HNN021 Project: Analyzing Restraint Reduction in Healthcare Settings

This report, based on the HNN021 AT1 project, investigates the critical topic of restraint reduction in healthcare settings. It synthesizes findings from multiple research articles, including studies on dementia care, rehabilitation settings, and mental health facilities. The report examines the implications of restrictive practices, which limit patient independence, and highlights the need for less restrictive interventions. It reviews articles focusing on the effects of physical restraints, the implementation of restraint reduction programs, and multidimensional approaches to minimize restraint use. The synthesis discusses potential biases in the research, the importance of staff education, and the adverse effects of restraints on patient mental health. The report emphasizes the necessity of minimizing restrictive practices and promotes the use of alternative strategies to enhance patient well-being and reduce the reliance on restraints in various healthcare environments.

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Title Page
Add your details here
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Search Strategy
Description of concepts Similar search terms, using “phrase searching”,
truncation (*), wild cards (?), alternate words and alternate spellings etc.
Limits:
(Language, peer
reviewed etc.)
Concept 1
acute hospital settings Wards, units, hospital settings, care homes. Peer-reviewed
articles.
Concept 2
interventions Management, treatment, procedure, protocol.
Concept 3
restraint Reduce restraint, minimize restraints in settings.
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AND
AND
OR
OR
OR

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Concept 4
Decrease incidents of
restraint.
Prevention of restraints in hospital settings.
Databases searched:
restraint Hospital settings
Acute care settings Minimizing restraints
In-patient wards interventions
Article summaries
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AND
OR

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Reference Purpose/Aim of
the study
Is the purpose
relevant to my
question?
Sample – Who
was included in
the study?
Consider: Does
the sample
represent the
target population
in my question?
Design
Consider: Is
the design
relevant?
Method
How was the
research
conducted?
Was there a
potential for
bias?
Findings
What were the
key findings?
Are the
findings
relevant for my
question?
Level of
Evidence
Is the research
high level
evidence or
just opinion?
Additional
notes
- Was ethics
review
undertaken?
- Is it primary
or secondary
research?
Article 1 To identify the
use and need of
physical restraints
in dementia care
settings.
People diagnosed
with dementia
were taken in the
sample and those
above the age of
82 years were
provided with a
physical restraint.
The design
chosen was the
experimental
research.
The research
included the
reviewing of
peer reviewed
articles which
matched the
criteria of
physical
restraints in the
hospital
settings.
The research
aimed at
highlighting
the importance
of educating
people
regarding
prevention of
physical
restraints and
showing them
its
consequences
over the
The research
used has a
good level of
evidence as it
uses other
credible peer
reviewed
articles for the
evaluation and
reviewing over
the topic.
The ethical
principles and
guidelines were
followed as per
the criteria of
research.
The research is
secondary in
nature as it
uses
theliterature
from other peer
reviewed
researches.
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patients.
Article 2 The Effect of a
Restraint
Reduction
Program on
Physical
Restraint Rates in
Rehabilitation
Settings.
Patients for two
rehabilitation
centre were taken
into consideration.
The research
was quasi
experimental
clinical trial
was conducted.
The research
reviewed the
peer reviewed
articles and
implying the
effect of a
restraint
reduction
program on
physical
restraint rates.
The findings
explained In
the study site,
an increase in
the use of
intermittent
restraint and a
concomitant
decrease in the
use of
continuous
restraint could
mean that
members of the
staff were
adopting a less
restrictive
policy.
The use of peer
reviewed
articles
suggests that
the literature is
credible
enough and has
good level of
evidence.
The research
was secondary
in nature and it
followed all the
ethical
principles and
guidelines
important for
the research to
be conducted.
Article 3 To witness the
level of
restraining
practices and
The incidents of
seclusion were
collected form the
record and entry
The research is
of the
descriptive
form.
The research
was conducted
based on the
number of
The restraints
were gradually
minimized over
a period of
The research
was peer
reviewed and
was credible
The ethical
considerations
were followed
which were
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implementing
possible measures
to prevent the
physical restraint
to the patients.
of the hospital
setting.
cases of
physical
restraint
present in the
hospital
setting.
time and the
recovery
rounds taken
by the staff
members were
helpful in
showing its
effectiveness.
and authentic
enough for the
purpose of
study.
essential for
the research to
complete.
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Synthesis of findings (800 words)
Restrictive practices are the implications which prevent an individual from independent movement or
liberty to act as per their needs without any coercion of others. Restrictive practices are a type of isolation
where people are confined in a particular room and cannot leave that room even if they want to do so
(Blair et al., 2017). These practices are generally taken into account when the person is believed to cause
some harm to himself or herself. But these practices are now days seen more prevalent in the health and
social care settings. This is because the nursing staffs have considerably more burden of work and due to
this they seclude the patients into some or the other forms of restraints. There is a need to check these
restraints as this hampers the abilities and capacities of the patients to do certain tasks. The health and
social care staff needs to use least restrictive interventions for the patients as this provides a good mindset
for accepting the challenging behaviour for the staff (McCarthy et al., 2017). These kind of practices are
mainly seen when people damage the surroundings of a public property or may cause potential damage to
himself or herself or to people in their vicinity. They are confined in the restraints so that they can be
easily managed in cases of extreme behaviours.
The research on the topic of education on physical restraint reduction in dementia care was done to
evaluate the consequences of restraining the individuals suffering from dementia (De Bellis et al., 2013).
The research explained that dementia is the fastest growing problem and is found among every seven
people in the world. People suffering from dementia forget things around them and the tasks of their daily
living. This makes the health and social care workers to restrain them in certain barriers so that they do
not cause any harm to themselves as well as others.People above the age of 82 years were kept restraint in
the hospital setting as they were at major risk of causing harm to them as well as to others.The research
used the peer reviewed articles to understand the researches done earlier inthis context. Among all the
reviewed articles 72 articles were chosen to review the research and literature appropriately. Therefore,
the samples chosen were appropriate as they were peer reviewed and credible enough for the audience to
believe. The methodology involved using of all the peer reviewed literature in the context of restraints for
people suffering from dementia.There was some extent of potential bias seen in the literature because the
research excluded the adult above the age of 82 years. They were kept in restrained environment as they
were potentially at risk of causing harm to them as well as to others in the setting. The research finally
aimed at educating people over the consequences of restraints (Muir‐Cochrane et al., 2018). The restraints
have potentially dangerous effects on the mental health of the patient. It also compromises their abilities
to work independently as per their wish. The best possible recommendation in the context of minimizing
restrictive practices is to educate people about the ill effects of restraints on the health of people (Duxbury
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et al., 2019). This will eventually bring the consequences in light and will prevent them from using such
practices in the health and social care settings.
The second research was on the topic The Effect of a Restraint Reduction Program on Physical
Restraint Rates in Rehabilitation Settings in Hong Kong. In this the adverse effect of using restraint
reduction programme has been examined (Lai et.al., 2011). They have investigated the effect of RRP on
the reduction of physical restraints in clinical care setting. In this article quasi experimental clinical trial
was being used. The sample chosen were the reviewed articles which were taken by the secondary
research method. Various type of sampling method was being used. In this article research was completed
with collaborative effort between two rehabilitation hospitals. Approval of the study was obtained from
the ethics committee of both rehabilitation hospitals and the university. Informed consent was also taken
from service users their proxies prior to collection of data. In this article all staff members of both the
hospitals were educated using education package. Packages to staff members was given in Chinese and
English language. Discussions, simulation exercises, and case studies were used as much as possible to
render the content more relevant to real life practice. It has been analysed from article that restraint rate in
the control site was 4.3 times higher than the intervention site.
The final research was taken over the topic of multidimensional approach towards restraint minimization
(Hernandez et al., 2017). The research was done with the aim of finding the best possible measures to
decrease the use of restraints in the health and social care settings.The sample was collected from the data
records and entry of the hospital settings. This was not that appropriate method of collecting samples as
the record entry can differ from person to person. The level of perception and the way of thinking of
people can differ fromone point to another. The method was descriptive type which depended on the
number of cases reported in the hospital setting as per the records and entries. There was no potential bias
observed in the study and the study concluded with the result that decreasing the time in restraint practice
daily would eventually help one in minimizing the restraint practice in the health and social care setting
(Champagne., 2018).The restraint practice should be minimized daily with a decrease in the hourly
practice. The staff members over the rounds witnessed that a decrease in the number of seclusion and
restraining hours led to a decrease in the restrictive practices.
It is important to minimize the use of restrictive practices in the field of health and social care because
this would lead to decrease theconfidence of the patient. It increases the dependency over the restraint and
confines the person to the barriers of restraint. Whereas, on the other hand it is essential for the staff
members to face more challenging behaviours in the field of health and social care (Sashidharan et al.,
2019). More challenges will lead them to enhanced understanding and managing capabilities of such
cases in their practice.
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REFERENCES
Blair, E.W., Woolley, S., Szarek, B.L., Mucha, T.F., Dutka, O., Schwartz, H.I., Wisniowski, J. and
Goethe, J.W., 2017. Reduction of seclusion and restraint in an inpatient psychiatric setting: a pilot
study. Psychiatric Quarterly, 88(1), pp.1-7.
Lai, C.K., Chow, S.K., Suen, L.K. and Wong, I.Y., 2011. The effect of a restraint reduction program on
physical restraint rates in rehabilitation settings in Hong Kong. Rehabilitation research and
practice, 2011.
Champagne, T., 2018. Sensory modulation in dementia care: Assessment and activities for sensory-
enriched care. Jessica Kingsley Publishers.
De Bellis, A., Mosel, K., Curren, D., Prendergast, J., Harrington, A. and Muir-Cochrane, E., 2013.
Education on physical restraint reduction in dementia care: A review of the literature. Dementia, 12(1),
pp.93-110.
Duxbury, J., Baker, J., Downe, S., Jones, F., Greenwood, P., Thygesen, H., McKeown, M., Price, O.,
Scholes, A., Thomson, G. and Whittington, R., 2019. Minimising the use of physical restraint in acute
mental health services: The outcome of a restraint reduction programme (‘REsTRAIN
YOURSELF’). International journal of nursing studies, 95, pp.40-48.
Hernandez, A., Riahi, S., Stuckey, M.I., Mildon, B.A. and Klassen, P.E., 2017. Multidimensional
approach to restraint minimization: The journey of a specialized mental health organization. International
journal of mental health nursing, 26(5), pp.482-490.
McCarthy, L., Garrett, G., Bennett, G., Sims, P., Vujkovic, D. and Taylor, N., 2017. Using technology to
enhance the therapeutic impact on seclusion.
Muir‐Cochrane, E., O'Kane, D. and Oster, C., 2018. Fear and blame in mental health nurses’ accounts of
restrictive practices: Implications for the elimination of seclusion and restraint. International journal of
mental health nursing, 27(5), pp.1511-1521.
Narita, Z., Inagawa, T., Yokoi, Y., Stickley, A., Maruo, K., Yamada, Y. and Sugawara, N., 2019. Factors
associated with the use and longer duration of seclusion and restraint in psychiatric inpatient settings: a
retrospective chart review. International journal of psychiatry in clinical practice, 23(3), pp.231-235.
Sashidharan, S.P., Mezzina, R. and Puras, D., 2019. Reducing coercion in mental
healthcare. Epidemiology and psychiatric sciences, 28(6), pp.605-612.
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