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Cited by 22Healthcare Decision-Making and RestraintsRestraint-Related DeathsElectroconvulsive Therapy Studies

Factors associated with the use of mechanical restraint in a mental health hospitalization unit: 8‐year retrospective analysis

Pérez‐Revuelta, Jose I., Torrecilla‐Olavarrieta, Rocío, García‐Spínola, Edgar, López‐Martín, Ángela, Guerrero‐Vida, Rafael, Mongil‐San Juan, Jose M., Rodríguez‐Gómez, Carmen, Pascual‐Paño, Juan M. +2 more·2021·Journal of Psychiatric and Mental Health Nursing
DOI 10.1111/jpm.12749
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Abstract

Accessible Summary: What is already known about the topic?: Our present understanding of mechanical restraint is heterogenous, largely due to the important differences between countries/regions. In Spain, the use of this restrictive practice is not regulated, nor is its use protocolized. Previous studies that have investigated the impact of organizational factors and changes in these protocols are often short and not conducted within a framework designed to establish a long‐term plan for reducing the use of mechanical restraint. What this paper adds to existing knowledge?: We demonstrate that the implementation of administrative and protocol changes in our psychiatric unit significantly reduced the use of mechanical restraint, thus laying the foundations for a regulatory framework. Our analysis shows that the profile of patients who require mechanical restraint is highly variable, but that certain clinical and institutional aspects within the framework of a long‐term plan for the reduction in mechanical restraint can be targeted with long‐lasting positive effects. What are the implications for practice?: Organizational changes focussed on training staff, promoting family support and requiring the registration and close monitoring of episodes empower the role of the nursing staff in the prevention, monitoring and regulation of mechanical restraint. Introduction: Mechanical restraint is a controversial restrictive practice to manage agitation or violent behaviour. Numerous studies have evaluated the factors and organizational changes that influence on mechanical restraint, but only for short time periods. None of those studies have assessed the effects of measures applied within the framework of a long‐term plan to reduce the use of mechanical restraint. Given the lack of specific legislation in Spain, more data are required for its proper regulation. Aim/Question: To evaluate the risk factors associated and the impact of specific measures designed to minimize the application of mechanical restraint in an acute mental health unit over an 8‐year period and previous observation of 5 years. Methods: Cross‐sectional study based on a retrospective analysis of mechanical restraint records. We compared admissions requiring ≥one episode of restraint versus admissions not requiring this coercive measure. Results: Between 2007 and 2014, 412 admissions (12%) required mechanical restraint. The data show that the measures applied in the previous five years had significantly reduced the total hours of restraint per semester. The factors associated with admissions requiring mechanical restraint were involuntary, unscheduled and longer admissions. The best predictor of restraint was involuntary admission (OR = 6.37), followed by the diagnosis of personality disorder (OR = 5.01). Discussion: Identification of the factors associated with mechanical restraint would allow for early detection strategies. Our results provide additional evidence on the usefulness of organizational changes to reduce coercive measures, even in a country without specific legislation. Implications for Practice: Organizational changes, such as staff training and increased family support during admission of episodes of mechanical restraint, can reduce the use of this measure. These measures also give the nursing staff greater responsibility in terms of their role in registering and monitoring the restrictive practice, thus helping to prevent or minimize the use of mechanical restraint.

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  • Once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis.

    “A similar cycle of coercive care provision may also be evident during admission, with the available literature indicating that once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis (34,76–88), and may be more likely to display aggressive behaviours (”

    From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [83]

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Authors
Pérez‐Revuelta, J. I., Torrecilla‐Olavarrieta, R., García‐Spínola, E., López‐Martín, Á., Guerrero‐Vida, R., Mongil‐San Juan, J. M., Rodríguez‐Gómez, C., Pascual‐Paño, J. M., González‐Sáiz, F., & Villagrán‐Moreno, J. M.
Affiliations
  • Andalusian Health Service (ES)
  • UGC Salud Mental Área de Gestión Sanitaria Norte de Cádiz Hospital Universitario de Jerez. Servicio Andaluz de Salud Jerez de la Frontera Cádiz 11407 Spain
  • Universidad de Cádiz (ES)
Corresponding author
González‐Sáiz, Francisco
ORCID
Venue
Journal of Psychiatric and Mental Health Nursing
Publisher
Wiley
Published
2021-03-26
Volume
28
Issue
6
Pages
1052-1064
ISSN
  • 1351-0126 (ISSN-L)
  • 1365-2850
DOI
10.1111/jpm.12749
OpenAlex
W3135486432
Cited by
22
References
72
Citations by year
2026: 3 · 2025: 4 · 2024: 3 · 2023: 6 · 2022: 4 · 2021: 2
FWCI
2.56
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Journal of Psychiatric and Mental Health Nursing (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Health Sciences › Medicine › Emergency Medicine › Restraint-Related Deaths
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
Keywords
mechanical restraint, restrictive practices, psychiatric hospitalization, involuntary admission, personality disorders, agitation, violent behavior, organizational change, restraint reduction, employee training, family support, nursing role, Spain, mental health law, coercion in mental health care
MeSH terms
Mental Disorders, Cross-Sectional Studies, Hospitalization, Humans, Mental Health, Restraint, Physical, Retrospective Studies

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