A systematic review of the safety and effectiveness of restraint and seclusion as interventions for the short-term management of violence in adult psychiatric inpatient settings and emergency departments.
OBJECTIVE
The aim of this review was to assess whether restraint and seclusion are safe and effective interventions for the short-term management of disturbed/violent behaviour. Staff and service user perspectives on the use of these interventions were also considered. The review was undertaken as part of the development process for a national guideline on the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings and emergency departments in the United Kingdom.


METHODS
An exhaustive literature search was undertaken. Systematic reviews, before and after studies, as well as qualitative studies were included. Searches were run from 1985 to 2002.


RESULTS
Thirty-six eligible studies were identified. However, none were randomised controlled trials. Most of the included studies had many limitations, such as small sample sizes, confounders not adequately accounted for, potential selection bias, poorly reported results, and lack of clarity as to whether mechanical restraints were used. This review must therefore be viewed as a mapping exercise, which illustrates the range and quality of studies that have been undertaken in this area to date.


CONCLUSIONS
Insufficient evidence is available to determine whether seclusion and restraint are safe and/or effective interventions for the short-term management of disturbed/violent behaviour in adult psychiatric inpatient settings. These interventions should therefore be used with caution and only as a last resort once other methods of calming a situation and/or service user have failed.
Nelstrop
Louise
L
Royal College of Nursing Institute, Radcliffe Infirmary, Oxford, UK.
Chandler-Oatts
Jackie
J
Bingley
William
W
Bleetman
Tony
T
Corr
Frank
F
Cronin-Davis
Jane
J
Fraher
Donna-Maria
DM
Hardy
Phil
P
Jones
Sophie
S
Gournay
Kevin
K
Johnston
Sue
S
Pereira
Stephen
S
Pratt
Peter
P
Tucker
Rick
R
Tsuchiya
Aki
A
D032763:Behavior Control / Q000379:methods; D004636:Emergency Service, Hospital; D019317:Evidence-Based Medicine; D006801:Humans; D001523:Mental Disorders; D010356:Patient Isolation; D012149:Restraint, Physical; D017751:Safety Management; D014754:Violence / Q000517:prevention & control*