The Barriers and Enablers to the Use of Alternative Approaches to Restrictive Practices: A Scoping Review and Causal Loop Diagram.

This was a scoping review, so it mapped literature rather than testing whether alternatives reduce restrictive practices. The paper states inclusion criteria of qualitative or mixed methods, but reports quantitative designs among the included studies. No studies were excluded on quality grounds, so methodological quality did not filter the evidence base. Most included articles focused on practitioners' perspectives, and the nursing profession was represented far more than other practitioner groups. The causal loop diagram is the authors' interpretation and is described as an initial framework, not a comprehensive model. The review was northern-hemisphere dominant, and some studies did not report participant gender.

The research was supported by a Deakin University Postgraduate Research Scholarship. The authors report no conflicts of interest and nothing to disclose.

Do not read the causal loop diagram as proof that communication, peer support or de-escalation training reduce restraint or seclusion. This scoping review mapped barriers and enablers rather than testing intervention outcomes.