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

Abstract

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.

‘Promoting and preserving safety and a life‐oriented perspective’: A qualitative study of nurses’ interactions with patients experiencing suicidal ideation

“…concealing or lying about SI). These findings can be associated with the study of Gerace and Muir-Cochrane (2019), indicating that nurses view restraint and seclusion as 'measures of last resort' to maintain safety. The present study confirms that a large number of nurses conform to these protocol-based measures in order to meet organizational expectations and to protect themselves in the event of an adverse outcome (Cutcliffe & Stevenson 2008, Hagen et al 2017a, Manuel & Crow 2014.…”

“…The findings highlight the potential of nursing actions such as making agreements and safety planning, actions that can only be considered as ‘therapeutic risk management strategies’ when being shaped in collaborative interaction (Kontio et al ; Stanley & Brown ). Furthermore, evidence suggests the potential of empathetic interactions, communication skills, and de‐escalation techniques as means to prevent or minimize the need for restraint and seclusion (Cusack et al ; Gerace & Muir‐Cochrane ; Kontio et al ). These insights reflect the importance of incorporating the rudiments of trauma‐informed and recovery‐oriented care in psychiatric hospitals, including attention for patients’ self‐determination and choice, emotional and physical safety, connection and hope, and mindful and collaborative interactions (Farkas ; Muskett ).…”

Staff experiences and understandings of the REsTRAIN Yourself initiative to minimize the use of physical restraint on mental health wards

“…The potential for some staff to be offended by perceiving an implicit criticism of their previous use of restraint, especially in a context of denuded resources and staffing levels, has to be sensitively dealt with in a context of demonstrating potential benefits. The perception that lack of resources is implicated in levels of coercion and undermined efforts at reduction is reinforced in other studies of staff views (Gerace & Muir Cochrane ).…”

“…These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. They also felt that containment use was a function of a lack of resources (Gerace & Muir Cochrane ).…”

On restrictive practices: Care and culture

“…To address this in part, The Australian College of Mental Health Nurses has recently been commissioned by the Australian National Mental Health Commission to undertake a project entitled “Safe in care, safe at work” which situates the safety of consumers and mental health nurses as central to the delivery of care in acute settings, where least restrictive care is facilitated. The project builds on the Supporting Mental Health Nurses towards cultural and clinical change: Facilitating ongoing reduction in seclusion and restraint in inpatient mental health settings in Australia project funded by the Commonwealth which I undertook with the college in 2017 (Muir‐Cochrane et al., ; Gerace & Muir‐Cochrane, ).This new project will develop a National framework for ensuring safety in care and safety for staff in Australian mental health services, reframing the policy narrative around seclusion and restraint reduction, to focus on ending fear and blame in mental health services and ensuring safety and improving quality at a national, state/territory and service level. It is anticipated that this work will indeed assist, at least in some part, in a revisioning of acute inpatient care and in a least restrictive, emotionally and physically safe environment.…”