Archives of Psychiatric Nursing
Volume 20, Issue 4 , Pages 175-185 , August 2006

The Conceptualization of Physical Restraint as a Nursing-Sensitive Adverse Outcome in Acute Care Psychiatric Treatment Settings

  • Angela M. Gerolamo

      Affiliations

    • Corresponding Author InformationAddress reprint requests to Angela M. Gerolamo MSN, APRN, BC, Pre-Doctoral Fellow, Center for Health Outcomes and Policy Research, RM 325, 420 Guardian Drive, Philadelphia, PA 19104.

References 

  1. Aiken LH, Patrician P. Measuring organizational traits of hospitals: The revised nursing work index. Nursing Research. 2000;49:146–153
  2. American Nurses' Association . Scope and standards of psychiatric–mental health nursing practice. Washington, DC: American Nurses Publishing; 2000;
  3. Bassett D, Tsourtos G. Inpatient suicide in a general hospital psychiatric unit: A consequence of inadequate resources?. General Hospital Psychiatry. 1993;15:301–306
  4. Bellus SB, Vergo JG, Kost PP, Stewart D, Barkstrom SR. Behavioral rehabilitation and the reduction of aggressive and self-injurious behaviors with cognitively impaired, chronic psychiatric inpatients. Psychiatric Quarterly. 1999;70:27–37
  5. Benson WD, Briscoe L. Jumping the hurdles of mental health care wearing cement shoes: Where does the inpatient psychiatric nurse fit in?. Journal of the American Psychiatric Nurses Association. 2003;9:123–128
  6. Berg A, Hallberg IR. Psychiatric nurses' lived experiences of working with inpatient care on a general team psychiatric ward. Journal of Psychiatric and Mental Health Nursing. 2000;7:323–333
  7. Bower FL, McCullough CS, Timmons ME. A synthesis of what we know about the use of physical restraints and seclusion with patients in psychiatric and acute care settings: 2003 Update. Online Journal of Knowledge Synthesis for Nursing. 2003, April;10:Document 1; retrieved on October 17, 2003, from http://www.stti.iupui.edu/library/ojksn/articles/100001.pdf
  8. Callaghan P. Organisation and stress among mental nurses. Nursing Times. 1991;87:50
  9. Canatsey K, Roper JM. Removal from stimuli for crisis intervention: Using least restrictive methods to improve the quality of patient care. Issues in Mental Health Nursing. 1997;18:35–44
  10. Cheung P, Schweitzer I, Tuckwell V, Crowley KC. A prospective study of aggression among psychiatric patients in inpatient wards. Australian and New Zealand Journal of Psychiatry. 1996;30:257–262
  11. Chou K, Lu R, Chang M. Assaultive behavior by psychiatric in-patients and its related correlates. Journal of Nursing Research. 2001;9:139–150
  12. Chou K, Lu R, Mao W. Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan. Archives of Psychiatric Nursing. 2002;16:187–195
  13. Clarke SP, Aiken LH. Failure to rescue. American Journal of Nursing. 2003;103:42–47
  14. Cleary M. The realities of mental health nursing in acute inpatient environments. International Journal of Mental Health Nursing. 2004;13:53–60
  15. Cleary M, Edwards C. ‘Something always comes up’: Nurse–patient interaction in an acute psychiatric setting. Journal of Psychiatric and Mental Health Nursing. 1999;6:469–477
  16. Cleary M, Jordan R, Horsfall J, Mazoudier P, Delaney J. Suicidal patients and special observation. Journal of Psychiatric and Mental Health Nursing. 1999;6:461–467
  17. Coleman JC, Paul GL. Relationship between staffing ratios and effectiveness of inpatient psychiatric units. Psychiatric Services. 2001;52:1374–1379
  18. Craig C, Ray F, Hix C. Seclusion and restraint: Decreasing the discomfort. Journal of Psychosocial Nursing and Mental Health Services. 1989;27:16–19
  19. Crowner M, Peric G, Stepcic F, Ventura F. Psychiatric patients' explanations for assaults. Psychiatric Services. 1995;46:614–615
  20. Delaney J, Clearly M, Jordan R, Horsfall J. An exploratory investigation into the nursing management of aggression in acute psychiatric settings. Journal of Psychiatric and Mental Health Nursing. 2001;8:77–84
  21. Dickerson F, Ringel N, Parente F, Boronow J. Seclusion and restraint, assaultiveness, and patient performance in a token economy. Hospital Community Psychiatry. 1994;45:168–170
  22. Donat DC. Impact of improved staffing on seclusion/restraint reliance in a public psychiatric hospital. Psychiatric Rehabilitation Journal. 2002;25:413–416
  23. Duxbury J. An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: A pluralistic design. Journal of Psychiatric and Mental Health Nursing. 2002;9:325–337
  24. Duxbury J, Whittington R. Causes and management of patient aggression and violence: Staff and patient perspectives. Journal of Advanced Nursing. 2005;50:469–478
  25. Fagin L, Brown D, Bartlett H, Leary J, Carson J. The Claybury community psychiatric nurse stress study: Is it more stressful to work in the hospital or the community?. Journal of Advanced Nursing. 1995;22:347–358
  26. Fagin L, Carson J, Leary J, DeVilliers N, Bartlett H, O'Malley P, et al. Stress, coping and burnout in mental health nurses: Findings from three research studies. International Journal of Social Psychiatry. 1996;42:102–111
  27. Fagin-Pryor EC, Haber L, Dunlap D, Nall JL, Stanley G, Wolpert R. Patients' views of causes of aggression by patients and effective interventions. Psychiatric Services. 2003;54:549–553
  28. Farrell GA, Dares G. Nursing staff satisfaction on a mental health unit. Australian and New Zealand Journal of Mental Health Nursing. 1999;8:51–57
  29. Ferguson JS, Smith A. Aggressive behavior on an inpatient geriatric unit. Journal of Psychosocial Nursing. 1996;34:27–32
  30. Forster PL, Cavness C, Phelps MA. Staff training decreases use of seclusion and restraint in an acute psychiatric hospital. Archives of Psychiatric Nursing. 1999;13:269–271
  31. Fourie WJ, McDonald S, Connor J, Barlett S. The role of the registered nurse in an acute inpatient mental health setting in New Zealand: Perceptions versus reality. International Journal of Mental Health Nursing. 2005;14:134–141
  32. Gerolamo AM. State of the science: Outcomes of acute inpatient psychiatric care. Archives of Psychiatric Nursing. 2004;18:203–214
  33. Gillig PM, Market R, Barron J, Coleman F. A comparison of staff and patient perceptions of the causes and cures of physical aggression on a psychiatric unit. Psychiatric Quarterly. 1998;69:45–60
  34. Green JS, Grindel CG. Supervision of suicidal patients in adult inpatient psychiatric units in general hospitals. Psychiatric Services. 1996;47:859–863
  35. Hall JE. Restriction and control: The perception of mental health nurses in a UK acute inpatient setting. Issues in Mental Health Nursing. 2004;25:539–552
  36. Haller RM, Deluty RH. Characteristics of psychiatric inpatients who assault staff severely. Journal of Nervous and Mental Disease. 1990;178:536–537
  37. Happell B, Martin T, Pinkahana J. Burnout and job satisfaction: A comparative study of psychiatric nurses from forensic and a mainstream mental health service. International Journal of Mental Health Nursing. 2003;12:39–47
  38. Health Care Financing Administration . Patient treatment in mental hospitals. Retrieved on October 5 2000, from http://www.hcfa.gov/testimony/1999/991026.htm1999, October;
  39. Heeren, J. K. (1991). Stress, hardiness, and burnout among psychiatric nurses working in hospital settings. Unpublished doctoral dissertation, University of Virginia.
  40. Higgins R, Hurst K, Wistow G. Nursing acute psychiatric patients: A quantitative and qualitative study. Journal of Advanced Nursing. 1999;29:52–63
  41. Ilkiw-Lavelle O, Grenyer B. Differences between patient and staff perceptions of aggression in mental health units. Psychiatric Services. 2003;54:389–393
  42. Ito H, Eisen SV, Sederer LI, Yamada O, Tchimori H. Factors affecting psychiatric nurses' intention to leave their current job. Psychiatric Services. 2001;52:232–234
  43. Johnson ME. Being restrained: A study of power and powerlessness. Issues in Mental Health Nursing. 1998;19:191–206
  44. Johnson ME. Violence on inpatient psychiatric units: State of the science. Journal of the American Psychiatric Nurses Association. 2004;10:113–121
  45. Johnson ME, Hauser PM. The practices of expert psychiatric nurses: Accompanying the patient to a calmer personal space. Issues in Mental Health Nursing. 2001;22:651–668
  46. Joint Commission on Accreditation of Healthcare Organizations (JCAHO) . Front line of defense: The role of nurses in preventing sentinel events. Oakbrook Terrace, IL: Joint Commission Resources; 2001;
  47. Kalogjera IJ, Watson WN, Myer AD. Impact of therapeutic management on use of seclusion and restraint with disruptive adolescent inpatients. Hospital and Community Psychiatry. 1989;40:280–285
  48. Katz P, Kirkland FR. Violence and social structure on mental hospital wards. Psychiatry. 1990;53:262–277
  49. Kearney, B. K. (1995). The experience of burnout in psychiatric/mental health nursing: An interpretive interactionist approach. Unpublished doctoral dissertation, The University of Texas at Austin.
  50. Kennedy J, Harrison J, Hills T, Bluglass R. Analysis of violent incidents in a regional secure unit. Medicine, Science, and the Law. 1995;35:255–260
  51. Kingdon DG, Bakewell EW. Aggressive behavior: Evaluation of a non-seclusion policy of a district psychiatric service. British Journal of Psychiatry. 1988;153:613–634
  52. Klinge V. Staff opinions about seclusion and restraint at a state forensic hospital. Hospital and Community Psychiatry. 1994;45:138–141
  53. Lake ET. Development of the practice environment scale of the nursing work index. Research in Nursing and Health. 2002;25:176–188
  54. Lanza ML, Kayne HL, Gulliford D, Hicks C, Islam S. Staffing of inpatient psychiatric units and assault by patients. Journal of the American Psychiatric Nurses Association. 1997;3:42–48
  55. Lanza ML, Kayne HL, Hicks C, Milner J. Environmental characteristics related to patient assault. Issues in Mental Health Nursing. 1994;15:319–335
  56. Lanza ML, Kayne HL, Pattison I, Islam S. Predicting violence: Nursing diagnosis versus psychiatric diagnosis. Nursing Diagnosis. 1994;5:151–157
  57. Lehane, M., & Rees, C. (1996). Alternatives to seclusion in psychiatric care. British Journal of Nursing, 5, 974, 976–979.
  58. Link BG, Stueve A, Phelan J. Psychotic symptoms and violent behaviors: Probing the components of ‘threat/control–override’ symptoms. Social Psychiatry and Psychiatric Epidemiology. 1998;33:S55–S60
  59. Lowe T, Wellman N, Taylor R. Limit-setting and decision making in the management of aggression. Journal of Advanced Nursing. 2003;41:154–161
  60. Maier GJ, Van Rybrobek GJ, Mays DV. A report on staff injuries and ambulatory restraints: Dealing with patient aggression. Journal of Psychosocial Nursing and Mental Health Services. 1994;32:23–29
  61. Marangos-Frost S, Wells D. Psychiatric nurses' thoughts and feelings about restraint use: A decision dilemma. Journal of Advanced Nursing. 2000;31:362–369
  62. McCue RE, Urcuyo L, Lilu Y, Tobias T, Chambers MJ. Reducing restraint use in a public psychiatric inpatient service. Journal of Behavioral Health Services Research. 2004;32:217–224
  63. Melchior ME, Bours GJ, Schmitz P, Wittich Y. Burnout in psychiatric nursing: A meta-analysis of related variables. Journal of Psychiatric and Mental Health Nursing. 1997;4:193–201
  64. Mistral W, Hall A, McKee P. Using therapeutic community principles to improve the functioning of a high care psychiatric ward in the UK. International Journal of Mental Health Nursing. 2002;11:10–17
  65. Mitchell PH, Ferketich S, Jennings BM. Quality Health Outcomes Model. Image Journal of Nursing Scholarship. 1998;30:43–46
  66. Mohr, W. K. (1995). The nature of nurses' experiences in for-profit psychiatric hospital settings. Doctoral dissertation, The University of Texas at Austin.
  67. Morales E, Duphorne PL. Least restrictive measures: Alternatives to four-point restraints and seclusion. Journal of Psychosocial Nursing. 1995;33:13–16
  68. Morrison E. The tradition of toughness: A study of nonprofessional nursing care in psychiatric settings. IMAGE: Journal of Nursing Scholarship. 1990;22:32–38
  69. Morrison E. Violent psychiatric inpatients in a public hospital. Scholarly Inquiry for Nursing Practice. 1990;4:65–82
  70. Morrison E. The culture of caregiving and aggression in psychiatric settings. Archives of Psychiatric Nursing. 1998;12:21–31
  71. National Quality Forum (NQF) . National voluntary consensus standards for nursing-sensitive care: An initial performance measure set. Retrieved on March 22, 2004, from http://www.qualityforum.org/activities/home.htm2004;
  72. Ng B, Kumar S, Ranclaud M, Robinson E. Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatric Services. 2001;52:521–525
  73. Nijman H, Merckelbach H, Allertz W, aCampo J. Prevention of aggressive incidents on a closed psychiatric ward. Psychiatric Services. 1997;48:694–698
  74. Nolan KA, Czobor P, Roy BB, Platt MM, Shope CB, Citrome LL, et al. Characteristics of assaultive behavior among psychiatric inpatients. Psychiatric Services. 2003;54:1012–1016
  75. O'Brien L, Cole R. Mental health nursing practice in acute psychiatric close-observation areas. International Journal of Mental Health Nursing. 2004;13:89–99
  76. Owen C, Tarantello C, Jones M, Tennant C. Violence and aggression in psychiatric units. Psychiatric Services. 1998;49:1452–1457
  77. Owen C, Tarantello C, Jones M, Tennant C. Repetitively violent patients in psychiatric units. Psychiatric Services. 1998;49:1458–1461
  78. Poster EC, Ryan J. A multiregional study of nurses' beliefs about work safety and patient assault. Hospital and Community Psychiatry. 1994;45:1104–1109
  79. Powell G, Caan W, Crowe M. What events precede violent incidents in psychiatric hospitals?. British Journal of Psychiatry. 1994;165:107–112
  80. Raja M, Azzoni A, Lubich L. Aggressive and violent behavior in a population of psychiatric inpatients. Social Psychiatry and Psychiatric Epidemiology. 1997;32:428–434
  81. Richmond I, Trujillo D, Schmelzer J, Phillips S, Davis D. Least restrictive alternatives: Do they really work?. Journal of Nursing Care Quality. 1996;11:29–37
  82. Robinson JR, Clements K, Land C. Workplace stress among psychiatric nurses. Prevalence, distribution, correlates, predictors. Journal of Psychosocial Nursing Mental Health Services. 2003;41(4):32–41
  83. Ryan T, Hills B, Webb L. Nurse staffing levels and budgeted expenditure in acute mental health wards: A benchmarking study. Journal of Psychiatric Mental Health Nursing. 2004;11:73–81
  84. Sammut RG. Psychiatric nurses' satisfaction: The effects of closure of a hospital. Journal of Advanced Nursing. 1997;26:20–24
  85. Schwab PJ, Lahmeyer CB. The use of seclusion on a general hospital psychiatric unit. Journal of Clinical Psychiatry. 1979;40:228–231
  86. Secker J, Benson A, Balfe E, Lipsedge M, Robinson S, Walker J. Understanding the social context of violent and aggressive incidents on an inpatient unit. Journal of Psychiatric and Mental Health Nursing. 2004;11:172–178
  87. Severinsson E, Hummelvoll JK. Factors influencing job satisfaction and ethical dilemmas in acute psychiatric care. Nursing and Health Sciences. 2001;3:81–90
  88. Severinsson EJ, Hallberg IR. Systematic clinical supervision, working milieu and influence over duties: The psychiatric nurse's viewpoint—A pilot study. International Journal of Nursing Studies. 1998;33:394–406
  89. Sheridan M, Henrion R, Robinson L, Baxter V. Precipitants of violence in a psychiatric inpatient setting. Hospital and Community Psychiatry. 1990;41:776–780
  90. Sullivan PJ. Occupational stress in psychiatric nursing. Journal of Advanced Nursing. 1993;18:591–601
  91. Swift MB, Williams RB, Potter ML. Behavior of nursing home residents. Journal of Psychosocial Nursing. 2002;40:40–45
  92. Tam E, Englesmann F, Fugere R. Patterns of violent incidents by patients in a general hospital psychiatric facility. Psychiatric Services. 1996;47:86–88
  93. Tardiff K. Emergency management of violent patients. New Trends in Experimental and Clinical Psychiatry. 1999;15:145–149
  94. Taxis JC. Ethics and praxis: Alternative strategies to physical restraint and seclusion in a psychiatric setting. Issues in Mental Health Nursing. 2002;23:157–170
  95. Taylor B, Barling J. Identifying sources and effects of carer fatigue and burnout for mental health nurses: A qualitative approach. International Journal of Mental Health Nursing. 2004;13:117–125
  96. Thompson P. The use of seclusion in psychiatric hospitals in the Newcastle area. British Journal of Psychiatry. 1986;149:471–474
  97. Thomsen S, Arnetz B, Nolan P, Soares J, Dallender J. Individual and organizational well-being in psychiatric nursing: A cross-cultural study. Journal of Advanced Nursing. 1999;30:749–757
  98. Visalli H, McNasser G, Johnstone L, Lazzaro CA. Reducing high-risk interventions for managing aggression on psychiatric settings. Journal of Nursing Care Quality. 1997;11:54–61
  99. Weiss EM. Deadly restraint: A nationwide pattern of death. The Hartford Courant. Retrieved on October 24 2003, from http://www.copaa.net/newstand/day1.html1998, October;
  100. Whittington R. Attitudes toward patient aggression amongst mental health nurses in the ‘zero tolerance’ era: Associations with burnout and length of experience. Journal of Clinical Nursing. 2002;11:819–825
  101. Whittington R, Patterson P. Verbal and non-verbal behavior immediately prior to aggression by mentally disordered people: Enhancing assessment of risk. Journal of Psychiatric and Mental Health Nursing. 1996;3:47–54
  102. Whittington R, Wykes T. Staff strain and social support in a psychiatric hospital following assault by a patient. Journal of Advanced Nursing. 1992;17:480–486
  103. Williams JE, Myers RE. Relationship of less restrictive interventions with seclusion/restraints usage, average years of psychiatric experience, and staff mix. Journal of the American Psychiatric Nurses' Association. 2001;7:139–144

 This project was supported by a research fellowship from The National Institute of Nursing Research, National Institutes of Health (T32-NR-007104).

PII: S0883-9417(06)00030-6

doi: 10.1016/j.apnu.2005.12.005

Archives of Psychiatric Nursing
Volume 20, Issue 4 , Pages 175-185 , August 2006