Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’)

Duxbury, Joy; Baker, John; Downe, Soo; Jones, Fiona; Greenwood, Paul; Thygesen, Helene; McKeown, Mick; Price, Owen; Scholes, Amy; Thomson, Gill; Whittington, Richard

doi:10.1016/j.ijnurstu.2019.03.016

Cited by 56 publications

(50 citation statements)

References 53 publications

(64 reference statements)

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“…The project achieved substantial reductions in use of physical restraint (Duxbury et al, ), in line with other evaluations of the 6CS (Barton, Johnson, & Price, ; Guzman‐Parra et al, ; LeBel et al, ; Lewis, Taylor, & Parks, ; Putkonen et al, ). Evaluation also included qualitative interviews with staff and patients concerned with overall experiences of participating in the project and experiences of restraint practices, as well as ethnographic observations of ward cultures and practices (see Duxbury et al, ).…”

Section: Project Contextsupporting

confidence: 75%

“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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Section: Project Contextsupporting

confidence: 75%

“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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“…There is international interest in minimising restrictive practices within mental health care (Duxbury 2015). This paper reports on a rapid ethnography situated within a larger evaluation of the REsTRAIN Yourself (RYS) initiative within mental health inpatient wards (Duxbury et al 2019a). The ethnographic account provides a contextual overview of the range of environments in included mental health wards; focused attention to specific cultural aspects that could theoretically have been influenced by the RYS approach; and general description of changes occurring on the wards over the time of the study.…”

Section: Introductionmentioning

confidence: 99%

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

McKeown

Thomson

Scholes

et al. 2019

Sociology Health & Illness

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Coercive practices, such as physical restraint, are used globally to respond to violent, aggressive and other behaviours displayed by mental health service users.1 A number of approaches have been designed to aid staff working within services to minimise the use of restraint and other restrictive practices. One such approach, the ‘REsTRAIN Yourself’ (RYS) initiative, has been evaluated in the UK. Rapid ethnography was used to explore the aspects of organisational culture and staff behaviour exhibited by teams of staff working within 14 acute admission mental health wards in the North West region of the English NHS. Findings comprise four core themes of space and place; legitimation; meaningful activity; and, therapeutic engagement that represent characteristics of daily life on the wards before and after implementation of the RYS intervention. Tensions between staff commitments to therapeutic relations and constraining factors were revealed in demarcations of ward space and limitations on availability of meaningful activities. The physical, relational and discursive means by which ward spaces are segregated prompts attention to the observed materialities of routine care. Legitimation was identified as a crucial discursive practice in the context of staff reliance upon coercion. Trauma‐informed care represents a potentially alternative legitimacy.

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“…Across all implementation wards, there was an average reduction of restraint by 22%, with some wards showing a reduction of 60% and others less so (8%). The association between ward type and study phase was statistically significant 2…”

Section: Resultsmentioning

confidence: 86%

“…The purpose of the study2 was to adapt a version of the six core strategies (leadership, data-informed practice, workplace development, restraint reduction tools, service-users involvement, debriefing) and evaluate its impact on restraint usage in mental health settings that became known as REsTRAIN YOURSELF. The study design was a non-randomised controlled trial consisting of a combination of qualitative and quantitative methods including assessment of physical restraint rates, patient and staff surveys, and ethnographic and interview data 2. Using hospital records before and after 6 months of interventions, physical restraint numbers were collected.…”

Section: Methodsmentioning

confidence: 99%

The usage of coercive measures in psychiatric units and its potential counter-therapeutic impact on outcome

Ghassemi

2019

Evid Based Nurs

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Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’)

Abstract: This is a repository copy of Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme ('REsTRAIN YOURSELF').

Cited by 56 publications

References 53 publications

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

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

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

The usage of coercive measures in psychiatric units and its potential counter-therapeutic impact on outcome

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