Coercive manoeuvres in a psychiatric intensive care unit

Abstract

Coercive manoeuvres in a psychiatric intensive care unit The practice of physical restraint techniques in the management of disturbed behaviour is a significant part of the role of mental health nurses, particularly in Psychiatric Intensive Care Units (PICUs). Debate about what constitutes good practice is intense, and the subject of recently issued guidelines by National Institute for Mental Health in England. However, the contribution of other forms of conflict management techniques has tended to be ignored. The purpose of this study was to identify, describe and categorize coercive manoeuvres used by nurses, and to examine the circumstances and appropriateness of their use. Non-participant observation of verbal and non-verbal interaction between patients and nurses during conflict situations was undertaken on one PICU. The critical incidents observed were identified, categorized and systematically recorded. Nurses used a variety of low level physical and interactional manoeuvres in order to manage patients' disturbed and resistive behaviour. These manoeuvres were seldom recorded, discussed or reviewed, although they were frequently used to manage critical conflict situations. These manoeuvres have neither been previously described nor evaluated. They may, in some cases, be useful substitutes for actual restraint, alternatively they may, in some cases, be judged undesirable. It is not known how widespread these practices are in acute psychiatry.

Achieving Equilibrium within a Culture of Stability—Cultural Knowing in Nursing Care on Psychiatric Intensive Care Units

“…As earlier research indicates, violence and disturbing behavior are a major issue on PICUs. Several publications pinpoint solutions for managing people with severe symptoms, for example, using mechanical restraints (Kaltiala-Heino et al, 2003), talk-down interventions (Ryan & Bowers, 2005), and time-outs (Beer, Pereira & Paton, 2008). In addition, our ethnography has identified a substantial and crucial effort from nurses on PICUs to create stability in the face of turbulence.…”

“…Furthermore, these approaches place greater demands on the need for specific nursing knowledge, which is less apparent in general psychiatric units. Nursing strategies for managing violence are represented in the literature and include talk-down interventions (Ryan & Bowers, 2005), deescalating techniques (Cowin et al, 2003;Taxis, 2002), and the use of time-outs (Beer, Pereira & Paton, 2008). Moreover, nurses' personal approaches are influential when caring for patients with challenging behavior, for example, having the ability to be in the moment (Carlsson, 2003), giving time, being honest, and maintaining personal control (Lowe, 1992).…”

Prevention and Management of Aggression Training and Violent Incidents on U.K. Acute Psychiatric Wards

“…In the UK, such courses originated within the prison system, and were then imported into general psychiatry, with modifications, via forensic psychiatric hospitals (Wright 1999 There is little published data on the frequency of use of manual restraint in the UK, with one study (Duff, Gray, & Brostor 1996) suggesting eight times per year on an average ward in order to manage aggressive behaviour. The hospitals in which this study took place did not routinely collect information on manual restraint use, nor is it easy to distinguish manual restraint from lower level coercion (Ryan & Bowers 2005). Manual restraint is used throughout psychiatric services in the UK, seclusion is only used in 70% of acute wards nationally (Garcia et al 2005), and mechanical restraint is not used at all.…”

Les chambres fermées en psychiatrie: poursuivre le débat pour dépasser les conflits

“…Selon les études qui en ont rendu compte, ces programmes ont un effet sur la diminution des incidents violents, sur le mieux-être des soignants et des soignés ainsi que sur la réduction des taux de mise en isolement. Comme l'ont observé Ryan et Bowers [16], les soignants utilisent dans leur pratique quotidienne un large éventail de techniques adaptées aux différentes situations auxquelles ils sont confrontés. Ces techniques, allant de la discussion apaisante à des contacts physiques fermes et à la contrainte, sont choisies en fonction de la situation, de la gravité du conflit qui les oppose au patient mais aussi suivant qu'ils connaissent bien ou non la personne et son degré de vulnérabilité.…”