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

Abstract

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.

Number of Seclusions in the Netherlands Higher in the 7 Years Since the End of a Nationwide Seclusion-Reduction Program

“…Though both may prevent injury to the patient, others, or property, they also have negative side effects for patients and staff. These include not only negative feelings like anger, humiliation, anxiety and aggressive feelings, but also injury, disruption in the therapeutic relationship, and posttraumatic stress disorder ( 1 – 3 ).…”

Chemical restraint: A qualitative synthesis review of adult service user and staff experiences in mental health settings

“…In EDs, restrictive interventions usually occur under a duty of care framework and associated legislation with clinical governance regarding the use of least restrictive practices (Knott et al, 2020). Further, in acute psychiatric units, service users ought to receive trauma‐informed and recovery‐oriented care (Hawsawi et al, 2020). Yet it seems from this research that this is not necessarily the service user experience.…”

“…There is a tendency for qualitative research of the experience of coercive practices to “bundle up” these practices into one phenomenon rather than exploring these practices individually. For example, Hawsawi et al (2020) conducted a qualitative literature review of nurses' and service users' shared experiences of seclusion and restraint. Shared experiences included disruption in care and in the therapeutic relationship and shared negative effects.…”

Análisis fenomenológico interpretativo de la experiencia de hospitalización en personas con diagnóstico de esquizofrenia

“…Adicionalmente, se manifestó haber percibido placer por parte del profesional que aplicaba el procedimiento. En suma, las prácticas expuestas se asocian al daño físicopsicológico 44 , trauma 3,10,11,15 , violación de los derechos humanos, control y deshumanización, y no favorecen la recuperación 18 .…”