Using Physical Restraint on Mental Patients in Various Healthcare Settings-Staff Perspective

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ACKNOWLEDGEMENT

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

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Table of Content

ACKNOWLEDGEMENTII

DECLARATIONIII

CHAPTER 03: LITERATURE REVIEW1

3.1Physical Restraint in Health Services (Physical Restraints)1

3.2Aggression and Seclusion3

3.2.1Seclusion As An Administrative Strategy5

3.2.2Client Characteristic Acuity6

3.2.3Work place Culture6

3.3Staff Composition And Experience7

3.3.1The Influence of Hospital Characteristics on Seclusion and Restraint Use7

3.3.2Nursing Care Staffing and Adverse Outcomes in Acute-Care Hospitals8

3.3.3Applying the Research on Nursing Care Staffing8

3.3.4Nursing Care Staffing and Seclusion and Restraint Use9

3.3.5Hospital Outcome Variation and the Evidence Base for the Conceptual Framework11

3.4Conflict13

3.4.1Failure to Rescue in Psychiatric Hospitals15

3.4.2Effective Rescue in Psychiatric Hospitals17

3.4.3Effective Rescue Promotes Positive Outcomes19

3.4.4Failure an Adverse Outcome Ethical and Legal Issues21

3.4.5Absence of a Theoretical Foundation for Seclusion and Restraint Use22

3.4.6Reasons for Seclusion and Restraint Use23

3.4.7Seclusion and Restraint Use Is Not Therapeutic23

3.4.8Seclusion and Restraint Use Is Associated With Morbidity and Mortality24

3.4.9Failure an Adverse Outcome Ethical and Legal Issues25

3.4.10Absence of a Theoretical Foundation for Seclusion and Restraint Use26

3.5Nursing Attitude27

3.5.1Influence of Patient and Hospital Characteristics on Seclusion and Restraint28

3.6Interventions30

3.7Falls/Related Wounds and Affiliated Mortality31

CHAPTER 04: DISCUSSION AND RECOMMENDATION34

DISCUSSION35

4.1Use of Restraint or Seclusion37

4.2Monitoring Of Seclusion and Restraint38

4.3Isolation Procedure40

4.4Administrative Supervision40

4.5Intake and Assessment42

4.6Psychiatric Care and Evaluation42

RECOMMENDATIONS45

4.7Treatment Planning45

4.8Staff Training45

4.9De-Escalation Techniques46

4.10Develop and Promote a Therapeutic Environment46

4.11Preventive Strategies of Aggression47

REFERENCES49

BIBLIOGRAPHY52

CHAPTER 03: LITERATURE REVIEW

The previous chapter introduced the problem of seclusion and restraint use in psychiatric hospitals. The need for a better understanding of the influence that the nursing staff numbers and skill mix might have on variation in hospitals' use of seclusion and restraint was established. The concept of failure to rescue was introduced as a way of understanding the phenomena that link nursing care staffing with adverse outcomes. The contribution that this study might make to an enhanced understanding of the potential link between seclusion and restraint use and nursing care staffing was described.

The purpose of this chapter is to introduce background literature describing the influence that nursing care staffing has on acute care hospitals' adverse outcome variation. This background literature forms the evidence base for the concept of failure to rescue (Silber, Williams, Krakauer & Schwartz, 1992) that provides the framework for this study. The concept will be used to frame a discussion of alternatives to seclusion and restraint use. Support for the concept that seclusion and restraint use is an adverse outcome will be explained. Approaches and findings from relevant research on seclusion and restraint use will be presented to support the rationale and methods used in this study. The specific contribution that this study makes toward enhancing an understanding of the factors that influence seclusion and restraint use will be discussed (Duxbury, 2002, pp.325).

Physical Restraint in Health Services (Physical Restraints)

The restraint is an obvious, ...