Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital

Background Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital. Purpose The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse assessment and surveillance during mechanical restraint episodes. Methods The nursing department standard requirement for frequency of face-to-face registered nurse assessment and surveillance of patients during episodes of mechanical restraint was increased on pilot units from once every thirty minutes to continuous assessment and surveillance throughout the duration of the restraint application. Quantitative data was collected on hours of duration of restraint episodes on four pilot units for three months before and three months after the intervention and mean duration of episodes was compared before and after the practice change. Results Mean duration of episodes on pilot units decreased 44% in the three months post intervention: 15% on adult units and 70% on the adolescent unit. Conclusion and Recommendation Increasing the frequency of registered nurse assessment and surveillance during mechanical restraint has been shown to decrease duration of restraint episodes. Nurses are encouraged to change practice standards for mechanical restraint, which is a high-risk emergency measure, to provide continuous psychiatric intensive care by a registered nurse. Keywords: mechanical restraint, physical restraint, psychiatric patient

Physical restraint in residential child care : the experiences of young people and residential workers

There have long been concerns about the use of physical restraint in residential care. This paper presents the findings of a qualitative study which explores the experiences of children, young people and residential workers about physical restraint. The research identifies the dilemmas and ambiguities for both staff and young people, and participants discuss the situations where they feel physical restraint is appropriate as well as their concerns about unjustified or painful restraints. They describe the negative emotions involved in restraint but also those situations where, through positive relationships and trust, restraint can help young people through unsafe situations

Effect of vasopressin 1b receptor blockade on the hypothalamic-pituitary-adrenal response of chronically stressed rats to a heterotypic stressor

Exposure to chronic restraint (CR) modifies the hypothalamic–pituitary–adrenal (HPA) axis response to subsequent acute stressors with adaptation of the response to a homotypic and sensitization of the response to a heterotypic stressor. Since vasopressin (AVP) activity has been reported to change during chronic stress, we investigated whether this was an important factor in HPA facilitation. We therefore tested whether vasopressin 1b receptor (AVPR1B) blockade altered the ACTH and corticosterone response to heterotypic stressors following CR stress. Adult male rats were exposed to CR, single restraint, or were left undisturbed in the home cage. Twenty-four hours after the last restraint, rats were injected with either a AVPR1B antagonist (Org, 30 mg/kg, s.c.) or vehicle (5% mulgofen in saline, 0.2/kg, s.c.) and then exposed to either restraint, lipopolysaccharide (LPS) or white noise. CR resulted in the adaptation of the ACTH and corticosterone response to restraint and this effect was not prevented by pretreatment with Org. Although we found no effect of CR on LPS-induced ACTH and corticosterone secretion, both repeated and single episodes of restraint induced the sensitization of the ACTH, but not corticosterone response to acute noise. Pretreatment with Org reduced the exaggerated ACTH response to noise after both single and repeated exposure to restraint

Judicial Restraint?

An independent judiciary is one of the cornerstones of American democracy and the rule of law. But increasing challenges to the authority of judges have many in the legal community concerned about maintaining the rightful balance of power

Optimizations of Human Restraint Systems for Short-Period Acceleration

A restraint system's main function is to restrain its occupant when his vehicle is subjected to acceleration. If the restraint system is rigid and well-fitting (to eliminate slack) then it will transmit the vehicle acceleration to its occupant without modifying it in any way. Few present-day restraint systems are stiff enough to give this one-to-one transmission characteristic, and depending upon their dynamic characteristics and the nature of the vehicle's acceleration-time history, they will either magnify or attenuate the acceleration. Obviously an optimum restraint system will give maximum attenuation of an input acceleration. In the general case of an arbitrary acceleration input, a computer must be used to determine the optimum dynamic characteristics for the restraint system. Analytical solutions can be obtained for certain simple cases, however, and these cases are considered in this paper, after the concept of dynamic models of the human body is introduced. The paper concludes with a description of an analog computer specially developed for the Air Force to handle completely general mechanical restraint optimization programs of this type, where the acceleration input may be any arbitrary function of time

Restraint and Seclusion of Students With a Disability Continue to Be Common in Some School Districts Patterns Remain Relatively Consistent Despite Recent Policy Changes

In 2013, Carsey released a brief that analyzed rates of restraint and seclusion using a large, nationally representative data set of U.S. school districts. This brief, which analyzes a more comprehensive data set and the most current Civil Rights Data Collection, serves as a follow-up to the pre­vious brief. Authors Douglas Gagnon, Marybeth Mattingly, and Vincent Connelly report that, despite numerous states with revised policies related to seclusion and restraint in schools between 2009 and 2012, trends in the rates of restraint and seclusion of students with a disability in the United States remained relatively consistent between survey years. Low-poverty, low-minority districts are more likely to report high rates of restraint than are high-poverty, high-minority districts, although this trend in the most recent data is less pronounced than the trend found in the 2009−2010 data. In addition, restraint and seclusion are most common in cities and least common in rural places. The authors conclude that future research should examine the factors that lead to the use of restraint and seclusion in some schools, as well as what conditions lead to uptake of alternative approaches to managing challenging student behavior

Stress rapidly suppresses in vivo LH pulses and increases activation of RFRP-3 neurons in male mice

Restraint stress is a psychosocial stressor that suppresses reproductive status, including LH pulsatile secretion, but the neuroendocrine mechanisms underlying this inhibition remains unclear. Reproductive neural populations upstream of gonadotropin-releasing hormone (GnRH) neurons, such as kisspeptin, neurokinin B and RFRP-3 (GnIH) neurons, are possible targets for psychosocial stress to inhibit LH pulses, but this has not been well examined, especially in mice in which prior technical limitations prevented assessment of in vivo LH pulse secretion dynamics. Here, we examined whether one-time acute restraint stress alters in vivo LH pulsatility and reproductive neural populations in male mice, and what the time-course is for such alterations. We found that endogenous LH pulses in castrated male mice are robustly and rapidly suppressed by one-time, acute restraint stress, with suppression observed as quickly as 12–18 min. This rapid LH suppression parallels with increased in vivo corticosterone levels within 15 min of restraint stress. Although Kiss1, Tac2 and Rfrp gene expression in the hypothalamus did not significantly change after 90 or 180 min restraint stress, arcuate Kiss1 neural activation was significantly decreased after 180 min. Interestingly, hypothalamic Rfrp neuronal activation was strongly increased at early times after restraint stress initiation, but was attenuated to levels lower than controls by 180 min of restraint stress. Thus, the male neuroendocrine reproductive axis is quite sensitive to short-term stress exposure, with significantly decreased pulsatile LH secretion and increased hypothalamic Rfrp neuronal activation occurring rapidly, within minutes, and decreased Kiss1 neuronal activation also occurring after longer stress durations

Variation found in rates of restraint and seclusion among students with a disability

The restraint and seclusion of individuals—practices usually associated with highly restrictive environments—are extreme responses to student behavior used in some public schools. In this brief, authors Douglas Gagnon, Marybeth Mattingly, and Vincent Connelly report that restraint and seclusion are used much more frequently on students with a disability than on students without a disability. In addition, the majority of U.S. school districts does not restrain or seclude students with a disability; 59.3 percent of districts report no instances of restraint, while 82.5 percent do not report a single instance of seclusion. However, a small proportion of districts report exceedingly high rates. The authors also find that low-poverty, low-diversity school districts use restraint and seclusion on students with a disability more than twice as often as high-poverty, high-diversity districts. The authors conclude that, overall, the relationships between restraint and seclusion rates, and disability type and school characteristics, warrant further research. This brief draws on data from the 2009–2010 Civil Rights Data Collection and the 2009 Small Area Income and Poverty Estimates

Hispanic Ethnicity, Male Gender and Age Predict Restraint Use and Hospital Resource Utilization in Pediatric Trauma

Child restraint reduces the severity of injuries in motor vehicle crashes. Racial/ethnic groups appear to have differing restraint use rates. The objective of this study was to identify restraint use differences between ethnic and other demographic subgroups of pediatric trauma patients. Prospective data were analyzed for 1072 consecutive pediatric patients aged 19 or less who were involved in motor vehicle crashes and brought to our Trauma Center over a 42 month period. The demographic breakdown of this study cohort was 55.3% male, 21.4% Hispanic, 9.7% African American, 64.5% Caucasian, 2.2% Asian and 2.2% other. The highest rates of restraint use (56.1%) were reported for children ages 0 to 3 years, and the lowest for those 12-15 years (p=.0001). Restraint use rates were lower among males than females (OR=0.72; 95% CI = 0.55, 0.93), and lower among Hispanic than non-Hispanic pediatric patients (OR=0.52; 95% CI = 0.37, 073). Restrained patients were more likely than unrestrained patients to be discharged to home. Restrained patients were less severely injured than unrestrained patients as measured by Revised Trauma Score, the Glasgow Coma Score, Injury Severity Score, ICU days and length of hospital stay. Low restraint use is associated with Hispanic ethnicity, male gender and the age group 12-15 years. Measures of injury severity consistently indicate more severe injuries among unrestrained than restrained patients

Annual performance indicators of enforced driver behaviours, 2002

The Centre for Automotive Safety Research at the University of Adelaide was commissioned by Transport SA to produce a report quantifying the effects of selected enforced driver behaviours: drink driving, speeding and restraint use, in South Australia for the calendar year 2002. The level of random breath testing (RBT) has increased substantially such that the annual average rate of testing was 2 tests for every 3 licensed drivers in 2002. An inverse relationship between detection rates and publicity expenditure suggests current publicity campaigns are supporting enforcement operations. Overall, speeding detection rates in 2002 decreased, especially speed camera detection rates. However, speeding detection rates were heavily influenced by police enforcement strategies and practices. Rural speed surveys indicated that the mean free speed decreased from 2000 to 2002 on 100km/h roads but showed no meaningful change on 60km/h and 110km/h roads each year. Determining the effectiveness of restraint use enforcement was very difficult because no specific restraint enforcement campaigns were undertaken. In the absence of available restraint enforcement details, the number of restraint related offences committed annually was used to provide a rough estimate of enforcement activities. Reasonably consistent observational surveys were useful in providing an indication of restraint wearing rates over time in a number of regions. The surveys indicated that both metropolitan and rural wearing rates increased in 2002 to a level of 96 per cent, just above the national target of 95 per cent.L.N. Wundersitz and A.J. McLea