Maria Knutzen
Oslo University hospital, Norway
Title: Patients subjected to seclusion and restraint in psychiatric wards
Biography
Biography: Maria Knutzen
Abstract
The starting point for studying patients subjected to restraint was my own experience. As a psychiatric nurse in emergency department I was responsible for providing nursing before, during and after the use of seclusion. Another reason was that use of restraint is professionally and ethically problematic since restraint devices potentially are risky and can harm the patient. Results from my research suggests that the patient's age, sex and reported behavior and clinical variables (number of admissions, duration, individual diagnoses and referral clause) are all factors that independently affect aspects of use of restraint (ie whether restraints are used, how frequently, type of restraint and duration). A key finding was that a small group of patients who were frequently subjected to restraint (9% of patients restrained, 56% females) represented 39% of all episodes of restraint. They differed from the other patients by being younger, having a longer duration of hospitalization and were frequently admitted. This “heavy tailed” distribution of episodes of coercive measures, where also found in our two subsequent national surveys of the use of restraint in all psychiatric institutions for adults. Identification of the small group of patients being frequently subjected to restraint (34 of the 3365 hospitalized patients) may provide a basis for quality assurance and a huge reduction of restraint. This would lead to a major improvement for the patient experience of being hospitalized, the ward atmosphere including other patients and staff.