title: eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: a cluster-randomized trial.
abstract: BACKGROUND
  The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible.
  
  
  OBJECTIVE
  The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients.
  
  
  METHODS
  In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course.
  
  
  RESULTS
  A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards.
  
  
  CONCLUSIONS
  After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.
authors.affiliation: Raija Kontio, Ph.D., Assistant Chief of Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Region, Kellokoski Hospital , Finland.
authors.forename: Raija
authors.initials: R
authors.lastname: Kontio
authors.forename: Anneli
authors.initials: A
authors.lastname: Pitkänen
authors.forename: Grigori
authors.initials: G
authors.lastname: Joffe
authors.forename: Jouko
authors.initials: J
authors.lastname: Katajisto
authors.forename: Maritta
authors.initials: M
authors.lastname: Välimäki
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology; D003068:Coercion; D003194:Computer-Assisted Instruction / Q000379:methods*; D004509:Education, Nursing, Continuing / Q000379:methods*; D005260:Female; D005387:Finland; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D001523:Mental Disorders / Q000451:nursing* / Q000523:psychology; D011568:Psychiatric Nursing / Q000193:education*; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: Cluster-randomized intervention trial; Mechanical restraint; Seclusion; eLearning