Mechanical restraint and characteristics of patient, staff and shifts in a psychiatric ward – 2017-10-26

Background: The use of coercion is a balance between depriving the patients’ autonomy and dignity and preventing endangerment of the body or health of self or others. It is of importance to obtain more knowledge about mechanisms leading to mechanical restraint in the attempt of reducing it.

Objective: To analyse for associations between incidence of mechanical restraint (MR) and staffing level, staff demographics, patient characteristics, type of shift (day/evening/night) and change of shifts.

Method: A naturalistic descriptive method was used to study cases of MR in a psychiatric ward. Data for each case of MR was obtained from an electronic reporting system. Care workers from each shift were identified using duty rosters. Analyses included binary logistic regression analyses.

Results: In 82% of the 114 cases of MR, the patient was diagnosed with personality disorders. In the multiple regression analysis, a significant association was found between the use of MR and the presence of male care workers on the ward (OR:1.44, 95% CI: 1.01–2.05; p = .04). Moreover, MR was associated with evening shifts, compared with day and night shifts (OR =1,29, 95% CI: 1.14–2.57, p = .01). Besides, months from January to December was associated with a decrease in MRs (OR: 0.88, 95% CI: 0.83–0.94; p = 7.3 E-6). No significant associations were found between MR and staffing level or experience.

Conclusions: MR was associated with evening shifts, higher number of male care workers on duty and a decrease from January to December.

Johanne Sofie Kodal, Jesper Nørgaard Kjær & Erik Roj Larsen
Nordic Journal of Psychiatry, Volume 72, 2018 – Issue 2