Background
Methods
Stage 1: identifying research questions
Stage 2: identifying relevant studies
Stage 3: study selection
Stage 4: capturing the data
Stage 5: collating, summarising and reporting the results
Results
Study characteristics
First author Date | Nation | Design/method | Aim | Setting and sample | Age group | Intervention |
---|---|---|---|---|---|---|
Petti 2001 | United States | A combination data collection applying semi-structured interviews and a cross-sectional questionnaire on debriefing incidents | Explore role of PIR in a S/R reduction project | 81 incidents, both patients and staff | Children and adolescents | Restraints and seclusion |
Bonner 2002 | United Kingdom | Descriptive pilot study Semi-structured interviews | Evaluate feasibility and helpfulness of PIR after restraints | Patients (N = 6) Staff (N = 12) | Adults | Restraints |
Fisher 2003 | United States | Cross-sectional study of patients and staff at clinic Observational design using questionnaire and register data from the clinic and the whole state (reference group) | Describe the results of a program to reduce S/R rates in a mental health hospital | Patients (N = 148; 25% response rate) Staff (N = 112; 15% response rate) | Adults | Restraints and seclusion |
Ashcraft 2008 | United States | Evaluation study with 58-month follow-up, implementing a new organisational program including PIR in two crisis clinics Registration of S/R rates | Reduce S/R use to zero S/R events | Two urban crisis centres, one small and one large | Adults | Restraints and seclusion |
Bonner 2010 | United Kingdom | Cross-sectional study assessing agreement on 6 statements (on a 7-point Likert scale) | Evaluate whether staff and patients found PIR helpful after restraint incidents | Patients (N = 30) Staff (N = 30) | Adults | Restraints |
Azeem 2011 | United States | Descriptive study using medical records reviewed over 33 months | Determine the effectiveness of six core strategies based on trauma-informed care at reducing S/R | Psychiatric hospital. Medical records (N = 458) | Children and adolescents | Restraints and seclusion |
Azeem 2015 | United States | Descriptive longitudinal study using register data on restraints incidents over 10 years at one clinic | Assess restraint reduction rates over 10 years in a clinic that implemented a restraint prevention programme | 52-bed psychiatric hospital | Children and adolescents | Restraints |
Lanthen 2015 | Sweden | Descriptive design Interviews | Examine patients’ experience of mechanical restraints and describe the patient care received | Former psychiatric patients. (N = 10) | Adults | Restraints |
Ling 2015 | Canada | Descriptive study Audits of a sample of patient charts containing post-restraint event patient debrief forms | Examine PIR data to understand patients’ experiences before, during and after restraint events | Audits (N = 55) | Adults | Restraints |
Riahi 2016 | Canada | Retrospective register data study: registration of S/R episodes, number and average time over a 36-month evaluation period | Describe the process and value of implementing the six core strategies | Specialized, tertiary mental health care facility with 326 beds | Adolescents | Restraints and seclusion |
Gustafs-son 2016 | Sweden | Descriptive design Interviews | Describe nurses’ thoughts and experiences of using coercive measures during forensic psychiatric care | Nurses (N = 8) | Adults | All kinds of coercion |
Goulet 2017 | Canada | Pilot study with case study design Individual semi-structured interviews with patients and staff Pre-post study assessing the prevalence of seclusion and restraint before and after PIR | Evaluate a PIR intervention implemented in an acute psychiatric care unit | Interviews: Patients (N = 3) Staff (N = 12) Pre-post study: Anonymised administrative data (N = 195 admissions) | Adults | Restraints and seclusion |
How are PIR s’ defined and described?
First author Date | Definitions | Descriptions | ||
---|---|---|---|---|
Purpose | Theoretical foundation or recommendations | Care philosophy | ||
Petti 2001 | Systematic debriefing | S/R reduction | Public recommendations | Strength-based care |
Bonner 2002 | After-incident support | |||
Fisher 2003 | Detailed behaviour analysis | Mapping of patients’ and staffs’ views on S/R events and thereby S/R prevention | Public S/R reduction programme | Person-centred care |
Ashcraft 2008 | Chain analysis | Capturing of the viewpoints of patients who have experienced S/R | Public S/R reduction programme | Recovery-oriented care |
Bonner 2010 | Discussion of events at patients’ own pace in a nonthreatening way | NICE guidelines | ||
Azeem 2011 | Rigorous problem solving | S/R prevention | Public S/R reduction programme | Trauma-informed and Strength-based care |
Azeem 2015 | Chain analysis of incidents | Restraint prevention | Public S/R reduction programme | Recovery-oriented, person-centred and strength-based care |
Lanthen 2015 | Quality and safety education for nurses project | Person-centred care | ||
Ling 2015 | ‘an opportunity to talk about feelings, reactions, and circumstances surrounding an inpatient’s restraint experience, from the inpatient’s perspective’(p. 387) | ‘an opportunity for clinicians to assess inpatients and determine necessary follow-up care’(p.387) | Public S/R reduction programme | |
Riahi 2016 | Formalised service-user debriefing | Exploration of events from patients’ perspectives to mitigate adverse S/R-related effects and use the lessons to inform future practice | Public S/R reduction programme | Recovery-oriented and trauma-informed care |
Gustafsson 2016 | Establishment of a communication forum for nurses and patients | |||
Goulet 2017 | ‘a complex intervention, taking place after an SR episode and targeting the patient and healthcare team to enhance the care experience and provide meaningful learning for the patient, staff, and organization’ [37] | Obtaining of patient feedback on their SR experiences | Bonner’s model (2008) |
How are PIR s’ conducted?
First author Date | Participants | Time | Content of PIR |
---|---|---|---|
Petti 2001 | Nursing staff other than those directly involved with the incident | As soon as the patient can respond coherently to questions | Mapping of reasons for S/R, possible prevention actions and alternative measures |
Bonner 2002 | Patients and staff | Participants’ comprehension of what happened before, during and after the restraint event; mapping of needs for after-incident care | |
Fisher 2003 | Patients and treatment team | Analysis of the events leading up to the S/R event and more long-term planning to avoid a repetition of S/R | |
Ashcraft 2008 | Patients and staff | What patient and staff could have done differently and what staff could do in the future to prevent S/R | |
Bonner 2010 | Staff, patients, caregivers and witnesses to incidents | Within 72 h | Mapping of the incident and surrounding events and consideration of what was helpful and unhelpful during the incident |
Azeem 2011 | Staff and patients involved | Within 48–72 h | Mapping of triggers, evaluation of interventions and possible S/R prevention alternatives and identification of traumatisation/retraumatization to patient and staff |
Azeem 2015 | Patients and staff involved in incidents, clinicians, physicians and sometimes hospital administrators | Within a few days | Analysis of the incident, triggers, helpful interventions and alternatives regarding S/R prevention |
Lanthen 2015 | Patients and staff Verbal and written follow-up | ||
Ling 2016 | Verbal or written follow-up Participants are decided by the patient and the team | Within 24 h If an inpatient declines, new offer within 72 h | Patients’ feelings, reactions and circumstances regarding the restraint experience; mapping of needs for follow-up care |
Gustafsson 2016 | Patients and nurses who performed the coercive measure | “too much time’ should not have passed” [p. 41] | Exchange of reciprocal understandings of the S/R event |
Riahi 2016 | Patients and staff | As soon as possible after event is clinically indicated | Exploration of the event, identification of triggers, alternative options and identification and healing of restraint-related damage |
Goulet 2017 | Patients and staff members identified in the staff report | Within 24–48 h, but flexibility in practice | Review of events leading to the incident, factors involved, effect on patients and changes in future practice |