Novel Approaches Needed: An Experimental Study with an Alternative to Mechanical Restraint
- PMID: 39201215
- PMCID: PMC11353919
- DOI: 10.3390/healthcare12161658
Novel Approaches Needed: An Experimental Study with an Alternative to Mechanical Restraint
Abstract
Despite many calls to reduce or eliminate the use of mechanical restraint, it is still widely used in many countries. Studies using patient interviews have a very clear message: Patients experience mechanical restraint as the most humiliating intervention. There seems to be a lack of alternatives for violent patients if all other approaches to prevent the use of coercion have failed. We developed a method using 30 kg bags, originally designed for fitness purposes, to be attached to a patient's wrist or ankle under 1:1 supervision. The method was tested with 10 experienced nurses and de-escalation trainers. A video was made and presented to six outpatients who had previously experienced mechanical restraint. All participants were interviewed. Transcribed interviews were analysed using qualitative content analysis. All participants approved of the method as a milder and less humiliating alternative to mechanical restraint. The nurses' main concerns were the risk of falls and the use of the bags as weapons. The latter could be controlled by using an additional bag. Patients were generally positive, especially if there was a history of abuse. The method should be further developed to replace at least some mechanical restraints. As with all 'milder means', care should be taken to really replace restraint and not to introduce additional coercion.
Keywords: alternative; coercion; human dignity; milder means; restraint.
Conflict of interest statement
Tilman Steinert and Sophie Hirsch have received funding from the German Association for Psychiatry and Psychotherapy for the development of a national guideline on the prevention of coercion. Tilman Steinert has received funding from the German Innovationsausschuss for an RCT on the implementation of this guideline. The other authors declare that they have no conflicts of interest.
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