International variation in containment measures for disturbed psychiatric inpatients: a comparative questionnaire survey.
BACKGROUND
Disturbed psychiatric inpatients are managed using a range of containment measures (e.g. seclusion, mechanical restraint) whose use differs by country. Little is known about why these differences exist, or about how staff choose between the different methods available to them.


OBJECTIVE
To compare psychiatric professionals attitudes to containment measures between countries with different practices, and to discover what factors have the greatest impact on preparedness to use a containment method.


METHODS
Surveys of psychiatric professionals in the United Kingdom, the Netherlands, Finland, and Australia, using the Attitude to Containment Measures Questionnaire.


RESULTS
Relative approval of different containment measures broadly matched what we know about different practices, with some notable differences. Staff in Finland expressed the highest level of approval of containment, staff in the UK the least, with those in the Netherlands in between. Individuals' preferences for different containment measures were largely determined by whether they considered it (i) safe for the patients undergoing it, (ii) prevented them from injuring others, and (iii) quickly calmed them.


CONCLUSIONS
Future evaluation research on containment measures should use time taken to calm the patient, injury to patients and others, as primary outcomes. National clinical audit and injury reporting systems would also enable the identification of methods that are truly physically injurious to patients, aiding in the rational selection of appropriate containment measures.
Bowers
Len
L
St Bartholomew School of Nursing and Midwifery, City University, London, UK. l.bowers@city.ac.uk
van der Werf
Bert
B
Vokkolainen
Aila
A
Muir-Cochrane
Eimear
E
Allan
Teresa
T
Alexander
Jane
J
D000328:Adult; D001291:Attitude of Health Personnel / Q000208:ethnology; D001315:Australia; D002983:Clinical Competence; D003431:Cross-Cultural Comparison; D005260:Female; D005387:Finland; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007297:Inpatients; D008297:Male; D009426:Netherlands; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000523:psychology*; D010356:Patient Isolation / Q000706:statistics & numerical data; D011568:Psychiatric Nursing / Q000193:education / Q000379:methods*; D012149:Restraint, Physical / Q000706:statistics & numerical data; D017751:Safety Management / Q000379:methods*; D020377:Self Efficacy; D011795:Surveys and Questionnaires; D006113:United Kingdom
D006993:Hypnotics and Sedatives