Psychosocial Correlates of Patients Being Physically Restrained within the First 7 Days in an Acute Psychiatric Admission Ward: Retrospective Case Record Review

By Wu, Wwk | East Asian Archives of Psychiatry, June 2015 | Go to article overview

Psychosocial Correlates of Patients Being Physically Restrained within the First 7 Days in an Acute Psychiatric Admission Ward: Retrospective Case Record Review


Wu, Wwk, East Asian Archives of Psychiatry


Abstract

Objective: Clinically, patients' characteristics may predict the use of physical restraint in a psychiatric ward. This study aimed to explore significant psychosocial variables in predicting the risk for application of physical restraint with intention of identifying patients at high risk for physical restraint at the time of admission to an acute psychiatric setting.

Methods: The case records of 335 adult patients aged > 18 years, who were treated in 4 acute psychiatric admission wards of a public hospital in Hong Kong from 1 November 2013 to 28 February 2014, were retrospectively reviewed.

Results: Results of statistical analysis indicated involuntary admission, current use of psychiatric medications, no history of violent behaviour, age, and depression as significant predictors of use of physical restraint. The model accounted for 28.5% to 38.5% of the variance in the use of physical restraint. Overall, this model had a success rate of 77.6%.

Conclusion: It was concluded that 39.7% of inpatients admitted to the acute psychiatric admission ward had been restrained at least once in the first 7 days. Significant predictors of restraint included involuntary admission, current use of psychiatric medications, no history of violent behaviour, age, and depression; all of which could be regarded as risk factors for restraint.

Key words: Restraint, physical; Social environment

(ProQuest: ... denotes formulae omitted.)

Introduction

Appropriate usage of physical restraint has challenged psychiatric nurses on ethical and practical levels. Physical restraint has been used frequently to manage challenging behaviour and to safeguard both patients and staff. Clinically, patients' characteristics seem important enough to predict the use of physical restraint. It is worthwhile examining the psychosocial profile of patients undergoing physical restraint in the acute psychiatric admission ward. A review of the extant literature shows that there have been very few studies on the psychosocial correlates of patients receiving such treatment. It would therefore be interesting to examine whether there are any significant psychosocial factors exhibited by patients via the use of physical restraint. Through understanding patient profiles, it is intended that psychiatric nurses will be able to identify the high-risk group for physical restraint. This would allow them to promptly provide intensive nursing care so as to minimise the application of physical restraint.

Guidelines for Physical Restraints

Systematic literature review on physical restraint of adult psychiatric inpatients indicates that, by physically restraining a patient, the use of physical force is applied to prevent or restrict a patient's movement. Mechanical devices for physical restraint include straps, cuffs, belts, and some other external devices to restrict a patient from moving. In the psychiatric setting, mechanical restraints involve strapping a patient to a bed in the supine position with wrist and ankle cuffs, with or without a belt across their waist. This is known as the 'four- or five-point restraint'.1 Hence, physical restraint in this study is defined as "the use of mechanical devices including safety vests, magnetic limb holders, magnetic shoulder straps, pelvic holders, magnetic waists and abdominal belts applied to the patient's wrists, ankles, shoulders, waist and body that restrict freedom of movement or being secured to the bed or chair".2

In the UK, the Royal College of Nursing offers guidelines stating that physical restraint should only be used when all other methods of managing the identified problem are considered not suitable or have failed.3 In Ireland, however, there is no legislation about restraining adults.4 In Australia, guidelines for the use of restraint vary across different states.5 In Israel, psychiatric nurses are allowed to restrain patients independently.6 Nurses in Canada are prohibited from using any form of restraint without consent from the client or decision-maker, except in some emergency situations. …

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