restraint is considered as ‘an emergency measure to prevent imminent harm to the patient or other persons when other means of control are not effective or appropriate’’.2(p.418) Physical restraint was used to prevent falls and related injuries in long‐term care settings.3,4 Some psychiatric hospitals considered it acceptable practice to use PR for agitated and violent persons.5,6 The use of PR in hospitals varies between countries.7 In some European (Dutch, German, Swiss) psycho‐geriatric nursing homes, PR was used as a fall preventive measure with the prevalence ranging from 26% to 56%.8 It was most frequently used in the care of older people with the prevalence ranging from 41% to 64% in Dutch nursing homes.4 Similarly, PR is still used in Singaporean psychiatric hospitals and nursing homes. Our local study in Singapore showed that 22% of residents were restrained to prevent dislodgement of a feeding tube, 18.7% were restrained to prevent falls, and 8.8% were restrained for agitation.9 There has been increasing attention placed on the use of PR in psychiatric settings.5 The use of PR in psychiatric settings has become a common practice among nurses to control challenging behavior and to prevent falls, despite many injuries and deaths having been reported to have resulted from the use of physical restraint.10, 11 Although PR is commonly used to prevent falls and fall‐related injuries, it has been found to be ineffective in preventing falls.12, 13 The use of restraint can result in falls and problems with balance and coordination14, 15 and can even cause death.16 The risk of suffering serious fall‐related injuries and fractures was found to be higher among those who were continuously restrained compared to those who were intermittently restrained.17, 18 Kron, Loy and Strumpf stated that applying PR increases the level of agitation rather than controlling it.15 In addition, use of PR has been associated with adverse outcomes including hospital acquired infections, increased length of hospital stay and poor cognitive functioning.17, 19 PR was also linked to higher medical costs involving significant legal risks,20 and litigation and criminal prosecution for hospitals.21 Physically restraining a patient may also lead to injury of staff members who are involved in the act.22, 23 PR intervention should be avoided if other therapeutic approaches can be successful in de‐escalating a patient's aggression. There is a worldwide move towards the reduction or elimination of restraints.22 In current practice, there are recommendations to reduce the use of PR for older people.4 Singapore's population is aging rapidly. It is estimated that the proportion of older people aged 65 and above will rise from 7.2% of the total population in the year 2000 to 18.2% in 2030. Mamun and Lim stated that there was a high rate of restraint use in nursing homes in Singapore with a statistically significant association between dementia and restraint use (p = 0.0004).9 In most acute psychiatric hospitals, PR was used for the management of behavioral problems in disturbed, aggressive, and violent patients and safety‐related problems like high risk for falls.24 The use of PRs should only be used as a last resort when all other interventions have failed to prevent patients from harming themselves or others. However, staff members have been observed carrying out this procedure against the patients’ will, which violate the patients’ rights and autonomy.25, 26 The misuse of PR can be seen as an organizational problem that reflects failure in leadership, communication, or in the therapeutic capacity to manage aggressive patients.26 Healthcare professionals could employ evidenced‐based practice (EBP) strategies to identify non‐pharmacological interventions such as structured framework or restraint minimization programs that include an educational program for nursing staff, policy or guideline change, restraint alternatives and behavioral strategies to manage agitated, aggressive and violent psychiatric patients without using PR. Through EBP, the quality of clinical judgment can be strengthened when rational inferences are made based on all the available information.27 A preliminary search was conducted in the Joanna Briggs Library, PubMed, CINAHL and Cochrane Library for any existing systematic reviews on this topic. Although a few systematic reviews on the evaluation of interventions for preventing and reducing the use of physical restraints were found, these studies were focused on long‐term geriatric settings. No recent systematic reviews on the effectiveness of non‐pharmacological interventions to reduce physical restraint in psychiatric settings were identified from the preliminary search. Therefore, this systematic review will critically review the literature to synthesize the best available evidence to consider the effectiveness of non‐pharmacological interventions for reducing the use of physical restraint in psychiatric settings.
URL: http://journals.lww.com/jbisrir/Fulltext/2014/12060/Effectiveness_of_non_pharmacological_interventions.4.aspx
URI: https://open-access.imh.com.sg/handle/123456789/4709
Appears in Collections:2014

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