Practice and Educational Interventions for Nurses to Reduce Restrictive Measures in Pediatric Mental Health: A...

Pediatric mental health crises are increasing in both frequency and severity, with restrictive measures such as restraint and seclusion (R/S) frequently used during episodes of acute behavioral escalation. Despite the known risks, there is limited evidence on pediatric-specific interventions, particularly those led or implemented by nurses, to reduce R/S.

This scoping review aimed to map the breadth and nature of evidence on nurse-led or nurse-implemented educational and practice interventions designed to reduce the use of restrictive measures in pediatric mental health settings among children 12 years or younger.

Guided by JBI methodology, Arksey and O'Malley's scoping review framework, and PRISMA-ScR reporting guidelines, comprehensive searches were conducted across MEDLINE, CINAHL, and PsycINFO. Studies published in English between 2014 and 2025 were screened. Eligible studies focused on nurses caring for children aged ≤ 12 years in inpatient, residential, or emergency psychiatric settings and reported on interventions aimed at reducing restrictive measures.

Nine U.S.-based studies met inclusion criteria, primarily quality improvement and quasi-experimental in design. Interventions included trauma-informed care, simulation-based training, early warning assessment tools, and collaborative problem-solving approaches. Multimodal strategies emphasizing workforce development and cultural transformation were most effective. Notably, few interventions were nurse-initiated or included nursing perspectives during development.

Nurses play a critical role in preventing behavioral escalation and R/S use. Interventions tailored to the nursing role, supported by leadership, and embedded into organizational policy are essential. Future research should prioritize nurse-designed, pediatric-specific, and culturally responsive strategies to enhance safety and therapeutic care.