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J Psychiatr Ment Health Nurs. 2013 Nov;20(9):830-9. doi: 10.1111/jpm.12033. Epub 2012 Dec 10.

Clinical decision making involved in secluding and restraining an adult psychiatric patient: an integrative literature review.

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  • 1Helsinki University Central Hospital, Peijas Hospital Clinic of Psychiatry, Vantaa.


The purpose of this integrative literature review was to describe different factors involved in the decision-making process of using seclusion or restraint, and to discuss the process in practice. The data used in this review were systematically retrieved from the following databases: CINAHL, Medline and PsycINFO. Manual data retrieval was conducted from the reference lists of the papers that came up in the original database search. A total of 32 studies were selected. Results suggest that the situations that lead to the use of seclusion or restraint are always dynamic and circumstantial. During the decision-making process staff observe a patient's behaviour, assesses risk and chooses and uses interventions that aim to de-escalate the situation. This process is affected by the previous experiences and history of staff as well as the behaviour and previous experience of the patient.

© 2012 John Wiley & Sons Ltd.


decision making; psychiatric nursing; restraint; seclusion

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