Abstract
Evidence does not support the use of restraint and seclusion (RS) to contain patients on psychiatric inpatient units, yet these practices continue to be used and defended. Use of RS often results in serious injuries to patients and psychiatric health care workers. Media exposure and legal challenges have led to negative opinions about RS but not their elimination. Substance Abuse and Mental Health Services Administration set a firm goal to permanently eliminate the use of RS, emphasizing that such practices are non-therapeutic. There is agreement that prevention is central to eliminating RS. The aims of this grounded theory study were to understand the contextual processes in preventing RS and the facilitators and barriers to prevention practice. Barriers include lack of resources at the micro-level, mismanaged messages at the institutional level, and, at the policy level, belief that all simply need a “change of heart.” Participants in this study did not think that they had adequate staffing, facilities, or education to prevent RS. Most were unaware of RS prevention policies.
Highlights
Exploring processes involved in preventing the use of restraint and seclusion (RS) in the psychiatrically hospitalized population of the Southeastern United States from the standpoints of psychiatric health care workers, along with significant gray literature and policy texts, provided information about a region that is mostly overlooked in the literature
Findings are organized at the micro, meso, and macro-levels corresponding to Bourdieu’s triune analytics, arranged from individual, institutional, and organizational perspectives
The individual strengths identified by participants related to personal attributes of the staff included believing that RS prevention and elimination is possible, using humor and focusing on self
Summary
Definitions of RS use are imprecise and how interventions are translated into practice is not universally understood. Some classify RS as treatment failure, whereas others view RS as effective tools for averting injuries during crises and emergency situations (Geller & Glazer, 2012) These practices include various physical holds, leather straps, bed nets, restraint beds, and isolation rooms. Institutional values play a key role in the ways in which psychiatric health care workers and patients treat one another interpersonally, and influence the everyday social norms and attitudes of the treatment environment. SAMHSA’s National Registry of Evidence-Based Programs and Practices determined that the clinical model called Six Core Strategies to Prevent Conflict and Violence: Reducing the Use of Seclusion and Restraint scored an overall rating of 2.8 on the readiness for implementation scale, reflecting a value just below being adequate for dissemination. This study contributed to the RS prevention science by identifying contextual variables that modulate facilitators and barriers to RS prevention practices, and by discovering new gaps in the translation of national policy and evidencebased best practices
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