An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings

Abstract

In Western society, policy and legislation seeks to minimize restrictive interventions, including physical restraint; yet research suggests the use of such practices continues to raise concerns. Whilst international agreement has sought to define physical restraint, diversity in the way in which countries use restraint remains disparate. Research to date has reported on statistics regarding restraint, how and why it is used, and staff and service user perspectives about its use. However, there is limited evidence directly exploring the physical and psychological harm restraint may cause to people being cared for within mental health inpatient settings. This study reports on an integrative review of the literature exploring available evidence regarding the physical and psychological impact of restraint. The review included both experimental and nonexperimental research papers, using Cooper's (1998) five-stage approach to synthesize the findings. Eight themes emerged: Trauma/retraumatization; Distress; Fear; Feeling ignored; Control; Power; Calm; and Dehumanizing conditions. In conclusion, whilst further research is required regarding the physical and psychological implications of physical restraint in mental health settings, mental health nurses are in a prime position to use their skills and knowledge to address the issues identified to eradicate the use of restraint and better meet the needs of those experiencing mental illness.

Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: A qualitative interview study

“…In the findings of the current study, patients' perceptions of situations such as conflicts with staff, insufficient communication, and debriefing are similar to those of previous studies (Aguilera-Serrano et al 2018;Cusack et al 2018). However, the results from this study add to existing knowledge, by linking patients' perceptions of situations with their underlying reasons for their own actions and reactions throughout the two identified patterns in the process of MR, as elaborated and discussed below.…”

“…; Cusack et al . ). However, the results from this study add to existing knowledge, by linking patients’ perceptions of situations with their underlying reasons for their own actions and reactions throughout the two identified patterns in the process of MR, as elaborated and discussed below.…”

“…Researchers argue that the contribution of patients' experiences and perceptions can lead to a reduction of coercion and improve clinical practice (Kontio et al 2012;Steinert 2016). The area of patients' perceptions of different types of coercive measures, especially seclusion and physical restraint (holding), has also been scrutinized by an array of researchers (Aguilera-Serrano et al 2018;Cusack et al 2018;Krieger et al 2018). However, as suggested by Kontio et al (2012), only a minority of this research has examined patients' perceptions of coercive measures as a process; that is, it includes situations before, during, and after exposure to coercion.…”

‘Promoting and preserving safety and a life‐oriented perspective’: A qualitative study of nurses’ interactions with patients experiencing suicidal ideation

“…These findings resonate with the literature emphasizing the widespread and continuing use by nurses of formal observations, restraint, door‐locking, and seclusion. Nurses perform these procedural actions despite evidence questioning their effectiveness in terms of suicide prevention and highlighting their predominant negative emotional and relational outcomes, including increased distress and social isolation, reduced autonomy, and (re)traumatization (Bowers et al ; Cox et al ; Cusack et al ; Huber et al ; Kontio et al ). The findings confirm some of these outcomes including the nurses’ perception that protective measures can exacerbate patients’ feelings of hopelessness and provoke counter‐reactions (e.g.…”

“…The findings highlight the potential of nursing actions such as making agreements and safety planning, actions that can only be considered as ‘therapeutic risk management strategies’ when being shaped in collaborative interaction (Kontio et al ; Stanley & Brown ). Furthermore, evidence suggests the potential of empathetic interactions, communication skills, and de‐escalation techniques as means to prevent or minimize the need for restraint and seclusion (Cusack et al ; Gerace & Muir‐Cochrane ; Kontio et al ). These insights reflect the importance of incorporating the rudiments of trauma‐informed and recovery‐oriented care in psychiatric hospitals, including attention for patients’ self‐determination and choice, emotional and physical safety, connection and hope, and mindful and collaborative interactions (Farkas ; Muskett ).…”