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



T. Laiho

HUCH Peijas Hospital

Clinic of Acute Psychiatry

PL 900

00029 HUS




Accessible summary

  • Understanding the factors associated with the decision to use seclusion or restraint may help to reduce the use of coercive measures through the implementation of appropriate measures.
  • This integrative literature review brings together a broad view of factors associated with decision making in the use of seclusion or restraint and discusses decision-making process in practice.
  • The results suggest that decisions to use seclusion or restraint are based on both observed behaviour of patient and previous clinical experiences of staff.


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.

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