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

Adam Gerace,Eimear Muir‐Cochrane

doi:10.1111/inm.12522

Adam Gerace, Eimear Muir‐Cochrane

Open Access

https://doi.org/10.1111/inm.12522

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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.

Highlights

Seclusion and restraint—restricting a consumer’s movement using environmental, physical, or mechanical means—are containment methods used with psychiatric consumers in inpatient settings and emergency departments (EDs) to prevent and manage the risk of harm because of behaviours such as aggression, violence, andAdam Gerace, BPsych(Hons), PhD
This study reports the results of a survey of the perceptions and attitudes of nurses working with psychiatric consumers in Australia regarding the current use of seclusion and restraint, and their perceptions regarding elimination of such practices in inpatient psychiatric settings and EDs in Australia
While seclusion and restraint are covered in less depth in the recently released Australian Fifth National Mental Health and Suicide Prevention Plan (Department of Health, 2017), seclusion is included as a practice to be addressed and monitored, and as one of the 24 key performance indicators under the domain of striving for ‘less avoidable harm’ in mental health care

Summary

Introduction

Seclusion and restraint—restricting a consumer’s movement using environmental, physical, or mechanical means—are containment methods used with psychiatric consumers in inpatient settings and emergency departments (EDs) to prevent and manage the risk of harm because of behaviours such as aggression, violence, andAdam Gerace, BPsych(Hons), PhD. These containment practices have been identified as involving deleterious physical and psychological effects for consumers and staff, and complex legal and ethical issues are associated with their use (McSherry 2017; Muir-Cochrane & Gerace, 2014). The policy statement stresses the need for research into alternatives to restrictive practice use and safe consumer management, as well as practice change (e.g. organizational culture, individual attitudes, leadership, staff training). It is the position of the ACMHN that seclusion and restraint use ‘be reduced and ended’ While seclusion and restraint are covered in less depth in the recently released Australian Fifth National Mental Health and Suicide Prevention Plan (Department of Health, 2017), seclusion is included as a practice to be addressed and monitored, and as one of the 24 key performance indicators under the domain of striving for ‘less avoidable harm’ in mental health care

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