Investigation on physical restraint use in hospital: health responsibility, ethical and medical legal considerations.

Background: The issue of restraint has long been considered a difficult political and social situation, affecting both healthcare wor-kers and facilities. The practice of restraint is still widespread in many public and private care settings, but there is a lack of systemic studies capable of monitoring the phenomenon. The framing of the question essentially concerns the right to personal freedom, guaranteed by the Italian Constitution. Materials and Methods: An anonymous questionnaire was developed containing questions on knowledge of the regulations on restraints, how, ways, and when they are implemented, and general information such as age, gender, educational qualification, qualification, O.Us. to which they belong. The collected data were statistically processed (Chi-square test) with the Epi Info 7.1.5 program (CDC-Atlanta- USA). A total of 1002 questionnaires were completed. The stratification of the sample by structure shows that 73.9% were public facilities. The indicative figure is represented by the 23.8% of respondents who say that "the restraint is not noted in the medical record". Conclusions: Restraint could be a real risk for the healthcare worker, encroaching on the issue of health liability. It is therefore important to raise awareness among healthcare professionals and top management of the need to structure, at company level, procedures that comply with the "Recommendations on physical restraint" to overcome the use of restraint through the improvement of care pathways in compliance with organizational and risk management standards.

Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study.

BACKGROUND: Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction. METHODS: In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles. RESULTS: This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients. CONCLUSION: The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.

Nasogastric tube feeding under physical restraint of children and young people with mental disorders: a comprehensive audit and case series across paediatric wards in England.

OBJECTIVE: To estimate the number of patients on paediatric wards in England who received nasogastric tube (NGT) feeding under physical restraint from April 2022 to March 2023, identify the demographics and clinical characteristics of these patients, and which personnel facilitated the restraint. DESIGN: Audit and anonymous case series SETTING: Paediatric wards in England. PATIENTS: Children and young people receiving this intervention in a 1-year period. OUTCOME MEASURES: An online survey was sent to all paediatric wards in England, with the option of submitting anonymous case studies. RESULTS: 136/143 (95.1%) acute paediatric units responded. 144 young people received this intervention across 55 (38.5%) paediatric units. The predominant diagnosis was anorexia nervosa (64.5%), age range 9-18 years (M=14.2, SD=2.1). The duration of NGT feeding under restraint ranged from 1 to 425 days, (M=60.2, SD=80.4). Numerous personnel facilitated the restraints, including mental health nurses, paediatric nurses, security staff, healthcare assistants and parents/carers. CONCLUSION: NGT feeding under restraint is a relatively common intervention in acute paediatric units in England. Understanding the demographics of those receiving this intervention may highlight where additional support is needed. Further research is needed to understand when this intervention transitions from a lifesaving intervention to ongoing management.

COVID-19 pandemic and emergency department visits for psychosis: Visit volume, restraint use, medication use, psychiatric hospitalization, and length of stay.

BACKGROUND: Individuals with a schizophrenia spectrum disorder were at heightened risk for interruptions in psychiatric care during the coronavirus-19 (COVID 19) pandemic. There is limited work exploring the pandemic's impact on emergency department (ED) visit volume, use of restraint and parenteral medications, inpatient psychiatric (IP) hospitalization, and ED length of stay (LOS) among this population. METHODS: We retrospectively examined 2134 ED visits with a billing code for psychosis between March 1, 2019-February 28, 2021. We used Poisson regression analysis to compare ED visit volume between the pandemic and pre-pandemic periods. Restraint use, parenteral antipsychotic or benzodiazepine use, IP hospitalization, and ED LOS were compared between the two periods using chi-square tests and independent samples t-tests. RESULTS: Overall volume of psychosis-related ED visits during the pandemic did not differ significantly from the prior year. Rates of restraint use (16.2 % vs 11.6 %, p < .01), parenteral antipsychotic (22.6 % vs 14.9, p < .001), and parenteral benzodiazepine (22.3 % vs 16.3 %, p < .001) use were significantly higher during the pandemic. Fewer patients had an IP hospital disposition during the pandemic than the year prior (57.8 % vs. 61.9 %, p < .05). ED LOS was longer during the pandemic compared to pre-pandemic (28.37 h vs 20.26 h, p < .001). CONCLUSIONS: Although the volume of psychosis-related ED visits remained constant, restraint and parenteral medication use rates were significantly higher during the pandemic. ED LOS increased but fewer ED visits resulted in IP hospitalization. These findings underscore the importance of planning for increased acuity of psychosis ED presentations during public health emergencies.

Pediatric Physical Restraint Coding in US Hospitals: A 2019 Kids Inpatient Database Study.

BACKGROUND: Reduction of physical restraint utilization is a goal of high-quality hospital care, but there is little nationally-representative data about physical restraint utilization in hospitalized children in the United States. This study reports the rate of physical restraint coding among hospitalizations for patients aged 1 to 18 years old in the United States and explores associated demographic and diagnostic factors. METHODS: The Kids' Inpatient Database, an all-payors database of community hospital discharges in the United States, was queried for hospitalizations with a diagnosis of physical restraint status in 2019. Logistic regression using patient sociodemographic characteristics was used to characterize factors associated with physical restraint coding. RESULTS: A coded diagnosis of physical restraint status was present for 8893 (95% confidence interval [CI]: 8227-9560) hospitalizations among individuals aged 1 to 18 years old, or 0.63% of hospitalizations. Diagnoses associated with physical restraint varied by age, with mental health diagnoses overall the most frequent in an adjusted model, male sex (adjusted odds ratio [aOR] 1.56; 95% CI: 1.47-1.65), Black race (aOR 1.43; 95% CI: 1.33-1.55), a primary mental health or substance diagnosis (aOR 7.13; 95% CI: 6.42-7.90), Medicare or Medicaid insurance (aOR 1.33; 95% CI: 1.24-1.43), and more severe illness (aOR 2.83; 95% CI: 2.73-2.94) were associated with higher odds of a hospitalization involving a physical restraint code. CONCLUSIONS: Physical restraint coding varied by age, sex, race, region, and disease severity. These results highlight potential disparities in physical restraint utilization, which may have consequences for equity.

Intention to use physical restraint in paediatric intensive care units and correlated variables: A multicentre and cross-sectional study.

OBJECTIVES: To determine the intention to use physical restraint (PR) and the relationship with sociodemographic and professional variables of the Paediatric Intensive Care Unit (PICU) nurses. RESEARCH METHODOLOGY/DESIGN AND SETTING: A multicentre and correlational study was carried out from October 2021 to December 2023 in five paediatric intensive care units from five maternal and child hospitals in Spain. The Paediatric Physical Restraint-Theory of Planned Behaviour Questionnaire was provided. Moreover, sociodemographic and employment variables were registered. RESULTS: A total of 230 paediatric nurses participated in the study. A total of 87.7 % were females with an average age of 35.5 ± 9.7 years and working experience of 10.5 ± 8.4 years. The mean scores obtained were 21.1 ± 3.8 for attitude, 13.1 ± 5.0 for subjective norms, 14.4 ± 4.3 for perceived behavioural control and 28.0 ± 6.0 for intention. The nurses apply more physical restraint to anxious patients, with scarce analgesics and sedation, those affected with pharmacological withdrawal symptoms and those with a high risk of accidental removal of vital support devices or fall from bed. The sex (p = 0.007) and type of employment contract (p = 0.01) are the variables that are significantly correlated with the intention to use of PR. CONCLUSION: The paediatric nurses analysed had a moderate attitude, social pressure and perceived behavioural control towards the use of PR. IMPLICATIONS FOR CLINICAL PRACTICE: It is important to know the factors that influence the intention to use physical restraint in order to standardise safe practice for critically ill paediatric and to ensure that patients' rights are respected by obtaining informed consent and assessing the prescription, continuation and removal of physical restraint.

Use of Electronic Health Record-Based Measures to Assess Quality of Care for Pediatric Agitation.

OBJECTIVES: Acute agitation during pediatric mental health emergency department (ED) visits presents safety risks to patients and staff. We previously convened multidisciplinary stakeholders who prioritized 20 proposed quality measures for pediatric acute agitation management. Our objectives were to assess feasibility of evaluating performance on these quality measures using electronic health record (EHR) data and to examine performance variation across 3 EDs. METHODS: At a children's hospital and 2 nonchildren's hospitals, we assessed feasibility of evaluating quality measures for pediatric acute agitation management using structured EHR data elements. We retrospectively evaluated measure performance during ED visits by children 5 to 17 years old who presented for a mental health condition, received medication for agitation, or received physical restraints from July 2020 to June 2021. Bivariate and multivariable regression were used to examine measure performance by patient characteristics and hospital. RESULTS: We identified 2785 mental health ED visits, 275 visits with medication given for agitation, and 35 visits with physical restraints. Performance was feasible to measure using EHR data for 10 measures. Nine measures varied by patient characteristics, including 4.87 times higher adjusted odds (95% confidence interval 1.28-18.54) of physical restraint use among children with versus without autism spectrum disorder. Four measures varied by hospital, with physical restraint use varying from 0.5% to 3.3% of mental health ED visits across hospitals. CONCLUSIONS: Quality of care for pediatric acute agitation management was feasible to evaluate using EHR-derived quality measures. Variation in performance across patient characteristics and hospitals highlights opportunities to improve care quality.

Staff responses to interventions aiming to reduce mechanical restraint in adult mental health inpatient settings: a questionnaire-based survey.

PURPOSE: To explore mental health staff's responses towards interventions designed to reduce the use of mechanical restraint (MR) in adult mental health inpatient settings. METHODS: We conducted a cross-sectional, questionnaire-based survey. The questionnaire, made available online via REDCap, presented 20 interventions designed to reduce MR use. Participants were asked to rate and rank the interventions based on their viewpoints regarding the relevance and importance of each intervention. RESULTS: A total of 128 mental health staff members from general and forensic mental health inpatient units across the Mental Health Services in the Region of Southern Denmark completed the questionnaire (response rate = 21.3%). A total of 90.8% of the ratings scored either 'agree' (45.2%) or 'strongly agree' (45.6%) concerning the relevance of the interventions in reducing MR use. Overall and in the divided analysis, interventions labelled as 'building relationship' and 'patient-related knowledge' claimed high scores in the staff's rankings of the interventions' importance concerning implementation. Conversely, interventions like 'carers' and 'standardised assessments' received low scores. CONCLUSIONS: The staff generally considered that the interventions were relevant. Importance rankings were consistent across the divisions chosen, with a range of variance and dispersion being recorded among certain groups.

Caregiver-reported use of physical restraints among community-dwelling older adults with severe dementia in Singapore.

BACKGROUND: Older adults with severe dementia are at increased risk of being physically restrained in nursing homes and acute care settings, but little is known about restraint use among those cared for at home. This study explores caregiver-reported use of restraints among community-dwelling older adults with severe dementia. METHODS: Using cross-sectional data from 215 family caregivers, we describe restraint use among older adults with severe dementia living at home. We then use multivariable logistic regression to identify factors associated with restraint use. RESULTS: Nearly half (47%) of caregivers reported on older adults who had been subject to restraints. Most caregivers reporting restraint use suggested safety reasons, such as prevention of falls (68%), wandering (30%), and removal of catheters or feeding tubes (29%); and 44% indicated doctors or other health care providers were involved in the decision to restrain. Feeding tubes (OR = 4.16, 95% CI: 1.27-13.59) and physically aggressive agitation behaviors (OR = 1.93, 95% CI: 1.09-3.40) were associated with higher odds of restraint use among older adults with severe dementia. Caregivers who received strong emotional support from friends (OR = 0.45, 95% CI: 0.21-0.95) were less likely to report restraint use while serving as a caregiver to others (OR = 2.77, 95% CI: 1.36-5.63) increased the odds of restraint use. CONCLUSIONS: The pervasiveness of restraint use is concerning and suggests a lack of evidence-based guidance and support for both caregivers and healthcare providers to prevent restraint use among older adults with severe dementia cared for at home.

Protocols to reduce seclusion in inpatient mental health units.

The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty-eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi-component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders.

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.

Contenção mecânica de idosos na atenção domiciliar: revisão de literatura / Mechanical restriction of older adults in domiciliary attention: literature review

Objetivos: Identificar na literatura publicações que abordem o uso de contenção mecânica na atenção domiciliar. Métodos: Revisão integrativa da literatura realizadas nas bases de dados MEDLINE, LILACS, CINAHL e SCOPUS, no período de 2008 a 2018. Resultados: As prevalências de contenção física variavam entre 20% a 40%, a alta variação ser refere as distintas metodologias e legislações vigentes quanto à pratica de contenção física. A grade lateral é a contenção mais comum e as razões mais citadas para conter foram segurança do paciente, para evitar quedas e pedido dos familiares. Identificou- -se que 16,7% dos profissionais afirmaram ter aconselhado aos cuidadores o uso de restrições e, que 93% destes não souberam identificar alternativas para esta prática. Conclusão: Recomenda-se orientações específicas ao cuidado domiciliar centradas nas famílias, evitando a transposição inadequada do meio hospitalar para o âmbito domiciliar, e disseminar intervenções alternativas à contenção. (AU)

Objectives: To identify in the literature publications that address the use of mechanical restriction in home care. Methods: Integrative literature review carried out in the MEDLINE, LILACS, CINAHL and SCOPUS data bases from 2008 to 2018. Results: The prevalence of physical restraint ranged from 20% to 40%, the high variability refers to the different methodologies and legislation regarding the practice of physical restraint. The lateral grid is the most common containment and the most cited reasons to contain were patients afety, to avoid falls and family members' request. It was identified that 16.7% of the professionals stated that they advised caregivers to use restrictions, and that 93% of them did not know how to identify alternatives for this practice. Conclusion: Specific guidelines for household-centered care are recommended, avoiding the inadequate transposition of the hospital environment into the home, and disseminating alternative interventions to containment. (AU)

Restrição física em pacientes nas Unidades de Terapia Intensiva: estudo exploratório-descritivo / Physical restraint in patients in Intensive Care Units: exploratory - a descriptive study

Objetivo: analisar os critérios para uso e monitorização de restrições físicas em pacientes internados na Unidade de Terapia Intensiva (UTI). Método: a pesquisa teve caráter exploratório, descritivo e qualitativo e foi realizada em duas UTIs da Bahia, com 85 profissionais de enfermagem. Os dados foram organizados com base na análise temática. Resultado: a equipe de enfermagem justifica a utilização da restrição física para a segurança do paciente. Como critério para seu uso, verificam-se o nível de consciência, o grau de agitação e/ou a desorientação. Para a monitorização, observam-se a integridade cutânea e as alterações do nível de consciência. Por isso, a avaliação neurológica foi a técnica mais empregada pelos profissionais para verificar a necessidade de restrição. O conhecimento da equipe em relação aos instrumentos legais que regem esse procedimento se mostrou superficial. Conclusão: identificaram-se fragilidades nos critérios de monitorização e suspensão da restrição física, visto que o conhecimento ainda é incipiente e que não há protocolos definidos. (AU)

Aim: to analyze the criteria for the use and monitoring of physical restrictions in patients admitted to Intensive Care Units (ICUs). Method: the research had an exploratory, descriptive and qualitative character and was performed in two ICUs in Bahia, with 85 nursing professionals. The data were organized based on thematic analysis. Result: the members of the nursing team justified the use of physical restraint for patient safety, reporting the checking of the level of consciousness, agitation and/or disorientation as criteria for its use. For monitoring, they observed patients' skin integrity and changes in the level of consciousness. Therefore, neurological evaluation was the technique most commonly used by professionals to verify the need for restriction. The knowledge of the team regarding the legal instruments that govern this procedure was superficial. Conclusion: we identified weak spots in the criteria for monitoring and - making use of physical restraint, since the knowledge is still incipient and there are no defined protocols.. (AU)

Uso de restrições físicas em instituições de longa permanência para idosos: percepção de profissionais de saúde e cuidadores de idosos / Use of physical restraints in nursing homes: perception of health professionals and elderly caregivers

Restrições físicas (RF), definidas como equipamentos que restringem a liberdade de movimento do indivíduo, são comumente observadas em instituições de longa permanência para idosos (ILPI). Objetivou-se averiguar e descrever a percepção de profissionais graduados na área de saúde e de cuidadores que atuam em instituições asilares quanto à definição, à utilização, à prescrição e a características positivas e negativas de RF junto a idosos residentes em ILPI. A pesquisa, caracterizada como exploratória e descritiva, utilizou como instrumento para coleta dos dados um questionário semiestruturado elaborado pelos pesquisadores. A amostra foi composta por 10 indivíduos, dos quais 40% eram profissionais de saúde e 60% cuidadores de idosos. Restrições físicas foram definidas como objetos para prender idosos, evitar suas quedas, mantê-los quietos e zelar por sua segurança e seu cuidado. Foram elencados como pontos positivos o cuidado e a segurança para com os idosos. Seis (60%) dos participantes não relataram haver pontos negativos, enquanto um (10%) participante considerou negativa a existência de atrofia muscular, um (10%) evidenciou favorecimento de déficit circulatório, um (10%) revelou constrangimento por parte do idoso e um (10%) reportou ansiedade e irritação por parte do idoso. O terapeuta ocupacional foi considerado pela maioria dos participantes o profissional mais indicado para prescrever e acompanhar o uso de RF. Observou-se que um pequeno número de profissionais de saúde e cuidadores de idosos apresenta familiaridade com a temática abordada neste estudo, o que ilustra a necessidade de condução de estudos posteriores sobre o assunto. (AU)

Use of physical restraints in nursing homes: perception of health professionals and elderly caregivers Physical constraints (PR), defined as equipments that restrict the freedom of the movement of a person, are commonly observed in nursing homes. The study aimed to investigate and describe the perception of health professionals and caregivers who work in nursing homes regarding the definition, use, prescription and positive/negative characteristics of PR. The research, characterized as quantitative, exploratory and descriptive, used a semi-structured questionnaire developed by the researchers to collect the data. The sample consisted of 10 individuals of which 40% were health professionals and 60% were elderly caregivers. Physical restraints were defined as objects to arrest the elderly, avoid their falls, keep them quiet and ensure their safety and care. The participants listed as a positive aspect related to the use of PR the care and safety of the elderly. Considering the negative aspects of PR, six (60%) participants listed no negative aspects, while one (10%) of them considered the existence of muscular atrophy, one (10%) said circulatory deficit, one (10%) recognized the embarrassment by aged people and one (10%) reported anxiety and irritation. The occupational therapist was considered by most participants as the professional indicated to prescribe and monitor the use of RF. It was observed a reduced number of health professionals and caregivers who dominate the topic approached on this study. This illustrates the need to conduct further studies on the subject. (AU)

Adaptación y validación española del Perception of Restraint Use Questionnaire (PRUQ) sobre el uso de restricciones físicas en personas mayores / Spanish adaptation and validation of the Perception of Restraint Use Questionnaire (PRUQ) on the use of physical restraints on the elderly

Fundamento: Adaptar y estudiar las propiedades psicométricas en población española del Perception of Restraint Use Questionnaire (PRUQ), que mide la importancia que dan los profesionales al uso de restricciones físicas en personas mayores. Material y métodos: Tras un proceso de traducción-retrotraducción y de adaptación lingüística, se obtuvo una versión en español. A continuación, se realizó un estudio multicéntrico, descriptivo y transversal para evaluar sus propiedades psicométricas. Mediante un muestreo no probabilístico se seleccionaron 20 centros de tres comunidades autónomas; aceptaron participar 830 profesionales. Resultados: De los 17 ítems del cuestionario, 15 pudieron traducirse de manera literal; en dos hubo que realizar modificaciones menores. Un panel de expertos consideró todos aceptables (índice de validez de contenido de 0,89); un estudio piloto confirmó la adecuada factibilidad del cuestionario. El análisis en componentes principales identificó tres dimensiones que explicaban el 66,2% de la varianza. El análisis factorial confirmatorio de este modelo tridimensional mostró un ajuste aceptable [CFI = 0,936; RMSEA = 0,080], siendo las cargas y las correlaciones factoriales estadísticamente significativas (p < 0,001). La consistencia interna (alfa de Cronbach) de la puntuación total fue de 0,92, y la fiabilidad test-retest (CCIa) de 0,87 (IC 95%: 0,78 a 0,92) en un intervalo de tres semanas. Conclusiones: La versión española del PRUQ muestra buenas propiedades psicométricas y se adapta al contexto cultural de este país. Puede considerarse útil para evaluar en qué situaciones se consideran más necesarias las restricciones físicas, lo que ayudaría a diseñar actividades de formación encaminadas a racionalizar su aplicación (AU)

Background: To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. Methods: After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. Results: 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications. All were considered acceptable by an expert panel (content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbach's alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95% CI: 0.78 to 0.92) over an interval of three weeks. Conclusions: The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application (AU)

El coste económico de los procedimientos de contención mecánica de origen psiquiátrico en España / The economic cost of psychiatric mechanical restraint in Spain

La agitación de origen psiquiátrico ocurre principalmente en pacientes con trastornos psicóticos como la esquizofrenia, el trastorno esquizoafectivo y la fase maníaca del trastorno bipolar. Los métodos tradicionales para el control de los pacientes agitados incluyen la contención verbal, la contención farmacológica y la contención mecánica. En este estudio se ha estimado el coste directo sanitario asociado a la aplicación de las técnicas de contención mecánica de origen psiquiátrico en España. La cuantificación se realizó en función del tiempo empleado por profesional o número de visitas. La valoración de los recursos se realizó a partir de costes unitarios y datos epidemiológicos publicados. La aplicación de un procedimiento de contención mecánica a un paciente psiquiátrico supone un coste total por episodio de 513-1.160 Euros (considerando una duración de 4 a 12 h, respectivamente). El coste total anual se ha estimado en 27 millones de euros, considerando una duración por episodio de 4 h (AU)

Agitation is a group of psychiatric symptoms that commonly occur in patients with psychotic disorders, including schizophrenia, schizoaffective disorder and manic phase of bipolar disorder. Traditional methods of controlling agitated patients include verbal de-escalation, mechanical and pharmacological restraints. This study attempts to determine the direct medical costs attributable to psychiatric mechanical restraint in Spain. This resource was evaluated using published unit costs and national epidemiological data. The estimated direct costs of a restraint episode ranged from Euros 513-Euros 1,160 (4 -12 h per episode duration, respectively). Total annual costs of psychiatric mechanical restraint considering a duration of 4 h per episode were estimated at Euros 27 million (AU)

La restricción física de los pacientes SIGLOS XIX Y XX / Physical restraint of patients: historical notes relating to the nineteenth and twentieth century

La restricción física ha sido considerada históricamente como un procedimiento necesario para controlar la conducta de los enfermos mentales. A finales del siglo xviii el tratamiento moral daría paso a nuevas iniciativas contrarias a la contención, como las instituidas por los psiquiatras ingleses. Éstos resaltaron la importancia de la formación y de la vigilancia, así como de unas ratios mínimas de personal, como factores determinantes para reducir el uso de la sujeción. Esta filosofía de trabajo, a pesar de sus beneficios, se introdujo de forma más tardía y en menor medida en el resto de Europa; si bien en otros países también se humanizaron los cuidados mediante nuevas propuestas terapéuticas. Por el contrario, en Estados Unidos la mayoría de los psiquiatras discrepó con los defensores de la no-restricción y siguió utilizando controvertidos métodos para controlar la conducta de los pacientes. En España numerosas dificultades impidieron mejorar las condiciones de las instituciones, muchas de las cuales se encontraban en una situación lamentable. Las iniciativas de algunos profesionales y unos tímidos avances legales trataron de aliviar la dureza de este procedimiento. A principios del siglo xx ya se disponía de manuales que incluían los cuidados a seguir durante la aplicación de una restricción física. En la década de 1950 la aparición de los nuevos fármacos psicotrópicos y la difusión de destacadas resoluciones sobre la protección de los derechos de los pacientes consiguió reducir el uso generalizado de este procedimiento(AU)

Physical restraint has been historically considered a necessary procedure to control the behaviour of the mentally ill. In the late eighteenth century moral treatment would pave the way for new initiatives against restraint, such as those instituted by British psychiatrists. They stressed the importance of training and supervision, as well as a minimum staff ratio, as being determining factors in reducing the use of restraint. This philosophy of treatment, despite its benefits, was introduced later and to a lesser extent in the rest of Europe; although, in other countries care was also made more humane through new therapeutic procedures. By contrast, in the United States most psychiatrists disagreed with those who advocated non-restraint, and continued using controversial methods to control the behaviour of patients. In Spain many difficulties hindered the improvement of conditions in institutions, many of which were in a sorry state. The initiatives of a few professionals and some cautious legal advances tried to alleviate the harshness of the treatment methods used. In the early twentieth century professional manuals were already available, which included the care to be given during the application of physical restraints. However, it was not until the 1950, when the emergence of new psychotropic drugs and the distribution of important guidelines on the protection of the rights of patients that the widespread use of this procedure would be successfully reduced(AU)

Effects of an Educational Program for the Reduction of Physical Restraint Use by Caregivers in Geriatric Hospitals

PURPOSE: The purposes of this study were to develop an educational program to reduce the use of physical restraints for caregivers in geriatric hospitals and to evaluate the effects of the program on cargivers' knowledge, attitude and nursing practice related to the use of physical restraints. METHODS: A quasi experimental study with a non-equivalent control group pretest-posttest design was used. Participants were recruited from two geriatric hospitals. Eighteen caregivers were assigned to the experimental group and 20 to the control group. The data were collected prior to the intervention and at 6 weeks after the intervention through the use of self-administered questionnaires. Descriptive statistics, chi-square test, Fisher's exact probability test, and Mann-Whitney U test were used to analyze the data. RESULTS: After the intervention, knowledge about physical restraints increased significantly in experimental group compared to the control group. However, there were no statistically significant differences between the groups for attitude and nursing practice involving physical restraints. CONCLUSION: Findings indicate that it is necessary to apply knowledge acquired through educational programs to nursing practice to reduce the use of physical restraints. User friendly guidelines for physical restraints, administrative support of institutions, and multidisciplinary approaches are required to achieve this goal.

Effects of on Education Program for Nurses on the Use of Restraints / 간호학회지

PURPOSE: This study was conducted to verify the effects of an education program of restraints use on nurses' knowledge, attitude and nursing performance related to restraints use. METHOD: A quasi experimental study with a pre and post non-equivalent design was used. The subjects were nurses who met the selection criteria and worked in intensive care units of two university hospitals located at K-city, Gyeongbuk. Twenty nurses in A hospital were designated as the experimental group and 20 nurses in B hospital as the control group. RESULT: The first hypothesis which assumed that the experimental group would have higher scores of knowledge than the control group was supported(F=62.66, p=0.000). The second hypothesis which assumed that the experimental group would have lower scores of attitude toward using restraints than the control group was supported(F=23.77, p=0.000). The third hypothesis which assumed that the experimental group would have higher scores of nursing performance than the control group was supported(F=3.28, p=0.032). CONCLUSION: An education program for nurses' on the use of restraints needs to be introduced to decrease inappropriate use of restraints.

La utilización de medidas coercitivas en psiquiatría / Use of coercive measures in psychiatry

Introducción. La utilización de medidas restrictivas en el tratamiento de los enfermos mentales se remonta a los orígenes mismos de la psiquiatría. El difícil equilibrio entre la protección y seguridad de los pacientes y el respeto a la elección de tratamiento y a la libertad del individuo ha suscitado un profundo debate en la práctica psiquiátrica desde los tiempos de Pinel y de la «terapia moral». La efectividad de su aplicación tanto a corto como a largo plazo, su repercusión sobre la adherencia al tratamiento, la percepción subjetiva de los propios pacientes que han sido sometidos a las mismas y su relación con la conciencia de enfermedad son sólo algunas cuestiones sobre las que aún existen pocos datos en la literatura.Objetivos. Este trabajo realiza una actualización y revisión sobre la utilización de medidas coercitivas en el tratamiento psiquiátrico y forma parte del proyecto EUNOMIA (estudio europeo sobre evaluación de las medidas coercitivas en el tratamiento psiquiátrico).Conclusiones. a) La utilización de medidas coercitivas (aislamiento, contención física y química) son procedimientos ampliamente extendidos en la hospitalización psiquiátrica; b) llama la atención la ausencia de estudios empíricos sistematizados sobre la evaluación de la utilización de tales medidas, y c) desde el punto de vista jurídico aún existe una gran ambigüedad en el marco regulador de su aplicación

Introduction. The use of coercive measures in the treatment of medical patients dates back to the origins of psychiatry. The difficult balance between patient protection and safety, patient rights and freedom to choose treatment has provoked strong discussion in the psychiatric practice since the age of Pinel and «moral treatment». Their short and long-term effectiveness and their influence on treatment adherence as well as the subjective perception of patients submitted to coercive measures and their relationship with the awareness of illness are only some of the questions for which we still have few answers.Objectives. This article reviews and updates the topic on the use of coercive measures in psychiatric treatment. It forms a part of the EUNOMIA project, a European study evaluating the use of coercive measures in the treatment of psychiatric patients in twelve countries.Conclusions. a) The use of coercive measures (seclusion, physical and chemical restraint) in the treatment of psychiatric patients is very common in psychiatric hospitalization; b) there is a remarkable lack of experimental studies concerning the use of these measures, and c) from the legal viewpoint, ambiguity still exists in the regulation of the application of these measures