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

Abstract

International efforts to minimize coercive practices include the US Six Core Strategies© (6CS). This innovative approach has limited evidence of its effectiveness, with few robustly designed studies, and has not been formally implemented or evaluated in the UK. An adapted version of the 6CS, which we called 'REsTRAIN Yourself' (RY), was devised to suit the UK context and evaluated using mixed methods. RY aimed to reduce the use of physical restraint in mental health inpatient ward settings through training and practice development with whole teams, directly in the ward settings where change was to be implemented and barriers to change overcome. In this paper, we present qualitative findings that report on staff perspectives of the impact and value of RY following its implementation. Thirty-six staff participated in semi-structured interviews with data subject to thematic analysis. Eight themes are reported that highlight perceived improvements in every domain of the 6CS after RY had been introduced. Staff reported more positively on their relationships with service users and felt their attitudes towards the use of coercive practices such as restraint were changed; the service as a whole shifted in terms of restraint awareness and reduction; and new policies, procedures, and language were introduced despite certain barriers. These findings need to be appreciated in a context wherein substantial reductions in the use of physical restraint were proven possible, largely due to building upon empathic and relational alternatives. However, yet more could be achieved with greater resourcing of inpatient care.

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

“…Other team members [MM, FJ] involved in the data collection also contributed to and confirmed the identified themes. The qualitative analysis of the evaluation of the RYS intervention collected on the seven intervention wards, post‐intervention, is presented in a companion article (Duxbury et al, ). Analysis relating specifically to staffing levels is uniquely presented in this paper.…”

“…The project achieved substantial reductions in use of physical restraint (Duxbury et al, ), in line with other evaluations of the 6CS (Barton, Johnson, & Price, ; Guzman‐Parra et al, ; LeBel et al, ; Lewis, Taylor, & Parks, ; Putkonen et al, ). Evaluation also included qualitative interviews with staff and patients concerned with overall experiences of participating in the project and experiences of restraint practices, as well as ethnographic observations of ward cultures and practices (see Duxbury et al, ). We report here on a distinct subset of the qualitative data with a specific focus on the perceived influence and importance of staffing levels.…”

Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study

“…Additional analysis of interview data is reported elsewhere (Duxbury et al . 2019b). Analysis was supported using MAXQDA software (version 11, VERBI Software GmbH, Berlin, Germany).…”

“…Findings are presented and illustrated with field note excerpts and quotes from interviews. Additional analysis of interview data is reported elsewhere (Duxbury et al 2019b). Analysis was supported using MAXQDA software (version 11, VERBI Software GmbH, Berlin, Germany).…”

Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’)

“…The adaptation was based on extensive consultation with stakeholders and became known as 'REsTRAIN YOURSELF'. The core strategies were operationalized through a number of specific interventions targeted for a UK context as follows: 1 The full implementation process and project evaluation, including secondary outcomes such as the perceived impact on the ward environment and therapeutic relationships, has been more fully, reported upon elsewhere (Duxbury et al 2016, Duxbury et al 2019. The aim of the phase of the study reported here however, was to examine changes in physical restraint use on participating wards following introduction of the intervention.…”