Restriction and Control: The Perceptions of Mental Health Nurses in a UK Acute Inpatient Setting

Abstract

In the United Kingdom there has been growing unease over standards of care and treatment in acute inpatient psychiatric services. Although recent reforms have declared nurses as pivotal to the social transformation required, few accounts inform modernisers about the reality of social systems, relations, and events in modern acute psychiatric services. This qualitative study explores the situation of nurses working in acute inpatient psychiatric services. It particularly describes the social control elements that continue to influence working norms. Five nurses were interviewed and texts of these interviews were transcribed and analysed using content analysis. As a further source of data, documents were interpreted to illuminate social mechanisms. Issues of objectivity, validity, and reliability were considered throughout. Ethical issues were considered throughout and approval for the study was gained from the appropriate Research Ethics Committee. Social control functions portrayed by day-to-day rituals and operating norms emerged as a central theme in the findings. Social control is a prominent working norm. This is described through activities of observation, surveillance, and managing "difficult" behaviours. Therapeutic relationships present as a paradox to the control assumed. Implications of these findings are discussed.

The Conceptualization of Physical Restraint as a Nursing-Sensitive Adverse Outcome in Acute Care Psychiatric Treatment Settings

“…Some of the effective interventions targeting restraint reduction incorporated measures to transform the unit culture in relation to this restrictive way to control aggressive behavior (Taxis, 2002;Visalli et al, 1997). Psychiatric units have their own culture, with social control practices strongly embedded in shared norms and values (Hall, 2004;Johnson, 1998). To guide future inquiry into this important yet largely neglected phenomenon, organizational culture will be added to the organization of nursing care components of the model.…”

“…Other nurses reported that job satisfaction results from having control over decision making (Farrell & Dares, 1999). Psychiatric nurses in England described their work as dominated by social control functions, limiting their authority to change their own working practices (Hall, 2004). Although job satisfaction and stress were not measured in this study, the nurses reported that they experienced failures in control, effectiveness, and humanism.…”

“…The extant literature related to inpatient psychiatric nurses was conducted in Australia and New Zealand (Berg & Hallberg, 2000;Cleary, 2004;Cleary & Edwards, 1999;Delaney, Clearly, Jordan, & Horsfall, 2001;Farrell & Dares, 1999;Fourie, McDonald, Connor, & Barlett, 2005;Happell, Martin, & Pinikahana, 2003;O'Brien & Cole, 2004;Taylor & Barling, 2004), Canada (Robinson, Clements, & Land, 2003), England (Callaghan, 1991;Fagin, Brown, Bartlett, Leary, & Carson, 1995;Fagin et al, 1996;Hall, 2004;Higgins, Hurst, & Wistow, 1999;Mistral, Hall, & McKee, 2002;Sammut, 1997;Sullivan, 1993;Whittington, 2002;Whittington & Wykes, 1992), Norway (Severinsson & Hummelvoll, 2001), Sweden (Severinsson & Hallberg, 1998), Japan (Ito, Eisen, Sederer, Yamada, & Tachimori, 2001), and a combination of two or more of the above countries (Melchior, Bours, Schmitz, & Wittich, 1997;Thomsen, Arnetz, Nolan, Soares, & Dallender, 1999).…”

Contentions mécaniques en psychiatrie : étude phénoménologique de l’expérience vécue du personnel infirmier

“…Le traitement infligé aux personnes en institution est également une source majeure de critiques pour plusieurs auteurs (Hall, 2004 (Winick, 2008). Ceci démontre la contradiction entre la personne et l'État tel que décrit par Szasz (2007) : en agissant contre la liberté individuelle, l'État est un dispositif de coercition qui détient le monopole de l'usage légal de la violence.…”

Restraint and Seclusion in Services for People with Mental Health Problems and Learning Disabilities: A Literature Review

“…She found that staff were socialised into the need for physical restraint and seclusion as the means for ensuring control; staff who favoured or tried 'verbal therapeutic interventions' would be isolated and unsupported by their colleagues. Themes of restriction, surveillance and control were also central to a content analysis of mental health nurses' perceptions of their work by Hall (2004) with some participants believing such functions made a positive contribution to care, and others certain that they disrupted or precluded engagement in nurse patient relationships.…”