On restrictive practices: Care and culture

Muir‐Cochrane, Eimear

doi:10.1111/jpm.12492

Cited by 5 publications

(2 citation statements)

References 3 publications

(4 reference statements)

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“…Coercion has been shown to be harmful for both service users and staff within mental health care, being injurious, traumatizing and re‐traumatizing, making the case for trauma‐informed care (Department of Health, ; Duxbury, Aiken, & Dale, ; MIND, ; Muir‐Cochrane, ; Sweeney, Filson, Kennedy, Collinson, & Gillard, ). Concomitantly, there has been widespread international interest in nurse staffing levels, across healthcare contexts, including mental health.…”

Section: Introductionmentioning

confidence: 99%

“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: Introductionmentioning

confidence: 99%

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

McKeown

Thomson

Scholes

et al. 2019

Psychiatric Ment Health Nurs

View full text Add to dashboard Cite

show abstract

“…Although the finding is not new and underpins Trauma‐Informed Care (TIC) approaches, TIC has not been widely implemented (Isobel & Edwards 2017). It is suggested that in addition to de‐escalation, instruction on TIC should be an integral component of any aggression management program (Muir‐Cochrane 2018). Trainers of such programs must balance instruction on physical restraint techniques with adequate training in de‐escalation and TIC.…”

Section: Discussionmentioning

confidence: 99%

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint

Meehan

McGovern

Kinery

et al. 2022

Int J Mental Health Nurs

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Despite recent changes to mental health policy in Australia and overseas, physical restraint continues to be widely employed in mental health services. While mental health nurses have a critical role to play in supporting initiatives designed to reduce restraint, it is unclear how they feel about moves to restrict the use of prone restraint. In this qualitative study, focus group interviews were conducted with mental health nursing staff and lived experience workers (LEWs) to gain their perspectives on the use of physical restraint in general and the restrictions being placed on prone (‘face down’) restraint. Five themes emerged: justifying the need for restraint, reliance on the prone position, the position is not the issue, time limits, and the psychological impact. Although mental health nurses were concerned about the risks associated with physical restraint, they provided strong justification for continued use of the prone position. LEWs raised concerns about the psychological impact of prone restraint and noted the need for a greater emphasis on de‐escalation and other restraint avoidance strategies. The findings highlight the complexities and challenges to be considered when developing initiatives to reduce reliance on the use of restraint in general, and prone in particular.

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Elimination of restrictive practices from acute adult mental health care services: A qualitative evidence synthesis of the lived experience literature.

Bennetts,

Pepin,

Moylan

et al. 2024

SSM - Mental Health

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On restrictive practices: Care and culture

Cited by 5 publications

References 3 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

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint

Elimination of restrictive practices from acute adult mental health care services: A qualitative evidence synthesis of the lived experience literature.

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