41 research outputs found
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A Review of Interventions to Reduce Mechanical Restraint and Seclusion among Adult Psychiatric Inpatients
Objective: This review examines nature and effectiveness of interventions to reduce the use of mechanical restraint and seclusion among adult psychiatric inpatients.
Method: Electronic searches were conducted to locate post-1960 empirical studies of restraint and seclusion reduction in English. A total of 36 studies were identified, mostly from the USA. Analysis was conducted using a structured data extraction tool.
Results: The majority of studies reported reduced levels or mechanical restraint and/or seclusion, but the standard of evidence was poor. There were no randomised trials. Most were retrospective studies of official records before and after the intervention was introduced, with varying follow-up periods. The interventions were diverse, but tended to include one or more of the following: new restraint and/or seclusion policies, staffing changes, staff training, review procedures and crisis management initiatives. The research was unable to address which of these elements was most effective. There was also evidence that some improved outcomes were achieved by substituting restraint or seclusion for each other or for alternatives forms of containment (medication in particular). Nurses’ attitudes, skills and approach to patient care were absent from the literature.
Conclusions: Interventions probably can reduce the use of restraint and seclusion, but better designed research is required to demonstrate their effectiveness conclusively. More attention should also be paid to understanding how interventions work, particularly from the perspective of nursing staff. This is essential to the successful implementation of restraint and seclusion interventions across different psychiatric settings and treatment populations
A resonant-term-based model including a nascent disk, precession, and oblateness: application to GJ 876
Investigations of two resonant planets orbiting a star or two resonant
satellites orbiting a planet often rely on a few resonant and secular terms in
order to obtain a representative quantitative description of the system's
dynamical evolution. We present a semianalytic model which traces the orbital
evolution of any two resonant bodies in a first- through fourth-order
eccentricity or inclination-based resonance dominated by the resonant and
secular arguments of the user's choosing. By considering the variation of
libration width with different orbital parameters, we identify regions of phase
space which give rise to different resonant ''depths,'' and propose methods to
model libration profiles. We apply the model to the GJ 876 extrasolar planetary
system, quantify the relative importance of the relevant resonant and secular
contributions, and thereby assess the goodness of the common approximation of
representing the system by just the presumably dominant terms. We highlight the
danger in using ''order'' as the metric for accuracy in the orbital solution by
revealing the unnatural libration centers produced by the second-order, but not
first-order, solution, and by demonstrating that the true orbital solution lies
somewhere ''in-between'' the third- and fourth-order solutions. We also present
formulas used to incorporate perturbations from central-body oblateness and
precession, and a protoplanetary or protosatellite thin disk with gaps, into a
resonant system. We quantify these contributions to the GJ 876 system, and
thereby highlight the conditions which must exist for multi-planet exosystems
to be significantly influenced by such factors. We find that massive enough
disks may convert resonant libration into circulation; such disk-induced
signatures may provide constraints for future studies of exoplanet systems.Comment: 39 pages of body text, 21 figures, 5 tables, 1 appendix, accepted for
publication in Celestial Mechanics and Dynamical Astronom