Forensic mental health nurses' experiences of rebuilding the therapeutic relationship after an episode of physical restraint in forensic services in Ireland: A qualitative study

Abstract

Few studies have explored how forensic mental health nurses can rebuild the therapeutic relationship following an episode of physical restraint in the acute forensic setting. In this study, we aimed to redress this gap in the literature by exploring with forensic mental health nurses the factors that enable or hinder the rebuilding of the therapeutic relationship following an episode of physical restraint. A qualitative study design was used to capture participants' experiences, views and perceptions of the therapeutic relationship following an episode of physical restraint in the acute forensic setting. Data were collected through individual interviews with forensic mental health nurses (n = 10) working in an acute forensic setting. Interviews were audio recorded, and transcribed verbatim and accounts were analysed using thematic analysis. Four themes were identified: ‘Building a Recovery Focused Therapeutic Relationship’; ‘Authoritarian Role’; ‘Inevitable Imbalance’; ‘Rebuilding the Therapeutic Relationship’; plus two sub‐themes ‘Facilitators to rebuilding’ and ‘Barriers to rebuilding’. Findings suggest that an inevitable imbalance exists in building a recovery‐focused therapeutic relationship and at times, is hindered by the authoritarian role of the forensic mental health nurse. Recommendations for changes in clinical practice and in upcoming policies should incorporate a dedicated debrief room and protected time for staff to debrief effectively following restraint. Routine post‐restraint‐focused clinical supervision would also be beneficial to mental health nursing staff.

Healthcare staff's experiences of using manual physical restraint: A meta‐synthesis review

“…Overall, the studies, published between January 2002 and June 2023, constituted a diverse participant population; sample sizes ranged from 5 to 41 with a total of 342 healthcare staff participants across the studies. Healthcare staff participants within the studies were mainly nursing and care staff, and worked in a variety of settings including the emergency department (Chapman et al, 2016), pediatric general hospitals (Brenner et al, 2014;Lombart et al, 2020;Svendsen et al, 2017), inpatient adult mental health (Bailey et al, 2021;Bigwood & Crowe, 2008;Bonner et al, 2002;Duffy et al, 2023;Meehan et al, 2022;Moran et al, 2009;Perkins et al, 2012;Sequeira & Halstead, 2004;Wilson et al, 2017), inpatient adult forensic mental health (Meehan et al, 2022;Moyles et al, 2023), inpatient child and adolescent mental health-eating disorders (Kodua et al, 2020), inpatient child and/or adolescent mental health-general Meehan et al, 2022), residential childcare (Steckley & Kendrick, 2008), and residential and inpatient learning disability services (Fish & Culshaw, 2005;Hawkins et al, 2005). Across studies, healthcare staff participants' ages ranged from 18 years to at least 63 years, and their experience of working within their specialties ranged from up to two weeks to at least 40 years.…”

“…The majority (11/19) of studies were conducted in the UK (Bailey et al, 2021;Bonner et al, 2002;Duffy et al, 2023;Fish & Culshaw, 2005;Hawkins et al, 2005;Kodua et al, 2020;Perkins et al, 2012;Sequeira & Halstead, 2004;Steckley & Kendrick, 2008;Wilson et al, 2017). Three studies were conducted in Ireland (Brenner et al, 2014;Moran et al, 2009;Moyles et al, 2023), two studies were conducted in Australia (Chapman et al, 2016;Meehan et al, 2022), and one study each was conducted in France (Lombart et al, 2020), New Zealand (Bigwood & Crowe, 2008), and Norway (Svendsen et al, 2017). The terms used to describe manual restraint varied across studies with just three studies referring to the practice as such (Chapman et al, 2016;Kodua et al, 2020).…”

“…The terms used to describe manual restraint varied across studies with just three studies referring to the practice as such (Chapman et al, 2016;Kodua et al, 2020). Eleven studies referred to manual restraint as "physical restraint" (Bailey et al, 2021;Bigwood & Crowe, 2008;Bonner et al, 2002;Duffy et al, 2023;Lombart et al, 2020;Meehan et al, 2022;Moyles et al, 2023;Perkins et al, 2012;Sequeira & Halstead, 2004;Steckley & Kendrick, 2008;Wilson et al, 2017), two studies referred to manual restraint as "physical intervention" (Fish & Culshaw, 2005;Hawkins et al, 2005), two studies referred to manual restraint as "restraint" (Moran et al, 2009;Svendsen et al, 2017), and one study referred to manual restraint as "restricting" (Brenner et al, 2014). Seven studies jointly explored staff's and service users' experiences of manual restraint (Bonner et al, 2002;Duffy et al, 2023;Fish & Culshaw, 2005;Hawkins et al, 2005;Sequeira & Halstead, 2004;Steckley & Kedrick, 2008;Wilson et al, 2017).…”

“…While all studies used appropriate data collection methods such as interviews and focus groups, four studies provided insufficient justification for the selected participant sample size (Brenner et al, 2014;Perkins et al, 2012;Steckley & Kendrick, 2008;Wilson et al, 2017), and three studies failed to provide any details of the interview/focus group topic guide that was used (Duffy et al, 2023;Moran et al, 2009;Perkins et al, 2012). Eight studies commented on whether "data saturation" had been achieved as evidenced by the use of phrases such as "saturation," "data saturation," and "no new information" (Bailey et al, 2021;Chapman et al, 2016;Fish & Culshaw, 2005;Kodua et al, 2020;Lombart et al, 2020;Meehan et al, 2022;Moyles et al, 2023;Sequeira & Halstead, 2004). Moreover, it could be inferred from the grounded theory methodology of a further study that "data saturation" principles had been adopted (Hawkins et al, 2005).…”

“…All studies presented verbatim participant quotes to evidence the analysis, and used appropriate data analysis methods and/or methodologies including grounded theory (Hawkins et al, 2005;Sequeira & Halstead, 2004), types of phenomenological analysis (Bailey et al, 2021;Bigwood & Crowe, 2008;Duffy et al, 2023;Fish & Culshaw, 2005;Moran et al, 2009), and types of thematic analysis (Bonner et al, 2002;Brenner et al, 2014;Chapman et al, 2016;Kodua et al, 2020;Lombart et al, 2020;Meehan et al, 2022;Moyles et al, 2023;Perkins et al, 2012;Steckley & Kendrick, 2008;Svendsen et al, 2017;Wilson et al, 2017). However, one study provided insufficient information of the analysis process (Steckley & Kendrick, 2008), and seven studies featured a somewhat superficial analysis, evidenced by the topic summary hallmark of generated themes (Bonner et al, 2002;Chapman et al, 2016;Fish & Culshaw, 2005;Hawkins, et al, 2005;Perkins et al, 2012;Steckley & Kendrick, 2008;Svendsen et al, 2017).…”