Skip to main content
SpringerLink
Log in

Alternatives to Seclusion and Restraint in Psychiatry and in Long-Term Care Facilities for the Elderly: Perspectives of Service Users and Family Members

  • Original Research Article
  • Published:
The Patient - Patient-Centered Outcomes Research Aims and scope Submit manuscript

Abstract

Background

There is growing interest in involving patients in decisions regarding healthcare technologies. This research project was conducted in collaboration with decision makers and health technology assessment agents in order to involve healthcare service users (and their loved ones) in the assessment of alternatives to seclusion and restraint in short-term psychiatric wards and long-term care facilities for the elderly.

Objective

This paper explores the viewpoints and suggestions of service users and service users’ families about alternatives to restraint and seclusion, as well as conditions under which they could be used among adults in short-term psychiatric care and residents in long-term care facilities.

Methods

Using a semi-structured guide, we held eight focus groups: five with mental health service users and three with family members of elderly people in long-term care facilities. Focus group discussions were digitally recorded and transcribed verbatim, and we performed content analysis using NVivo 8 software.

Results

In both care environments, participants emphasized the importance of communicating with service users, as well as assessing their needs and their particular situation, for reducing the use of restraint and seclusion. A better welcome and accompaniment of people admitted for short-term psychiatric care emerged also as key approaches to reduce the use of restraint and seclusion. Long-term care facilities could also reduce the need for restraint and seclusion by creating a stimulating home environment and individualized occupational therapy programs. Participants in both groups suggested that caregivers other than healthcare staff could be more involved, especially peer-support workers in the case of psychiatric care and volunteers in the case of long-term care facilities.

Conclusion

Participants suggested that changes were needed at a broader and more systemic level than simply replacing current measures of restraint and seclusion with alternative techniques. They favored an approach focused more on the person than on the techniques: they suggested that listening to and communicating with the service user could reduce the use of restraint and seclusion in both healthcare environments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

Notes

  1. The term ‘service users’ is used here as a synonym for patients. It includes people who are, or have previously been, users of health services directly affected by the technology in question.

  2. In the remainder of this paper, the term ‘participants’ will be used when referring to study participants.

References

  1. Bridges JF, Jones C. Patient-based health technology assessment: a vision of the future. Int J Technol Assess Health Care. 2007;23(1):30–5.

    Article  PubMed  Google Scholar 

  2. Coulter A. Perspectives on health technology assessment: response from the patient’s perspective. Int J Technol Assess Health Care. 2004;20(1):92–6.

    Article  PubMed  Google Scholar 

  3. Facey K, Boivin A, Gracia J, et al. Patients’ perspectives in health technology assessment: a route to robust evidence and fair deliberation. Int J Technol Assess Health Care. 2010;26(3):334–40.

    Article  PubMed  Google Scholar 

  4. Lehoux P, Williams-Jones B. Mapping the integration of social and ethical issues in health technology assessment. Int J Technol Assess Health Care. 2007;23(01):9–16.

    Article  PubMed  Google Scholar 

  5. Facey KM, Hansen HP. Patient-focused HTAs. Int J Technol Assess Health Care. 2011;27(4):273–4.

    Article  PubMed  Google Scholar 

  6. Abelson J, Giacomini M, Lehoux P, et al. Bringing ‘the public’ into health technology assessment and coverage policy decisions: from principles to practice. Health Policy. 2007;82(1):37–50.

    Article  PubMed  Google Scholar 

  7. Gagnon MP, Gagnon J, St-Pierre M, et al. Involving patients in HTA activities at local level: a study protocol based on the collaboration between researchers and knowledge users. BMC Health Serv Res. 2012;12:14.

    Article  PubMed  Google Scholar 

  8. de Vries OJ, Ligthart GJ, Nikolaus T. Differences in period prevalence of the use of physical restraints in elderly inpatients of European hospitals and nursing homes. J Gerontol A Biol Sci Med Sci. 2004;59(9):M922–3.

    Article  PubMed  Google Scholar 

  9. Evans D, Wood J, Lambert L. Patient injury and physical restraint devices: a systematic review. J Adv Nurs. 2003;41(3):274–82.

    Article  PubMed  Google Scholar 

  10. Huckshorn KA. Seclusion & restraint: where have we been? Where are we now? Where are we going? J Psychosoc Nurs Ment Health Serv. 2004;42(9):6–7.

    PubMed  Google Scholar 

  11. Colaizzi J. Seclusion & restraint: a historical perspective. J Psychosoc Nurs Ment Health Serv. 2005;43(2):31–7.

    PubMed  Google Scholar 

  12. Evans LK, Strumpf NE, Allen-Taylor SL, et al. A clinical trial to reduce restraints in nursing homes. J Am Geriatr Soc. 1997;45(6):675–81.

    PubMed  CAS  Google Scholar 

  13. Neufeld RR, Libow LS, Foley WJ, et al. Restraint reduction reduces serious injuries among nursing home residents. J Am Geriatr Soc. 1999;47(10):1202–7.

    PubMed  CAS  Google Scholar 

  14. Ministère de la Santé et des Services sociaux [MSSS] (2002). Orientations ministérielles relatives à l’utilisation exceptionnelle des mesures de contrôle: contention, isolement et substances chimiques. http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2002/02-812-01.pdf. Accessed 4 Aug 2013.

  15. Ministère de la Santé et des Services sociaux [MSSS]. Vers un changement de pratique afin de réduire le recours à la contention et à l’isolement. Cadre de référence pour l’élaboration des protocoles d’application des mesures de contrôle. Édition révisée 2011. Québec: MSSS; 2011.

  16. Krueger RA, Casey M. Focus groups: a practical guide for applied research. Thousand Oaks: Sage Publications; 2008.

  17. Massey OT. A proposed model for the analysis and interpretation of focus groups in evaluation research. Eval Program Plann. 2011;34(1):21–8.

    Article  PubMed  Google Scholar 

  18. Wong LP. Focus group discussion: a tool for health and medical research. Singapore Med J. 2008;49(3):256–60 (quiz 61).

    Google Scholar 

  19. Kitzinger J. Qualitative research. Introducing focus groups. BMJ. 1995;311(7000):299–302.

    Article  PubMed  CAS  Google Scholar 

  20. Smithson J. Using and analysing focus groups: limitations and possibilities. Int J Soc Res Methodol. 2000;3(2):103–19.

    Article  Google Scholar 

  21. QSR International Pty Ltd. NVivo 8 qualitative data analysis software. Melbourne: QSR International Pty Ltd; 2008.

  22. Huberman AM, Miles MB. Qualitative data analysis: an expanded sourcebook. 2nd ed. Thousand Oaks: Sage Publications; 1994.

    Google Scholar 

  23. Repper J, Carter T. A review of the literature on peer support in mental health services. J Ment Health. 2011;20(4):392–411.

    Article  PubMed  Google Scholar 

  24. Keski-Valkama A, Koivisto AM, Eronen M, et al. Forensic and general psychiatric patients’ view of seclusion: a comparion study. J Forensic Psychiatry Psychol. 2010;21(3):446–61.

    Article  Google Scholar 

  25. Kontio R, Joffe G, Putkonen H, et al. Seclusion and restraint in psychiatry: patients’ experiences and practical suggestions on how to improve practices and use alternatives. Perspect Psychiatr Care. 2012;48(1):16–24.

    Article  PubMed  Google Scholar 

  26. Meehan T, Vermeer C, Windsor C. Patients’ perceptions of seclusion: a qualitative investigation. J Adv Nurs. 2000;31(2):370–7.

    Article  PubMed  CAS  Google Scholar 

  27. Association québécoise pour la Réadaptation psychosociale (2012). Pairs aidants réseau: le programme québécois pairs aidants réseau. http://aqrp-sm.org/pairs-aidants-reseau/programme/. Accessed 4 Aug 2013.

  28. Saarnio R, Isola A. Use of physical restraint in institutional elderly care in Finland: perspectives of patients and their family members. Res Gerontol Nurs. 2009;2(4):276–86.

    Article  PubMed  Google Scholar 

  29. Moore K, Haralambous B. Barriers to reducing the use of restraints in residential elder care facilities. J Adv Nurs. 2007;58(6):532–40.

    Article  PubMed  Google Scholar 

  30. Strumpf NE, Evans LK. Physical restraint of the hospitalized elderly: perceptions of patients and nurses. Nurs Res. 1988;37(3):132–7.

    Article  PubMed  CAS  Google Scholar 

  31. Malterud K. Qualitative research: standards, challenges, and guidelines. Lancet. 2001;358(9280):483–8.

    Article  PubMed  CAS  Google Scholar 

  32. Creswell JW, Miller DL. Determining validity in qualitative inquiry. Theory Into Pract. 2000;39(3):124–30.

    Article  Google Scholar 

  33. Tjørnhøj-Thomsen T, Hansen HP. Knowledge in health technology assessment: who, what, how? Int J Technol Assess Health Care. 2011;27(04):324–9.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by a grant from the Canadian Institutes of Health Research (CIHR; grant # 201010KAL-234745-KAL-CFBA-111141). The authors (Marie-Pierre Gagnon, Marie Desmartis, Mylène Tantchou Dipankui, Johanne Gagnon, and Michèle St-Pierre) declare no conflicts of interest with respect to the authorship and/or publication of this article. We would like to thank Caroline Busque, François Winter, Caroline Cimon Dick, Claudia Parent, and Pauline Cyr for their collaboration in organizing and facilitating the focus groups in their respective regions. Special thanks also to Marc Rhainds and Martin Coulombe, who facilitated access to the field; and to Louisa Blair for translation and editing assistance. We also acknowledge our debt to Mélanie Hamel, in whose memory this paper is submitted.

Author information

Authors and Affiliations

  1. Centre hospitalier universitaire de Québec Research Centre, Hôpital Saint-François d’Assise, 10 rue de l’Espinay, Québec, QC, G1L 3L5, Canada

    Marie-Pierre Gagnon & Marie Desmartis

  2. Faculty of Nursing, Université Laval, Québec, Canada

    Marie-Pierre Gagnon, Mylène Tantchou Dipankui & Johanne Gagnon

  3. Department of Management, Université Laval, Québec, Canada

    Michèle St-Pierre

Authors
  1. Marie-Pierre Gagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marie Desmartis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mylène Tantchou Dipankui
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Johanne Gagnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michèle St-Pierre
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie-Pierre Gagnon.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Gagnon, MP., Desmartis, M., Dipankui, M.T. et al. Alternatives to Seclusion and Restraint in Psychiatry and in Long-Term Care Facilities for the Elderly: Perspectives of Service Users and Family Members. Patient 6, 269–280 (2013). https://doi.org/10.1007/s40271-013-0023-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40271-013-0023-2

Keywords

Search

Navigation