eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: A cluster-randomized trial

Abstract

Background: The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. Aims: The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients. Methods: In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course. Results: A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards. Conclusions: After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.

• Cluster-randomized intervention trial
• eLearning
• Mechanical restraint
• Seclusion

Acknowledgments

The study protocol has been registered in The Current Controlled Trials register (ISRCTN32869544, www.med.utu.fi/epsychnurse/)—Improving nurses’ continuing vocational training in psychiatric hospitals and inpatient units.

Disclosure of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This research was financially supported by the European Commission (Leonardo da Vinci, FI-06B-F-PP-160701), the University of Turku: Foundations’ Professor Pool, the Finnish Cultural Foundation, the Hospital District of Helsinki and Uusimaa (EVO) and the Hyvinkää Hospital Region (EVO), which are gratefully acknowledged.