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

Tingleff, Ellen Boldrup; Hounsgaard, Lise; Bradley, Stephen P.; Gildberg, Frederik Alkier

doi:10.1111/inm.12549

Cited by 12 publications

(21 citation statements)

References 49 publications

(117 reference statements)

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“…Counter-behaviour can be active resistance due to a lack of other strategies available to those in dependent situations [e.g. inpatients] or protest reactions such as taking a passive role with withdrawal and attempts to evade contact [64]. The last point may be one of several explanations for the patients' passivity in PIRs, as this disciplining approach may contribute to silencing voices [61].…”

Section: Discussionmentioning

confidence: 99%

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

Hammervold

Norvoll

Vevatne

et al. 2020

BMC Health Serv Res

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Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients' recovery processes and care providers' ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers' experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context. Methods: Within a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015-2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient's next of kin, contributed with input regarding the interview guide and analysis process. Results: Care providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs' potential could be further exploited as they struggled to get hold on the patients' voices in the encounter. The care providers considered that issue to be attributable to the patients' conditions, the care providers' safety and skills and the characteristics of institutional and cultural conditions.

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Section: Discussionmentioning

confidence: 99%

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

Hammervold

Norvoll

Vevatne

et al. 2020

BMC Health Serv Res

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“…Forensic care is experienced as predominantly non‐caring but with small pockets of good care (Hörberg et al )where being punished and threatened with consequences are parts of daily life (Hörberg et al ; Olsson et al ). Staff refusing to understand patients’ perspectives or treating patients as inferiors may aggravate conflicts and result in the use of coercive measures (Tingleff et al ). Patients live with restrictions and confinement in an unhome‐like atmosphere where they ‘strive to convert the unfamiliar to the familiar and the impersonal to the personal’ (Olausson et al , p. 521).…”

Section: Introductionmentioning

confidence: 99%

“…For patients to feel involved, they must be invited and heard in discussions and dialogue; rather than just receiving information, they need to be engaged in their own care through mutual trust (Livingston et al 2013;Selvin et al 2016). Patients may experience that coercive measures are used in their best interest, to prevent them from doing things they would regret (Holmes et al 2015;Tingleff et al 2019). Staff setting limits in an empathic, authoritative manner can be perceived as positive (Maguire et al 2014).…”

Section: Introductionmentioning

confidence: 99%

‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care

Marklund¹,

Wahlroos²,

Looi

et al. 2019

Int J Mental Health Nurs

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Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients’ experiences and perceptions of forensic psychiatric inpatient care. Semi‐structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, ‘I know what I need to recover’, and three main categories: ‘A need for meaning in a meagre existence’, ‘A need to be a person in an impersonal context’, and ‘A need for empowerment in a restricted life’. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person‐centred and recovery‐oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.

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“…Disruption in the therapeutic relationship referred to the breakdown or lack of emotional rapport and connection between staff and consumers due to the use of coercive practices. Coercive practices disrupted the therapeutic relationship through creating physical conflicts between nurses and consumers and blocking social and emotional engagement (Jacob et al 2017; Tinglleff et al 2019; Wilson et al 2017). This social and emotional engagement could be improved through facilitating a conversation between both nurses and consumers (Fitzpatrick & McCarthy 2014).…”

Section: Methodsmentioning

confidence: 99%

“…This social and emotional engagement could be improved through facilitating a conversation between both nurses and consumers (Fitzpatrick & McCarthy 2014). Many consumers and nurses mentioned that nurses’ conscious communication provided some comfort and a sense of compassion (Ezeobele et al 2014; Hamid & Daulima 2018; Holmes et al 2015; Jacob et al 2017; Tingleff et al 2019). However, other consumers and nurses reported that any pre‐existing rapport vanished during coercive practices (Jacob et al 2017; Wilson et al 2017).…”

Section: Methodsmentioning

confidence: 99%

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

Hawsawi

Power

Zugai

et al. 2020

Int J Mental Health Nurs

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Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses' experiences: Absence of less coercive alternatives; and consumers' experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery-oriented, trauma-informed and consumer-centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers' experiences with coercive practices.

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

Cited by 12 publications

References 49 publications

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

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