The use of restraint and seclusion in a psychiatric ward

Whilst the use of restraint and seclusion has been common place in psychiatric practice for decades to control patients' uncontrolled, violent behaviour it raises ethical and legal concerns. The aim of this review was to identify through the literature the issues arising from the use of restraint and seclusion in a psychiatric ward. Material and Methods: A literature search was performed in Medline, Cinahl, BNI, PsycINFO, and Scopus databases with keywords relevant to the subject of this review. Results: Restraint and seclusion as therapeutic interventions are used in a psychiatric ward to provide physical protection for the patient, for other patients and for the staff, at the same time maintaining the ward's therapeutic milieu. Restraint aims at restricting patients' body mobility and the use of seclusion aims to decrease sensory stimuli that increase patients' agitation. Guidelines have been developed for the use of restraint and seclusion to ensure the implementation of a therapeutic plan. Current practice advocates minimal use of either intervention with the aim of ultimately abolishing both practices. However, the existing current trends regarding the use of restrictive measures are to minimize until abolish them. Conclusions: The therapeutic use of seclusion and restraint is acceptable when practitioners follow the appropriate instructions and guidelines. However, the main goal of health professionals, especially nurses, who are directly involved in the implementation of those restrictive measures, is to minimize their use. This could be achieved through training and adequate staffing levels.

Keywords: Physical restraint, seclusion, psychiatric patients, aggressive behaviour, nurses