Running head: THE NEED TO REDUCE SECLUSION AND RESTRAINT IN 1

The Need to Reduce Seclusion and Restraint in Psychiatric Facilities

Joanna Collins

Bon Secours Memorial School of Nursing

NUR 3208

Professor Karyn Shultz MS, RN, CNE

February 4, 2017

Honor Code I pledge

The Need to Reduce Seclusion and Restraint in Psychiatric Facilities

There is a growing rate of violence among patients in psychiatric facilities across the

United States and the need to reduce the use of seclusion and restraint is a pressing concern.

While there are many ways to decrease the need for seclusion and restraints, (Gaynes, Brown, &

Lux, 2016) encourages the use of risk assessment intervention and protocols to decrease

aggression. (Gaynes et al., 2016) states that there is limited evidence for de-escalating

aggressive behavior and that further research is needed. In addition, using flashpoints per

(Bowers, 2014) to guide implementation of early intervention techniques can be useful in

prevention of seclusion and restraints. As defined by, (Bowers, 2014, p. 501) flashpoints are

events or social circumstances that are most likely to trigger a conflict or containment event in

the very short term. The purpose of this paper is to discuss the need for further research into

earl intervention protocols to prevent the use of seclusion and restraints in psychiatric facilities.

Discussion

Currently, there are early intervention techniques used by mental health workers to de-

escalate patients and prevent more restrictive alternatives. The Safewards Model, provided by

(Bowers, 2014) depicts the use of flashpoints to recognize early triggers that can lead a patient to

have aggressive behavior and ways to modify the flashpoints to prevent further escalation.

Flashpoints, as depicted in this model, can be anything that can affect a patients mood

negatively, bring about a sense a fear, or cause agitation. For example, a flashpoint can be

anything in the patients hospital environment such as, being in a locked facility, a crowded

milieu, and being around other individuals with a negative outlook. They can be outside hospital

influences such as, a patient receiving bad news about a loved one or not having the money to

pay a bill. It is possible to control any of these flashpoints with a trained team that is educated in

de-escalation techniques and milieu management. This is done by using modifiers such as with

trained staff and managing the environment per (Bowers, 2014). However, there is no set

protocol in place that has been researched to effectively decrease seclusion and restraints.

(Gaynes et al., 2016) completed a systematic review of interventions currently being used

to de-escalate patients and prevent seclusion and restraints. The review found that evidence is

limited regarding effective interventions to prevent the development of aggressive behavior in

THE NEED TO REDUCE SECLUSION AND RESTRAINT IN 3

acute care settings (Gaynes et al., 2016). In conclusion, the review found that using a risk

assessment on all patients on a psychiatric unit may decrease subsequent aggressive behavior.

Conclusion

Reduction of seclusion and restraints in psychiatric facilities is a growing concern. Using

early interventions such as, recognizing flashpoints or using a standard risk assessment and

intervention protocol may prove beneficial in the future of psychiatric care. However, there is

lack of research into the effectiveness of any specific early intervention method to decrease the

number of seclusion and restraint episodes in psychiatric units. Seclusion and restraint use can

have a negative effect on an already vulnerable patient population. Therefore, anytime a

preventative method can be utilized over the decision for seclusion or restraints it should be.

Further research into ways to prevent the need for seclusion and restraints in psychiatric facilities

needs to be addressed to effectively care for individuals suffering from mental illness and

improve their overall outcomes long-term.

References

Bowers, L. (2014, February 19). Safewards: A new model of conflict and containment on

psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21, 499-508.

http://dx.doi.org/10.1111/jpm.12129

Gaynes, B. N., Brown, C., & Lux, L. J. (2016). Strategies to de-escalate aggressive behavior in

psychiatric patients. [PubReader]. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK379399/