Deaths in custody: the role of restraint

Duxbury, Joy; Aiken, Frances; Dale, Colin

doi:10.1108/20420921111207873

Cited by 25 publications

(18 citation statements)

References 49 publications

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“…, Ashcraft & Anthony , Duxbury et al . ). Further, physical injuries ranging from those that are minor to major, have been reported, including coma, broken bones, bruises, cuts requiring stitches, facial damage, dehydration, choking, circulatory and skin problems, loss of mobility, and incontinence (Paterson & Duxbury ).…”

Section: Discussionmentioning

confidence: 97%

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Duxbury

2015

Psychiatric Ment Health Nurs

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Aggression is reported to be prevalent in psychiatric inpatient care and its frequency towards healthcare professionals is well documented. While aggression may not be entirely avoidable, its incidence can be reduced through prevention and the minimization of restrictive practices such as physical restraint. The study aims to explore three common 'defences' to account for the use of physical restraint; to challenge each defence with regard to the evidence base; and to identify how services are responding to the challenge of reducing the use of restrictive interventions. Following a number of investigations to highlight serious problems with the use of physical restraint, it seems timely to examine its efficacy in light of the evidence base. In order to do this, three key defences for its use will be challenged using the literature. A combination of interventions to minimize the use of restraint including advance planning tools, and recognition of potential trauma is necessary at an organizational and individual level. Patients can be severely traumatized by the use of restrictive practices and there is a drive to examine, and reduce the use and impact of using these models that incorporate trauma informed care (TIC) and person centredness.

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Section: Discussionmentioning

confidence: 97%

The Eileen Skellern Lecture 2014: physical restraint: in defence of the indefensible?

Duxbury

2015

Psychiatric Ment Health Nurs

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“…Coercion has been shown to be harmful for both service users and staff within mental health care, being injurious, traumatizing and re‐traumatizing, making the case for trauma‐informed care (Department of Health, ; Duxbury, Aiken, & Dale, ; MIND, ; Muir‐Cochrane, ; Sweeney, Filson, Kennedy, Collinson, & Gillard, ). Concomitantly, there has been widespread international interest in nurse staffing levels, across healthcare contexts, including mental health.…”

Section: Introductionmentioning

confidence: 99%

“Catching your tail and firefighting”: The impact of staffing levels on restraint minimization efforts

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

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Accessible summary What is known on the subject? Mental health nursing in the UK and other countries faces an acute workforce crisis. Safe staffing levels are called for, and in some jurisdictions have been legislated for. The evidence base linking staffing levels and patient outcomes is limited. Staffing levels are implicated in adverse experiences of service users and staff within mental health ward settings, and they might contribute to levels of violence and aggression and the application of restrictive practices, such as physical restraint but there is limited research evidence to support this. Programmes such as Safewards, No Force First, the Engagement Model and the Six Core Strategies can reduce the use of restrictive practices. What does this paper add to existing knowledge? Staffing levels on acute mental health wards appeared crucial in the implementation of a restraint minimization project. Both staff and service users implicate insufficient staffing for deficiencies in the relational elements of care, such as lack of face‐to‐face contact between nurses and service users. Similarly, staffing levels are associated with perceived problems in the cause of violence and aggression and responses to it. Despite successes in minimizing restrictive practices in this project, difficulties implementing alternative forms of practice that would reduce use of physical restraint, such as de‐escalation, were also attributed to staffing levels. There is an irony that a project concerned with safety itself provoked concern over safe staffing levels. What are the implications for practice? Efforts to reduce restrictive practices will be hampered without adequate staffing levels. Restrictive practices may justifyably be framed as an employment relations matter. Organisations and policy makers ought to address environmental, contextual and resourcing factors, rather than identify problems exclusively in terms of perceived aberrant behaviour of staff or service users. Abstract IntroductionSafe staffing and coercive practices are of pressing concern for mental health services. These are inter‐dependent, and the relationship is under‐researched. AimTo explore views on staffing levels in a context of attempting to minimize physical restraint practices on mental health wards. Findings emerged from a wider data set with the broader aim of exploring experiences of a restraint reduction initiative. MethodsThematic analysis of semi‐structured interviews with staff (n = 130) and service users (n = 32). ResultsFive themes were identified regarding how staffing levels impact experiences and complicate efforts to minimize physical restraint. We titled the themes—“insufficient staff to do the job”; “detriment to staff and service users”; “a paperwork exercise: the burden of non‐clinical tasks”; “false economies”; and, “you can't do these interventions.” DiscussionTendencies detracting from relational aspects of care are not independent of insufficiencies in staffing. The relational, communicative and organizational developm...

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“…The panel commissioned Duxbury et al. () to conduct a systematic review of the most up to date national and international research on restraint‐related deaths. The report authors concluded, “There is much rhetoric and advice given in the press and professional journals on preventing restraint‐related deaths but much of this is based on opinion and less on valid studies.…”

Section: Time and The Multifactorial Causes Of Restraint Deathmentioning

confidence: 99%

“…It is now generally accepted that the risk of death arising from restraint is not exclusively linked to specific techniques, nor wholly attributable to certain positions (Paterson et al., ). Rather, the fatal outcome is determined by a combination of the prevailing health status of the individual being restrained, the physiological changes caused by the subjective experience of restraint along with the resulting resistance to it, as well as the nature and degree of force employed by staff (Duxbury, Aiken, & Dale, ). The research base around our understanding of these risk factors and their interplay continues to grow despite real‐world fidelity within experiments often remaining ethically out of reach (Paterson et al., ; Tamsen & Thiblin, ).…”

Section: Introductionmentioning

confidence: 99%

“…Whilst the safety margins that may be crossed during a physical restraint are almost impossible to definitively calculate, this paper will draw the reader's attention to a number of factors which suggest that a risk of harm to the individual being restrained can manifest itself within this approved time frame. Duxbury et al (2011) to conduct a systematic review of the most up to date national and international research on restraintrelated deaths. The report authors concluded, "There is much rhetoric and advice given in the press and professional journals on preventing restraint-related deaths but much of this is based on opinion and less on valid studies.…”

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confidence: 99%

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