In psychiatric settings, the use of seclusion and/or restraints can be emotionally and psychologically traumatizing for patients. Patients often experience these interventions as inhumane and humiliating, and such interventions can have physical and mental adverse effects and in some cases can be fatal. This study examined the role of demographic, clinical, and hospital variables in predicting seclusion and/or restraint episodes in adult psychiatric inpatients. A total of 395 patients were included in the study. Adult psychiatric inpatients previously restrained (n = 91) were compared to psychiatric inpatients never restrained (n = 304). A binary logistic regression research design was used to examine the relationship of demographic variables, clinical variables, and hospital variables on the likelihood of being placed in seclusion or restraints. The results yielded age as a significant predictor for patients being restrained. Also, individuals diagnosed with bipolar disorder were less likely to experience a seclusion and/or restraint event than patients diagnosed with depressive disorder or within the schizophrenia spectrum. In addition, findings suggest that adult psychiatric inpatients that experienced restraint episodes were restrained within the 1 st month of admission, during the weekday and during the 1 st shift. In summary, given the findings from this study, knowledge of risk factors that precede patient restraint could enhance education and provide staff with information necessary to meet the clinical needs of the psychiatric inpatient population. Research indicates that the use of seclusion and restraint has decreased followed by implementation of educational programs designed to help staff assess patient clinical care needs and develop more therapeutically appropriate alternatives (Bower et al., 2003). By being aware of possible risk factors associated with seclusion and/or restraint, mental health providers can use early intervention and prevention strategies to reduce the use of seclusion and/or restraint. This would provide safer environments for mental health patients receiving treatment.

Seclusion as a concept is poorly understood and this is reflected in the literature on the topic, particularly from nursing authors. This has led to an emotionally charged altercation rather than academic debate, both within the literature and at conferences. But why bother learning about seclusion at all, particularly as it is used less and less within mental health? We would point out to those sceptical about the value of this book that seclusion is not only of interest as an intervention per se, but is valuable in reflecting a shifting ethos within care. For some reason, seclusion has been neglected; we believe that one reason is that it impinges upon widely held myths and beliefs within psychiatric practice. Questioning about seclusion uncovers uncomfortable facts and assumptions concerning the values underpinning today's mental health care approaches. Such uncomfortable questioning is often avoided for safer research pursuits. Also, we hold that this book is necessary in examining issues pertaining to seclusion practice. There is a gap within nursing knowledge in so far as seclusion is concerned, as our chapter on education upholds. Yet inquiries and litigation have highlighted the fact that seclusion practice must be more clearly understood as an intervention. At present, such understanding is erratic and far from useful in providing a higher standard of care. Practitioners need to make informed decisions regarding seclu sion, and this book aims to provide the necessary information on which to base these decisions.

The primary research question is as follows: is having an early de-escalation support team readily available a valid option for successfully reducing the frequency of mechanical restraint, physical restraint and seclusion in an Inpatient Psychiatric Hospital setting? For simplicity, this team will be called the Early De-escalation Intervention Team (EDIT). The hospital involved in this study is a large regional psychiatric facility. The hospital’s Director of Performance Management created EDIT to bridge the gap between classroom training, application, and experience. Through rigorous coaching and modeling, the hospital believes EDIT has successfully partnered with staff to improve skill sets, increase safety, and dramatically reduce the utilization of mechanical restraint, physical restraint, and seclusion episodes. With the proper utilization of a team like EDIT, mental health staff would be able to work in a safer environment. Greater availability of EDIT staff to provide verbal de-escalation is likely to be associated with lower rates of mechanical restraint, physical restraint, and seclusion. Therefore, this study will examine 350 days of mechanical restraint, physical restraint, and seclusion data after EDIT was initially implemented, as well as 350 days of data before the creation of EDIT. After investigating the duration and frequency of mechanical restraint, physical restraint, and seclusion rates on one of the hospital’s most acute adult inpatient units, my hypothesis is that duration and frequency of mechanical restraint, physical restraint, and seclusion use will diminish significantly in the data pulled from the 350 days after implementation of EDIT in comparison to the 350 days of data prior to EDIT.