Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

Abstract

Restrictive practices continue to be used in mental health care despite increasing recognition of their harms and an international effort to reduce and ultimately eliminate their use. The aim of this qualitative study was to explore mental health nurses' views of the potential elimination of these practices. Nine focus groups were conducted with 44 mental health nurses across Australia, and the data analysed using thematic analysis. Overall, the nurses expressed significant fear about the potential elimination of restrictive practices and saw themselves as being blamed for both the use of these practices and the consequences should they be eliminated. Findings detail the conflicts facing staff in balancing the need for ward safety for everyone present while at the same time providing person-centred care. Nurses described the changing role of the mental health nurse in acute settings, being more focussed on risk assessment and medication while at the same time attempting to practise in trauma-informed person-centred ways. The impact on ward safety with increasing acuity of consumers plus the presence of forensic consumers and those affected by methamphetamine was emphasized. Change initiatives need to take into account nurses' deep concerns about the consequences of eliminating all forms of control measures in hospitals and respond to the symptoms and behaviours consumers present with and associated unpredictable and concerning behaviours. Attempts to eliminate restrictive practices should, therefore, be carefully considered and come with a clear articulation of alternatives to ensure the safety of consumers, visitors, and staff.

What are adult psychiatric inpatients' experience of seclusion: A systematic review of qualitative studies

“…Given this evidence, it may be that for some participants in this review, separating from the reality of what was happening was a dissociative coping strategy in response to being retraumatized. Mental health staff, patients and their families have expressed concerns that seclusion is a traumatic intervention that could trigger memories of historical trauma (Brophy et al, ; Muir‐Cochrane, O'Kane, & Oster, ). Strout's () review of qualitative literature found that physical restraint is also experienced as retraumatizing.…”

Undergraduate students' perspectives on pursuing a career in mental health nursing following practicum experience

“…Not only does this impact student experiences of their practicums and recruitment into the mental health field, but also suggests the need for a fundamental shift in the way mental health care is conceptualised and enacted. Literature demonstrates that nurses in these settings are caught in tension between desiring to engage in therapeutic relationships with patients, but perceiving practices that contain and control patients as necessary for safety and treatment (Slemon, Jenkins, & Bungay, ; Larsen & Terkelsen, ; Muir‐Cochrane, O'Kane, & Oster, ). Change initiatives are needed that shift the practices of care towards prioritising the therapeutic relationship and empowering patients, while also acknowledging the need for safety for all individuals in the inpatient mental health setting.…”

A lack of therapeutic engagement and consumer input in acute inpatient care planning limits fully accountable mental health nursing practice

“…The fear of blame from an adverse event can result in a strong focus on documentation ‘to cover oneself’ (Manuel & Crowe ; Clancy & Happell ) as well as a reliance on restrictive practices (Slemon, Jenkins & Bungary ). For instance, fear and blame have been found to undermine attempts to eliminate seclusion and restraint in mental health care (Muir‐Cochrane, O'Kane & Oster ). Nurses can feel trapped between the policy of seclusion reduction on the one hand, and on the other hand, the imperative to protect themselves and others through the use of seclusion as a risk management strategy.…”