The Impact of Total Patient Care Nursing on Restraint and Seclusion in a Pediatric Inpatient Psychiatric Unit

Date of Award

Fall 11-21-2026

Document Type

Doctoral Research Paper

Degree Name

Psy.D. in Clinical Psychology

Organizational Unit

Graduate School of Professional Psychology

First Advisor

Laura River

Second Advisor

Laura Meyer

Third Advisor

John Holmberg

Copyright Statement / License for Reuse

All Rights Reserved
All Rights Reserved.

Keywords

Seclusion, Restraint, Total patient care, Nursing care delivery, Pediatric psychiatric inpatient, Coercive measures

Abstract

Seclusion and restraint (S/R) are common but high-risk interventions on pediatric inpatient psychiatric units, and nursing care delivery models may influence how often units rely on them. This retrospective, quasi-experimental study examined whether implementation of a total patient care (TPC) nursing model, in which one nurse holds full responsibility for a small group of patients during a shift, was associated with changes in S/R use on a 24-bed pediatric inpatient psychiatric unit. Admissions before and after the unit's transition to TPC were compared on the number of seclusion and restraint episodes, as well as occurrence of restrictive events (at least one seclusion or restraint episode). Comparisons were conducted in the full sample (n = 257 admissions) and, to address non-independence from repeat admissions, in a subset limited to patients with only one admission (n = 201). No statistically significant differences emerged between groups in either analysis. These null findings should be interpreted in light of a short post-implementation window, the absence of a concurrent comparison condition, and limited data on implementation fidelity. Results did not support the hypothesis that TPC could rapidly reduce S/R use; however, S/R rates also did not increase after the transition, suggesting that in early implementation TPC yielded S/R use that was similar to treatment as usual. Future research using longer observation windows and prospective designs is needed to clarify TPC's effect on S/R use in pediatric psychiatric care.

Copyright Date

10-18-2026

Publication Statement

Copyright is held by the author. Permanently suppressed.

Rights Holder

Lisa LeFeber

Provenance

Received from Author

File Format

application/pdf

Language

English (eng)

Extent

41 pgs

File Size

430 KB

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