Abstract
Public guidelines in many western countries recommend post-incident reviews (PIRs) with patients after restraint use in mental health care. PIRs are one of several elements of seclusion and restraint reduction in internationally used programmes. PIRs may improve restraint prevention, patients’ recovery processes and care providers’ ethical mindfulness. The knowledge base on PIRs is, however, vague. This qualitative study explores professional care providers’ experiences and considerations regarding PIRs that included patients after restraint use in a Norwegian context.MethodsWithin a phenomenological hermeneutical framework, 19 multidisciplinary care providers were interviewed about their experiences and views regarding PIRs that included patients after restraint events. The interviews were performed over the period 2015–2016. Data analysis followed a data-driven stepwise approach in line with thematic content analysis. A group of two patient consultants in mental health services, and one patient’s next of kin, contributed with input regarding the interview guide and analysis process.ResultsCare providers experienced PIRs as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing. However, the care providers considered that PIRs’ potential could be further exploited as they struggled to get hold on the patients’ voices in the encounter. The care providers considered that issue to be attributable to the patients’ conditions, the care providers’ safety and skills and the characteristics of institutional and cultural conditions.ConclusionHuman care philosophies and a framework of care ethics seem to be preconditions for promoting patients’ active participation in PIRs after restraints. Patients’ voices strengthen PIRs’ potential to improve care and may also contribute to restraint prevention. To minimise the power imbalance in PIRs, patients’ vulnerability, dependency and perceived dignity must be recognised. Patients’ individual needs and preferences should be assessed and mapped when planning PIRs, particularly regarding location, time and preferred participants. Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way. Patients’ experiences with PIRs should be explored, especially if participation by trusted family members, peers or advocates may support the patients in PIRs.
Highlights
Post-incident reviews (PIRs) have been implemented in several western countries in recent years as part of seclusion and restraint (S/R) reduction programmes
Care providers experienced Post Incident Review (PIR) as having the potential to improve the quality of care through a) knowledge of other perspectives and solutions; b) increased ethical and professional awareness; and c) emotional and relational processing
Care providers must receive training to strengthen their confidence in conducting PIRs in the best possible way
Summary
Post-incident reviews (PIRs) have been implemented in several western countries in recent years as part of seclusion and restraint (S/R) reduction programmes. Restraint can be defined as a ‘mechanical or physical reaction against the patient including (the) use of straps, belts, other equipment or physically holding the patient preventing behaviour that might harm patients, care providers or (the) environment’ [4]. We rely on this definition in this research. The international development of laws applicable to persons with psychosocial disabilities has encouraged more critical attitudes towards coercive measures, especially their use with people in vulnerable situations. Despite the promise of these S/R reduction programmes, most studies on them have been based on development work aimed at S/R reduction, not rigorous research, so it is difficult to assess how much the different interventions have individually contributed to these supposedly promising results [2, 7, 11]
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