Text

theses

Background
Traditionally restraint and seclusion were viewed as a form of treatment, however the use of restraint and seclusion has led to increased physical and mental injuries to staff and patients. Currently de-escalation has been viewed as a safer option for aggressive and violent patients. Understanding which intervention yields decreased injuries, aggression and violence will guide legislation, practice and institutions leading to safer patients and staff.

Objectives
To identify which intervention leads to decreased physical and psychological injury to patients and staff.

Inclusion criteria
Types of participants
Adults 18 years of age and above, who are aggressive/violent patients being cared for within in-patient psychiatric units, and mental health staff who work with inpatient psychiatric patients.

Types of studies
Experimental and epidemiological study designs, including randomized controlled trials (RCTs), non-randomized controlled trials, prospective and retrospective cohort studies, before and after studies, quasi-experimental studies.

Outcomes
Outcomes measures include frequency of physical injuries to patients and staff from aggressive patients, frequency of psychological injuries to patients and staff from violent, aggressive incidents, frequency of violence, agitation and aggression, competence of staff at managing aggression and violence.

Search Strategy
A comprehensive multi-step search was completed to find both published and unpublished studies. Only those studies reported in English were included. The search strategy was not limited by date of reporting.

Methodological quality
Studies were assessed for methodological quality using standardized critical appraisal instruments from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument.

Data extraction
Data extracted from studies included in the review were analyzed using the standardized data extraction tool from JBI-MAStARI (Appendix II).

Data synthesis
Due to heterogeneity between studies statistical meta-analysis could not be conducted. The results have been presented in narrative form.

Results
Fourteen studies were included in this review. There are many forms of de-escalation and based on the studies where techniques were taught to staff, the intervention was effective in decreasing injury in approximately half the studies. De-escalation techniques taught to patients decreased injury in 100% of the studies included in this review.

Conclusion
Consensus on which intervention works best between de-escalation techniques or R/S could not be reached, nor is there overwhelming evidence for a particular type of de-escalation that works best for decreasing aggression and violence. Caution should be exercised when choosing a de-escalation technique for implementation in institutions due to lack of regulating agencies that inform practice and standards. In addition, the literature is lacking best practices for de-escalation techniques that are backed by evidence. Restraint and seclusion should still be used as a last resort due to inherent risk associated with the intervention.

ETD_10435

DNP

Includes bibliographical references

doi:10.7282/t3-m1xs-3x57

ETD doctoral

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