Comparing the effect of non-medical mechanical restraint preventive factors between psychiatric units in Denmark and Norway

Abstract

Background: The use of mechanical restraint (MR) is controversial, and large differences regarding the use of MR are often found among countries. In an earlier study, we observed that MR was used twice as frequently in Denmark than Norway. Aims: To examine how presumed MR preventive factors of non-medical origin may explain the differing number of MR episodes between Denmark and Norway. Methods: This study is a cross-sectional survey of psychiatric units. Linear regression was used to assess the confounding effects of the MR preventive factors, i.e. whether a difference in the impact of these factors is evident between Denmark and Norway. Results: Six MR preventive factors confounded [∆exp(B)> 10%] the difference in MR use between Denmark and Norway, including staff education (− 51%), substitute staff (− 17%), acceptable work environment (− 15%), separation of acutely disturbed patients (13%), patient–staff ratio (− 11%), and the identification of the patient's crisis triggers (− 10%). Conclusions: These six MR preventive factors might partially explain the difference in the frequency of MR episodes observed in the two countries, i.e. higher numbers in Denmark than Norway. One MR preventive factor was not supported by earlier research, the identification of the patient's crisis triggers; therefore, more research on the mechanisms involved is needed. Clinical implications: None of the six MR preventive factors presents any adverse effects; therefore, units in Denmark and Norway may consider investigating the effect of implementing, the identification of the patient's crisis triggers, an increased number of staff per patient, increased staff education, a better work environment and reduced use of substitute staff in practice.

• Coercion
• Mechanical restraint
• Mental health
• Nursing
• Psychiatry

Notes

Acknowledgements

We thank the Health Science Research Foundation in the Capital Region of Denmark, the Mental Health Services in the Capital Region of Denmark, and the Mental Health Centre Sct. Hans, Copenhagen University Hospital for funding this project. We thank all of the clinical nurse managers of the “closed” psychiatric units in Norway and Denmark for participating in this project.

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

Supplementary material available online

Appendix: A description of mechanical restraint (MR) preventive factor measurements

Notes

1. The review was a a systematic review combining qualitative and quantitative research, so the highest recommendation grade could be: qualitative; at least one high-quality meta-synthesis, systematic review, or meta-summary, or a body of high-quality evidence, or quantitative; at least one meta-analysis, systematic review or one or a body of high-quality RCT.

2. STEP 1: READING: Determine if it is difficult for the interviewers to read the question uniformly to all respondents. STEP 2: INSTRUCTIONS: Look for problems with any introductions, instructions or explanations from the respondent's point of view. STEP 3: CLARITY: Identify problems related to communicating the intent or meaning of the question to the respondent. STEP 4: ASSUMPTIONS: Determine whether there are problems with assumptions or the underlying logic. STEP 5: KNOWLEDGE/MEMORY: Check whether respondents are likely to not know or have trouble remembering information. STEP 6: SENSITIVITY/BIAS: Assess questions for sensitive nature or wording, and for bias. STEP 7: RESPONSE CATEGORIES: Assess the adequacy of the range of responses to be recorded. STEP 8: OTHER: Look for problems not identified in Steps 1–7 (19).