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Practice and Educational Interventions for Nurses to Reduce Restrictive Measures in Pediatric Mental Health: A
Katy Fisher-Cunningham1, Andri Hardman2,3, Shari Clifton4
1Department of Population Health and Health Systems Science, The University of Oklahoma Health Campus, Fran and Earl Ziegler College of Nursing, Oklahoma City, Oklahoma, USA.
Insights
Nurse-led interventions can reduce the use of restraint and seclusion (R/S) in pediatric mental health settings. Effective strategies involve trauma-informed care and simulation-based training, emphasizing nursing roles in preventing behavioral escalation.
Area of Science:
- Pediatric Mental Health Nursing
- Evidence-Based Practice
- Healthcare Quality Improvement
Background:
- Increasing frequency and severity of pediatric mental health crises necessitate alternatives to restrictive measures like restraint and seclusion (R/S).
- Limited evidence exists on pediatric-specific interventions, especially nurse-led ones, to decrease R/S use during acute behavioral escalations.
Purpose of the Study:
- To conduct a scoping review mapping the evidence on nurse-led or nurse-implemented interventions aimed at reducing R/S in pediatric mental health settings for children aged 12 years or younger.
- To identify the nature and breadth of educational and practice interventions targeting R/S reduction.
Main Methods:
- A comprehensive scoping review guided by JBI methodology, Arksey and O'Malley's framework, and PRISMA-ScR guidelines.
- Searches across MEDLINE, CINAHL, and PsycINFO for English-language studies published between 2014 and 2025.
- Inclusion criteria focused on nurses caring for children ≤12 years in psychiatric settings and interventions reducing R/S.
Main Results:
- Nine U.S.-based studies, mainly quality improvement and quasi-experimental, met the criteria.
- Interventions included trauma-informed care, simulation training, early warning tools, and collaborative problem-solving.
- Multimodal strategies focusing on workforce development and cultural transformation were most effective, though few interventions were nurse-initiated.
Conclusions:
- Nurses are crucial in preventing behavioral escalation and reducing R/S use.
- Interventions must be tailored to nursing roles, supported by leadership, and integrated into organizational policies.
- Future research should prioritize nurse-designed, pediatric-specific, and culturally responsive strategies for enhanced safety and therapeutic care.
Background:
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.
Objectives:
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.
Data Sources:
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.
Conclusions:
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.
Implications For Practice:
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.
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