Delirium frequently occurs among hospital in-patients, with significant attributable healthcare costs. It is associated with long-term adverse outcomes, including an eightfold increased risk of subsequent dementia. The purpose of this article is to inform clinicians of the best practices for spotting, stopping and treating delirium and provide guidance on common challenging clinical dilemmas. For spotting delirium, suggested screening tools are the 4 ‘A's Test (in general medical settings) and the Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). Prevention is best achieved with multicomponent interventions and targeted strategies focusing on: (a) avoiding iatrogenic causes; (b) brain optimisation by ensuring smooth bodily functioning; (c) maintaining social interactions and normality. Non-pharmacological approaches are the first line for treatment; they largely mirror prevention strategies, but the focus of empirical evidence is on prevention. Although sufficient evidence is lacking for most pharmacological approaches, an antipsychotic at low doses for short durations may be of utility for highly distressing or high-risk situations, particularly in hyperactive delirium, but only as a last resort.

The International Psychogeriatric Association (IPA) has expressed significant concerns over the use of physical restraints in older people across diverse aged care settings. Following an extensive analysis of the available literature, the IPA’s Early Career Network (ECN) has formulated a collection of evidence-based recommendations aimed at guiding the use of physical restraints within various care contexts and demographic groups. Physical restraints not only infringe upon human rights but also raise significant safety concerns that adversely impact the physical, psychological, social, and functional well-being of older adults. Furthermore, their effectiveness in geriatric settings remains inadequate. Given these considerations, the IPA and its ECN firmly assert that the use of physical restraints should only be considered as a final recourse in the care of older people.

In the last decade, conducted electrical weapons (CEWs) have become a new tool for law enforcement agencies as an alternative to firearms. They provide security in the intervention for both the police and the citizen and try to cause the least possible harm to the subject to immobilize.

The health care providers who perform in joint actions with the police in which CEWs are used should be aware of how they work, risk groups, as well as the most frequent clinical effects associated with the application of electrical discharge, and the complications that can be produced according to the area of impact of the electrodes.

For this purpose, the current medical literature was reviewed by consulting the main health care sciences database (PubMed) to determine the medical measures to be taken before, during, and after the use of these weapons. Also presented and shared is the Zaragoza (Spain) Fire Department protocol.

The treatment of mental illness is undergoing a paradigm shift, moving away from involuntary treatments towards rights-based, patient-centred care. However, rates of seclusion and restraint in Ireland are on the rise. The World Health Organisation’s QualityRights initiative aims to remove coercion from the practice of mental health care, in order to concord with the Convention on the Rights of Persons with Disabilities. The QualityRights initiative has recently published a training programme, with eight modules designed to be delivered as workshops. Conducting these workshops may reduce coercive practices, and four of the modules may be of particular relevance for Ireland. The ‘Supported decision-making and advance planning’ and the ‘Legal capacity and the right to decide’ modules highlight the need to implement the Assisted Decision-Making (Capacity) Act, 2015, while the ‘Freedom from coercion, violence and abuse’ and ‘Strategies to end seclusion and restraint’ modules describe practical alternatives to some current involuntary treatments.

This is a retrospective cohort study based on data from five nursing homes which aims to appraise how physical and cognitive characteristics of nursing home residents were associated with the use of restraints, and to provide information on their prevalence in Spain. The goal was to assess, in a visual way, the possible interactions between the nursing homes residents’ characteristics and their association with the use of restraints. Motivation, risk factors, characteristics of the residents analysed by validated rating systems that assess mobility, level of dependence, cognitive condition and nutritional status, and their association with the use of restraints, were described by means of linear and non-linear multivariate approaches in the form of self-organised maps. Findings showed that the prevalence of restraints was high when compared to other developed countries. The visual analysis reinforced the knowledge that a greater impairment was associated with the use of restraints and vice versa. However, the residents’ characteristics were not always associated with the use of restraints. Subjective factors seem to play a relevant role in decision-making, so it is important to assess risk factors continuously and determine the actual need for the use of restraints from an individual perspective by basing the criteria on specific objectives, and on consistent, reproducible and reliable methods. Initiatives to minimise these subjective factors should be promoted. Likewise, a clear definition of physical restraints should be offered at each centre. In addition, effective legislation that clearly states the need, alternatives and motivation for the use of restraints is needed.

Section 136 of the Mental Health Act 1983 is routinely used by the police to remove a person thought to be suffering from a mental disorder, from a place to which the public have access, to a place of safety. Persons detained under Section 136 of the Mental Health Act 1983 routinely spend significant amounts of time in a place of safety whilst awaiting a mental health assessment. During that time it is feasible that the patient will require intramuscular medications for rapid tranquillisation, often with the use of physical restraint. However, Section 136 of the Mental Health Act 1983 does not grant the power to treat a person against their will and there is a lack of clarity on the most appropriate legal framework for physically restraining and administering intramuscular medications for rapid tranquillisation to a person detained under Section 136 of the Mental Health Act 1983. In this article, we attempt to explore the various legal frameworks available and identify the one most appropriate for this purpose.

Background: Physical restraint use is common in institutional care for old people and mainly used to prevent falls, despite the fall-preventive effect of physical restraints being questioned in previous research. The aim of the study was to investigate the use of physical restraints in Sweden in 2000 and 2007.

Methods: Data were collected from two comparable census surveys conducted in all institutional care units for old people in 2000 (n = 3,669) and 2007 (n = 2,914). Information on residents’ characteristics and physical restraint use was collected using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

Results: In 2000 16.0% (95% confidence interval (CI) 14.8%–17.2%) of the residents were restrained compared to 18.2% (95% CI 16.8%–19.6%) in 2007 (p = 0.017). Adjusting for residents' characteristics showed that residents in 2007 were more likely to be physically restrained, relative to the residents in 2000 (odds ratio (OR) 1.031, 95% CI 1.005–1.058, p = 0.017). In 2007 the residents had been restrained longer, and a higher proportion were restrained for unknown reasons.

Conclusions: Physical restraint use is still common. Moreover, the findings of this study suggest a small increase (OR 1.031) in the prevalence of physical restraint use from 2000 to 2007 adjusted for residents’ characteristics.

Introduction: Although in most developed countries the use of restraints is regulated and restricted by law, the concept of restraint in nursing home care remains ambiguous. This study aims to explore how care professionals and family members of nursing home residents with dementia in the Netherlands experience and define the concept of restraint.

Methods: Individual interviews were held with relatives (n = 7) and key persons (n = 9) in seven nursing homes. We also conducted eight focus group discussions with nursing home staff. In addition, a structured questionnaire was administered to the nurses of participating nursing homes.

Results: In the questionnaire, over 80% of the respondents indicated considering “fixation” (e.g. use of belts) as a restraint and 50 to 70% of the respondents regarded other physical interventions, such as geriatric chairs and bedrails, as restraints. The interviews and focus group discussions show that the residents' perception of the intervention, the staff's intention behind the intervention and concerns of privacy are the criteria used by the respondents in defining an intervention as a restraint.

Conclusions: When trying to diminish restraint use, it is important to be aware of the “local logic” of care practice and to take into account the fact that, for staff and relatives, an intervention is only regarded as a restraint when it is bothering a resident or when an intervention is used for the sole purpose of restricting freedom and/or when interventions invade the privacy of a resident.

The National Institute for Clinical Excellence (2005) published guidance on the management of disturbed behaviour in mental health settings and emergency departments. The guidance included some of the recommendations made in the Independent Inquiry into the death of David Bennett (2003). One important recommendation requires that staff implementing physical interventions (restraint) and/or parenteral rapid tranquilisation are able to effectively manage the physical health of the patient including any immediate complications that may arise.

This article provides background and a syllabus for training for staff to be able to meet the physical assessment skills and interventions required by recent UK national guidance. Also reported is the creation, role and deployment of a 24-hour Medical Emergency Response Team in an in-patient mental health setting to ensure responses to both medical and psychiatric emergencies offer improved safety and adhere to the new guidance. The article describes the provision of a person with the sole responsibility monitoring a patients physical safety during restriant, 24 hour a day, 7 days a week.

The article will be of interest to those working in in-patient mental health and learning disability services, especially those where they are not served by a resuscitation team as part of a District General Hospital and where there is no resident Duty Medical Officer.