Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review
Coercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This rev...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-08-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/9/2791 |
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| author | Damián Fernández-Costa Juan Gómez-Salgado Javier Fagundo-Rivera Jorge Martín-Pereira Blanca Prieto-Callejero Juan Jesús García-Iglesias |
| author_facet | Damián Fernández-Costa Juan Gómez-Salgado Javier Fagundo-Rivera Jorge Martín-Pereira Blanca Prieto-Callejero Juan Jesús García-Iglesias |
| author_sort | Damián Fernández-Costa |
| collection | DOAJ |
| description | Coercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This review aims to assess the impact of the main alternative measures to prevent or limit the use of coercive measures with restraints in the management of agitated psychiatric patients. The research was conducted following the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in Medline, Cochrane Library, CINAHL, Web of Science, PsycInfo, LILACS, and Health Database of records between 2015 and 2020. After a critical reading, 21 valid articles were included. Both simple interventions and complex restraint programs were evaluated. Training in de-escalation techniques, risk assessment, and implementation of the “six core strategies” or “Safewards” program were the most assessed and effective interventions to reduce aggressive behaviors and the use of coercive measures. According to the revised literature, it is possible to reduce the use of restraints and coercive measures and not increase the number of incidents and violent behaviors among the patients through a non-invasive and non-pharmacological approach. However, further research and further randomized clinical trials are needed to compare the different alternatives and provide higher quality evidence. |
| first_indexed | 2024-03-10T16:43:34Z |
| format | Article |
| id | doaj.art-155b4e641b2c4b4c895b05dcac1bc2d7 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T16:43:34Z |
| publishDate | 2020-08-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-155b4e641b2c4b4c895b05dcac1bc2d72023-11-20T11:49:48ZengMDPI AGJournal of Clinical Medicine2077-03832020-08-0199279110.3390/jcm9092791Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping ReviewDamián Fernández-Costa0Juan Gómez-Salgado1Javier Fagundo-Rivera2Jorge Martín-Pereira3Blanca Prieto-Callejero4Juan Jesús García-Iglesias5Faculty of Nursing, Department of Nursing, University of Huelva, 21071 Huelva, SpainFaculty of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, SpainAndalusian Health Service, Primary Care Emergency Service, Health Sciences Doctorate School, University of Huelva, 21007 Huelva, SpainHospital Transport Consortium, Isla Cristina Health Center, Isla Cristina, 21410 Huelva, SpainHospital Virgen de la Bella, Lepe, 21440 Huelva, SpainFaculty of Labour Sciences, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, SpainCoercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This review aims to assess the impact of the main alternative measures to prevent or limit the use of coercive measures with restraints in the management of agitated psychiatric patients. The research was conducted following the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in Medline, Cochrane Library, CINAHL, Web of Science, PsycInfo, LILACS, and Health Database of records between 2015 and 2020. After a critical reading, 21 valid articles were included. Both simple interventions and complex restraint programs were evaluated. Training in de-escalation techniques, risk assessment, and implementation of the “six core strategies” or “Safewards” program were the most assessed and effective interventions to reduce aggressive behaviors and the use of coercive measures. According to the revised literature, it is possible to reduce the use of restraints and coercive measures and not increase the number of incidents and violent behaviors among the patients through a non-invasive and non-pharmacological approach. However, further research and further randomized clinical trials are needed to compare the different alternatives and provide higher quality evidence.https://www.mdpi.com/2077-0383/9/9/2791agitationaggressive behaviorsmental disorderspsychiatrymechanical restraint |
| spellingShingle | Damián Fernández-Costa Juan Gómez-Salgado Javier Fagundo-Rivera Jorge Martín-Pereira Blanca Prieto-Callejero Juan Jesús García-Iglesias Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review Journal of Clinical Medicine agitation aggressive behaviors mental disorders psychiatry mechanical restraint |
| title | Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review |
| title_full | Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review |
| title_fullStr | Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review |
| title_full_unstemmed | Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review |
| title_short | Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review |
| title_sort | alternatives to the use of mechanical restraints in the management of agitation or aggressions of psychiatric patients a scoping review |
| topic | agitation aggressive behaviors mental disorders psychiatry mechanical restraint |
| url | https://www.mdpi.com/2077-0383/9/9/2791 |
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