Ray N K, Rappaport M E
New York State Commission on Quality of Care for the Mentally Disabled, USA.
Psychiatr Serv. 1995 Oct;46(10):1032-7. doi: 10.1176/ps.46.10.1032.
The authors examined rates of use restraint and seclusion during September 1992 in 125 psychiatric settings in New York State.
Psychiatric centers and general hospitals with psychiatric services were surveyed by mail about use of restraint and seclusion during a one-month period and about facility characteristics. Four measures of use of restraint and seclusion were calculated: percentage of patients restrained, percentage of patients secluded, rate of seclusion orders, and rate of restraint orders.
Use of restraint and seclusion varied dramatically among the psychiatric settings studied. Use of restraint was not related to use of seclusion. Of the 112 tested relationships between facility and patient characteristics and variations in the restraint and seclusion measures, only 12 proved to be significant. None of the variables correlated significantly with variations in more than two of the four measures of restraint or seclusion, and only three correlated with at least two of the four measures.
Variations in use of restraint and seclusion in psychiatric settings in New York State are dramatic and difficult to correlate with differences in the patient populations. The authors suggest that such variations prevail because of the disparate clinical perspectives on the advisability of restraint and seclusion and the limited comparative monitoring of restraint and seclusion practices in psychiatric settings.
作者调查了1992年9月纽约州125家精神科机构中使用约束和隔离的比率。
通过邮件对设有精神科服务的精神科中心和综合医院进行调查，了解其在一个月期间约束和隔离的使用情况以及机构特征。计算了约束和隔离使用的四项指标：被约束患者的百分比、被隔离患者的百分比、隔离医嘱率和约束医嘱率。
在所研究的精神科机构中，约束和隔离的使用情况差异很大。约束的使用与隔离的使用无关。在机构与患者特征以及约束和隔离措施变化之间的112种测试关系中，只有12种被证明具有显著性。没有一个变量与约束或隔离的四项指标中超过两项的变化显著相关，只有三个变量与四项指标中的至少两项相关。
纽约州精神科机构中约束和隔离的使用差异很大，且难以与患者群体的差异相关联。作者认为，出现这种差异是因为对于约束和隔离的可取性存在不同的临床观点，以及精神科机构中对约束和隔离做法的比较监测有限。
