Nurses Experiences of Control & Restraint in an Acute Mental Health Setting By Tiziana Portelli.

Nurses Experiences of Control & Restraint in an

Acute Mental Health Setting

ByTiziana Portelli

Introduction

The overall purpose of this study was to explore nurses’ experiences of control & restraint in an acute mental

health setting.

Reasons for choosing this topic:

• Various researchers report that incidents of violence and threats of violence have shown a considerable increase over the last few years.

• Increased number of staff injuries whilst restraining patients.

• Personal interest.

Aims & Objectives …

• Develop a clear picture of how many nurses

had any form of training;

• Establish the understanding that nurses have

about C & R;

• Establish when & how C & R should be used;

• Establish knowledge of alternatives.

Literature Review

To identify from the literature:

• A definition of control & restraint

• When to use it

• Managing the process

• Alternatives

• Published research regarding nurses views & experiences

Definition of control & restraint

Definitions lack consistency within the literature.

(Johnson, 1998)

It is an intervention it involves a designated system of techniques.

(Anderson et al., 1999)

Control & restraint interventions are a common method for managing a range of clinical

situations. (Steel, 2000)

Methodology

• Purposive, mixed method, correlational

design;

• Population – qualified nurses in acute

psychiatric setting;

• Sample – all acute wards;

• Self designed structured questionnaire;

• Data analysis – numerical and thematic.

Findings

• demographic data

• training

• control & restraint & other techniques

• control & restraint & injuries

• post procedures

Findings …

• Demographics of sample …

• n = 56

• fairly evenly distributed sample

• majority were staff nurses

• 10 of these were RMN’s

• Majority had over 6 years service

Develop a clear picture of how many nurses had a form of training

• Most participants had no training

• Those that did, received it after they were already

working in acute wards

• This could be because a large number of nurses are

general trained

• Also could be related to lack of resources

• There is no hospital policy indicating training as a

requirement

Establish the understanding that nurses have about C & R

• Nurses clearly understood the importance and need for training

• This may be because of their experiences and their knowledge that there is a high tendency for patients to become violent & aggressive

• A high % felt anxious and lacked knowledge in several key areas

Establish when & how C & R should be used

• Participants did not have a clear

understanding of what it is and when and how

it should be used;

• Nurses lack de-escalation skills;

• Physical restraint is the first choice in nearly

all situations;

• Staff regularly incur injuries during C&R

Establish knowledge of alternatives

• Nurses had neither knowledge nor training on alternatives

• Local mentality may be significant

• Nurses may lack confidence to use other approaches.

MAIN CONCLUSION ….

• … there is an overwhelming lack of knowledge and training concerning control and restraint amongst nurses working in acute wards within the hospital where this research was conducted.

• This fact might then result in the frequent and inappropriate use of control and restraint techniques being applied to patients.

Limitations of the study

• Results can’t be generalised• Few psychiatric nurse participants• Small scale study • A number of participants' did not

comment

Strengths of study

• Good response rate

• Good representation of nurses grade, experience etc

• Use of questionnaires proved beneficial.

Recommendations

• Clinical practice

• Education

• Management

• Further research

References …

Johnson, M.E. (1998) Being restrained: a study of power and powerlessness. Issues in Mental Health Nursing. 19:191-206

Anderson, L, N., Minarik, P, A., Dilmorth, J, M., Jones, J., Nash, K, P.,O’ Donell, K, P., & Steinmiller,E, A.(1999). Responding to difficult patients. American Journal of Nursing, 99(12), 26-32

Steel, E.(2000). Seclusion and restraint practice standards: a review and analysis.Retrieved October5,2011, from http://www.ncstac.org/index.php?option=com_contentandview=articleandid=94%3Asecl

Thank you for your attention.