The Use of Physical Restraint in Norwegian Adult Psychiatric Hospitals
Table 1
Included articles ().
Number
Category
Articles [reference]
Methods/participants ()
Key findings
1
Patients’ perceptions (1)
Patients’ satisfaction and self-rated improvement following coercive interventions [12]
Questionnaire to adult psychiatric patients (total sample , of which 19 subjected to coercion were matched to other patients) (only 3 had been physically restrained)
No significant difference in satisfaction between coerced and matched noncoerced patients
2
Patients’ perceptions (1)
Psychiatric inpatients’ experiences with restraint [13]
Interviews with adult psychiatric patients () following physical restraint
(i) Patients gave refusal of medication, refusal to follow staff directions, or their own aggression as reasons for restraint (ii) Many felt that restraint could have been avoided (iii) Some felt angry and distrustful of staff after restraint
3
Patients’ perceptions (1)
Coercion and patient satisfaction on psychiatric acute wards [14]
173 interviews and questionnaires with patients, data from medical records
Objective coercion (including mechanical restraint) had a significant negative effect on overall patient satisfaction
4
Staff’s perceptions (2)
Staff’s experiences with patients’ assaults in a Norwegian psychiatric university hospital [15]
Questionnaire to staff at one adult psychiatric hospital ()
(i) Patients’ assault, acting-out, and self-harming were given as most important reasons for physical restraint (ii) 80% of staff believed that physical restraint was used appropriately, and 94% believed it did not influence patients’ recovery
5
Staff’s perceptions (2)
Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital [16]
Questionnaire to staff at one adult psychiatric hospital ()
(i) A majority of staff believed that the interventions were used correctly (ii) Male staff, highly educated staff, and staff at high-use wards were most critical to use (iii) 70% had been assaulted in connection with the interventions
6
Staff’s perceptions (2)
Staff’s choice of formal and informal coercive interventions in psychiatric emergencies [17]
Questionnaire with simulated cases to staff at one adult psychiatric hospital ()
(i) Informal interventions are preferred by staff (ii) Such interventions are typically not recorded and their importance may therefore be overlooked
7
Staff’s perceptions (2)
Attitudes to coercion at two Norwegian psychiatric units [18]
Questionnaire with simulated cases to staff at two adult psychiatric units ()
There was a limited degree of variance in staff’s responses with respect to degree of restrictiveness The study supported the idea that a range of different interventions are used in emergency situations
8
Rates, characteristics (3)
The care conditions for especially dangerous psychotic patients [19]
Review of records at one institution (Reitgjerdet)
(i) In 1977, physical restraint was used 15 444 days (22.4% of all patient days) (ii) In 1980, it was used 566 patient days (iii) In the first third of 1981, it was used only 1,5 patient days
9
Rates, characteristics (3)
Use of coercive measures in Norwegian psychiatric institutions [20]
Examination of records of mechanical restraint (“screening”)
During the first six months of 1988, 203 patients had been mechanically restrained for 10,767 hours
10
Rates, characteristics (3)
Changes in the use of coercive measures in Norwegian psychiatric institutions [21]
Examination of records of mechanical restraint (“screening”)
(i) 9402 hours of mechanical restraint were recorded in the first half of 1990 (ii) Single patients create large variations in use (iii) No correlation between size of ward or staff ratio and use of coercion (iv) No difference in levels from previous study (1986–1988)
11
Rates, characteristics (3)
Psychiatric security units in Norway; patients and activity [22]
Review of medical records of patients in Norwegian security units ()
25% had been subjected to physical restraint during a six-month period in 1993
12
Rates, characteristics (3)
Polar day and polar night: month of year and time of day and the use of physical and pharmacological restraint in a north Norwegian university psychiatric hospital [23]
Review of protocols and medical records regarding restraint during a 5.5-year period
(i) There was a daily peak with most use of restraint in the afternoon and early evening and a seasonal peak—with the most use of restraint in autumn (ii) Patterns of use might be caused by light-dark cycles, variations in life-events, and variations in the ward environment
13
Rates, characteristics (3)
Medicate, restrain, or seclude? Strategies for dealing with violent and threatening behaviour in a Norwegian university psychiatric hospital [24]
Review of protocols and medical records from a 5.5-year period at a psychiatric hospital
(i) 797 episodes of physical restraint were identified (ii) Patients’ sex, age group, and diagnostic group were of importance to use (more use with male, younger, and nonpsychotic patients)
14
Rates, characteristics (3)
Association between patients’ gender, age, and immigrant background and use of restraint—a 2-year retrospective study at a department of emergency psychiatry [25]
The study retrospectively examined routinely collected data and data from restraint protocols in a department of acute psychiatry over a 2-year period
(i) 14% of the patients were subjected to physical and/or pharmacological restraint (ii) The rate was significantly higher among patients with immigrant background, especially in the younger age groups
15
Rates, characteristics (3)
Staff injuries after patient-staff incidences in psychiatric acute wards [26]
507 patient-staff incidents in a psychiatric acute ward
Holding the patient with force was more frequent in incidents where more than one body part was injured
16
Rates, characteristics (3)
A cross-sectional prospective study of seclusion, restraint, and involuntary medication in acute psychiatric wards [9]
Medical records data from 1014 involuntarily admitted patients in acute psychiatric wards, of which 117 had been physically restrained
(i) Increased risk of restraint for patients that were aggressive or had tendency to self-injury (ii) Lower risk for patients from other ethnic groups (iii) Increased risk in urban areas
17
Rates, characteristics (3)
Characteristics of psychiatric inpatients who experienced restraint and those who did not: a case-control study [27]
Retrospective case-control study of records’ data from three acute wards, two-year sample
Restrained patients (mechanically and pharmacologically) were more likely to be male, reside outside catchment area, have immigrant background, have longer stays, be involuntarily admitted, and have specific diagnoses (substance use, schizophrenia, psychoses, and bipolar disorder)
18
Rates, characteristics (3)
Mechanical and pharmacological restraints in acute psychiatric wards—why and how are they used? [8]
Data from records of patients () that had been subjected to mechanical restraint in three acute wards during a two-year period
(i) Occurring or imminent assault was most frequent reason for restraint (ii) Diagnoses, age, and reason for restraint increased the likelihood of being subjected to specific types of restraint
19
Rates, characteristics (3)
Characteristics of patients frequently subjected to pharmacological and mechanical restraint—a register study in three Norwegian acute psychiatric wards [28]
Retrospective study of records’ data from three acute wards
9.1% of those restrained (either mechanically or pharmacologically) had been so 6 or more times, accounting for 39.2% of all restraint episodes
20
Rates, characteristics (3)
Mechanical restraint in psychiatry: preventive factors in theory and practice [29]
Different data sources, including questionnaire to clinical nurse managers in Norway ()
Mandatory review, patient involvement, and no crowding were identified as preventive factors
21
Rates, characteristics (3)
Comparing the effect of nonmedical mechanical restraint preventive factors between psychiatric units in Denmark and Norway [30]
Cross-sectional survey of psychiatric units
The following factors were found to partly explain differences in restraint levels: staff education, substitute staff, acceptable work environment, separation of acutely disturbed patients, patient-staff ratio, and identification of the patients’ crises triggers
22
Intervention studies (5)
Patients’ perception of coercion in acute psychiatric wards: an intervention study [31]
Three interventions were used: patients’ engagement in the formulation of treatment plans, patient and staff evaluations, and renegotiations of treatment plans. Data were obtained on self-rating scales
(i) The interventions resulted in marginal changes (in the staff’s respect and understanding and total satisfaction) (ii) Actions taken to control behaviour (i.e., seclusion) were more strongly related to perceived coercion than aspects of compulsory treatment
23
Case studies (6)
Venous thromboembolism in connection with physical restraint [32]
Case report
Venous thromboembolism may occur in connection with physical restraint
24
Case studies (6)
Thrombosis associated with physical restraints [33]
Literature review and two cases
Immobilization and trauma to the legs while restraining a patient may lead to thrombosis
25
Case studies (6)
Physical restraint and near death of a psychiatric patient [34]
Literature review and case report
Physically restraining (holding) a patient in the prone position with a significant weight load on the torso can lead to asphyxiation
Ethnographic study (observation and interviews with five patients and six nurses) of an open seclusion unit
Distrust is prevalent, but trust can be created Regarding themselves as potential causes of distrust can contribute to nurses’ developing a realistic view of their practice
27
Ethnographic studies (7)
Coercion in a locked psychiatric ward: perspectives of patients and staff [36]
Ethnographic study
Description of one patient’s negative perceptions of physical restraint
28
Ethnographic studies (7)
Fear, danger, and aggression in a Norwegian locked psychiatric ward [37]
Ethnographic study
Physical restraint seen as a threat and means of control and as a reminder of danger
