Restraint and seclusion practices in psychiatric inpatient hospitalization in Tanzania
Healthcare worker perspectives and implications for patient-centered care
Bibliographic Data
| ID | 24217831 |
|---|---|
| Authors | Julia Sieg (0009-0001-0629-4172, Heidelberg University), Jackline Dereck Rwakilomba (Kilimanjaro Christian Medical Centre University), Louise Joel (Kilimanjaro Christian Medical Centre University), Kim Madundo (0000-0003-0927-1678, Kilimanjaro Christian Medical Centre University), Brandon A Knettel (0000-0003-2986-1579, School of Nursing, Duke University) |
| Year | 2026 |
| Volume | 13 |
| Publication date | 2026-01-01 |
| Peer Reviewed | Yes |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | Cambridge Prisms Global Mental Health (JOURNAL) |
| Journal identifiers | ISSN: 2054-4251 • E-ISSN: 2054-4251 |
| Publisher | Cambridge University Press (CUP) (PUBLISHER) |
| DOI | 10.1017/gmh.2026.10291 |
| OpenAlex | W7214623778 |
| Language | EN |
| References cited | 32 |
Restraint and seclusion (R/S) are used in psychiatric settings to manage aggression and agitation. Because these practices can cause psychological harm, physical injury and death, guidelines designate them as last-resort measures, yet their use frequently extends beyond psychiatric emergencies. In this study, we explored how R/S are understood, experienced and enacted within psychiatric care in Tanzania, focusing on their application, perceived impacts and future directions for training and intervention. We observed practices and conducted qualitative interviews with 20 doctors, nurses, clinical attendants and security guards involved in psychiatric care at a single Tanzanian hospital. We analyzed observational notes and data using applied thematic analysis. Seclusion rooms were used frequently and for extended periods. Physical restraint, such as physically holding patients or using bedsheets to cover their heads, was employed to facilitate chemical restraint or seclusion. While participants acknowledged physical restraint was potentially harmful, several expressed support for increasing chemical restraint and seclusion. Staff experienced a tension between their intentions to provide care and the potential for harm that was further compounded by the resource-limited context. To ensure patient safety and well-being, there is a need for safer, more humane standards and training in alternative aggression management techniques, including verbal de-escalation.
aggression management · chemical restraint · De-escalation · employee training · healthcare worker perspectives · Patient safety · Patient-centered care · physical restraint · psychiatric inpatient care · resource-limited settings · Seclusion · Tanzania · Electroconvulsive Therapy Studies · Healthcare Decision-Making and Restraints · Restraint-Related Deaths
Applied Thematic Analysis
Mental Health Service Users’ Perceptions and Experiences of Sedation, Seclusion and Restraint
Understanding Healthcare Professionals’ Decision-Making Regarding Physical Restraint in Acute Psychiatric Wards
Effectiveness of CRSCE-Based De-escalation Training on Reducing Physical Restraint in Psychiatric Hospitals
Exploring the views of people with mental health problems' on the concept of coercion
Coercion and power in psychiatry
How Many Interviews Are Enough
| Citation velocity | historical |
|---|---|
| Highly cited | No |