Manual restraint of adult psychiatric inpatients: a literature review

Previous reviews have highlighted the ethical dilemmas faced by psychiatric nurses when deciding how to manage aggressive or violent behaviour among inpatients (Busch & Shore 2000;Fisher 1994). In some instances, maintaining the safety of the patient and others has been achieved by the use of mechanical restraint and/or seclusion. Increasingly regarded as emergency measures, patients can find the experience of restraint or seclusion traumatic. The reviews note, however, that the methods and rates of use for these interventions vary widely and are influenced by a number of non-clinical or cultural factors. This is perhaps exacerbated by a lack of research evidence to guide clinical practice. The literature on restraint and seclusion is broad, incorporating a diverse range of treatment settings and patients groups. Interpretation of research findings is hindered by such diversity. For example, it is not clear how far evidence from adult inpatients is relevant to the experience of adolescents. It is also unsatisfactory that restraint and seclusion are so frequently combined into a single measure of physical control when the research demonstrates such marked differences in their application. The present review is limited to mechanical restraint, defined as the use of straps, belts or other equipment to restrict movement, as distinct from physical contact during the process of putting patients into mechanical restraints. As a consequence, no UK studies are included in the review since mechanical restraint is rarely used. The review only includes studies of adult psychiatric inpatients