Nurses' experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: a qualitative study

Abstract

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made. Accessible summary• While the decision to use restraint and seclusion was not taken lightly, nurse participants felt that there were no effective alternatives to the use of these measures.• Adverse interpersonal, physical and practice environments contributed to the onset of aggression in old age psychiatry inpatient settings.• Policies to reduce or eliminate the use of restraint and seclusion need to take account of wide-ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices. AbstractRestraint and seclusion are often ineffective and can affect patients adversely. In this study, we explored nurses' experiences of restraint and seclusion in short-stay acute old age psychiatry inpatient units and how these experiences underpin resistance to eliminating these practices. Qualitative interviews were conducted with nurses in three old age psychiatry units in Melbourne, Australia. The results provide one overarching theme, lack of accessible alternatives to restraint and seclusion, indicating that nurses believe there are no effective, accessible alternatives to these practices. Three related themes contribute to this perception. First, an adverse interpersonal environment contributes to restraint and seclusion, which relates to undesirable consequences of poor staff-to-patient relationships. Second, an unfavourable physical environment contributes to aggression and restraint and seclusion use. Third, the practice environment influences the adoption of restraint and seclusion. The findings contribute to the limited evidence about nurses' experiences of these practices in short-stay old age psychiatry, and how account needs to be taken of these experiences and contextual influences when introducing measures to address these practices. Policies addressing these measures need to be accompanied by wide-ranging initiatives to deal with aggression, including providing appropriate education and support and addressing ethical and workplace cultural issues surrounding these practices.

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

“…This spread in perceptions may be associated with the availability of appropriate less restrictive alternatives and deserves further examination as to reasons (Muir‐Cochrane et al . ). Respondents accepted that seclusion and restraint use were deleterious to their relationships with consumers, as other research has supported (Mohr et al .…”

“…noise or lack of low‐stimulation spaces) not being conducive to reducing irritation and aggression (Muir‐Cochrane et al . , ).…”

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

“…Mental health nurses’ accounts of fear and blame highlight the need for policies aimed at reducing or eliminating restrictive practices to ‘take account of wide‐ranging strategies to deal with aggression, including the provision of appropriate education and support and addressing ethical and workplace cultural issues associated with these practices’ (Muir‐Cochrane et al . , p. 109). There is also increasing evidence of the usefulness of trauma‐informed care in both acute inpatient and ED settings (Hall et al .…”

Psychiatric staff attitudes toward coercive measures: An experimental design

“…In studies conducted in European countries, the reported levels of restraint and seclusion use was less than 1%. Therefore, the situation in Jordanian psychiatric settings indicates that the frequency of restraint and seclusion is critical and threatening and it may reflect the cultural beliefs and values within which a psychiatric system is situated …”

“…Therefore, the situation in Jordanian psychiatric settings indicates that the frequency of restraint and seclusion is critical and threatening and it may reflect the cultural beliefs and values within which a psychiatric system is situated. 14 Since nurses' attitudes are often recognized as a possible influence on the use of coercive measures due to their direct relationship with the expressed behaviors, nurses in mental healthcare facilities need to adopt better practice models that are more evidence-based and less restrictive to psychiatric patients. 15…”