Exploring restrictive measures using action research: A participative observational study by nursing staff in nursing homes

Abstract

Aim In nursing homes, nursing staff have a key role in the use of restrictive measures. However, their active role in reducing restrictive measures has so far been limited. The aim of this study is to explore how and when the application of restrictive measures in nursing homes occurs including underlying factors, together with nursing staff. Design Participatory action research was chosen for a bottom‐up understanding of the use of restrictive measures. Method Two Dutch nursing homes participated in 2016/2017 with 18 nursing staff members in the action research team. Nursing staff carried out 33 observations followed by a reflective interview. Results Nursing staff observed a wide range of restrictions, including restrictions in freedom of choice, not being able to go outside, not being in charge of medication, and a directive/unresponsive care attitude. Factors influencing restrictions included habits and institutionalization, cognitive ability of the resident, availability of personnel, and responsibility for safety. A responsive care attitude and raising awareness were seen as good practices to enhance freedom. Conclusions By taking a distant view on their work, nursing staff discovered a broad range of restrictions, including ‘less obvious’ restrictions. Active forms of learning may position nursing staff to discuss and reduce restrictive measures. Impact What problem did the study address?: Restrictive measures are still common in nursing homes. Despite their key role in using restrictive measures, nursing staff's active role in research has been limited. What were the main findings?: By participating as researchers, nursing staff gained a broader perspective on restrictive measures. Many ‘less obvious’ restrictions were related to routines and institutionalization and were considered as eye opening by nursing staff. Where and on whom will the research have impact?: Active forms of learning such as observing and reflecting has the potential to position nursing staff as ‘agents of change’.

A systematic review on the use of action research methods in mental health nursing care

“…Thus, action research is a driver for change and improvement in the practice of mental health nurses. As in other nursing contexts, the findings point to the importance of awareness as a starting point for change (Bekkema et al, 2021 ; Cusack et al, 2018 ). This awareness allows the participants to improve their attitude and knowledge about the phenomenon of concern (Tolosa‐Merlos et al, 2021 ).…”

“…This, together with the support received from the group, improves team relations, increasing motivation and satisfaction in the work environment (Afshar et al, 2020 ; Chen et al, 2021 ). Throughout the process, participants gain confidence and security, key aspects for the empowerment of participants (Alomari et al, 2020 ; Bekkema et al, 2021 ; Cusack et al, 2018 ).…”

Organisational impact on the use of restrictive measures: The perspective of Swedish front‐line managers

“…It could also be that managers, like staff, lack sufficient knowledge to identify measures as being restrictive or to promote alternatives (Bekkema et al, 2021; Schippers et al, 2018). Both interpretations are further confirmed by staff in their comments on the survey, noting that the presence of knowledgeable front‐line managers is required to change practices.…”

The therapeutic relationship at the heart of nursing care: A participatory action research in acute mental health units

“…Through the FGs, those nurses who did not keep the diaries or who had naturalised or were less aware of the change that had occurred were able to reflect on and corroborate the findings from the diaries. In general, although the nurses reported that the process had been demanding and time‐consuming (Moreno‐Poyato et al, 2019), they acknowledged that the process had enabled them to substantially improve their clinical practice, mainly due to individual changes (Alomari et al, 2020; Bekkema et al, 2021; Cusack et al, 2018) and also organisational changes (Cordeiro & Soares, 2018). However, although there had also been changes at the collective level (Afshar et al, 2020; Chen et al, 2021), the nurses were hesitant to maintain these changes as these were dependent on other people in the team.…”

“…The use of diaries facilitated the individual reflexivity of the nurses that led them to identify that their attitude was essential for the change and improvement of the therapeutic relationship, thus fostering individual commitment to solve the problem (Bolg et al, 2020). Moreover, the FGs contributed to the collective reflection that allowed the nurses to identify the factors that helped them and those that prevented them from having an adequate therapeutic relationship, which are essential aspects to be able to later reach a consensus regarding strategies for improvement (Bekkema et al, 2021; Casey et al, 2022; Cusack et al, 2018).…”