Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis.
Simon Nielson, Lucy Bray, Bernie Carter and 1 others
PMID 32633554WHAT IT FOUND
Restraint in child and adolescent mental health inpatient services was associated with younger age, male gender, aggression, self-harm, diagnoses, emergency admissions and longer stays.
No study reported children’s own psychological harm.
Key findings
01Five studies reported that between 27% and 44% of inpatient children and adolescents experienced physical restraint, most studies recognised underreporting, and a study reported that 60% of physically restrained children experienced on average 14 restraints each.
02Restraint was associated with younger age, male gender, developmental, psychotic, externalising or internalising diagnoses, a history of aggression, self-harm or trauma, emergency admission, afternoon or evening timing and longer stays.
03No reviewed study reported child-reported psychological consequences, while two studies discussed a relationship between longer restraint duration and increased risk of physical harm.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Most included studies used retrospective records, so missing or underreported restraint episodes are likely. The studies varied in age, setting, admission length and how restraint was defined or recorded. Many studies were single-site or small, and their findings may not generalise. The review relied on proxy reporting rather than children’s own accounts. No included study reported child-reported psychological consequences of restraint. The evidence does not show whether restraint reduces harm or improves outcomes.
The easy way to misread this
Do not read these associations as evidence that restraint is effective or safe. The review did not test whether restraint improves outcomes, and it found no child-reported psychological accounts.