Physical restraint and the therapeutic relationship

Abstract

Physical Restraint and the Therapeutic Relationship Medium secure psychiatric services in the UK are designed to fulfil a therapeutic function in addition to those of security and custodianship (Mason et al., 2009). The development of strong nurse-patient therapeutic relationships is seen as essential in developing an effective therapeutic milieu in such environments (Thomas, Shattell, & Martin, 2002). However, in addition to such a therapeutic role, nurses who work in secure settings also have to deal with security issues such as compulsory detention, forced treatment, and risk to others (Mason, Lovell, & Coyle, 2008). It has been questioned whether staff who work in such services can fulfill both security and therapeutic roles, or whether these roles are incompatible. Physical restraint activities may be used in a forensic environment as part of routine care, but concerns have been raised about how restraint fits with ethical practice (Mohr, 2010). In addition to being the one who employs the restraint techniques, it is also usually nursing staff who make the decision of whether the patient is restrained. The emotional effect of being involved in restraint or nurses being seen as being part of the system of detention may damage any staff / patient therapeutic alliance (Steele, 1993;. Conacher, 1993). The literature on the impact of physical restraint on the therapeutic relationship is limited. Research has mainly focused on nursing staff views of physical restraint. For example, Lee, Gray, Gournay, Wright, Parr and Sayer (2003) found that nurses reported that physical restraint was useful in regaining control after an incident, but expressed feelings of ambivalence and concern regarding the after-effects of the restraint. Bigwood and Crowe (2008 found that nurses felt a conflict between their therapeutic role and the milieu of control in the service. They expressed feeling better about physically restraining a patient if they were able to undertake the restraint in a therapeutic way and if they thought that all other options had been explored. Perkins, Prosser, Riley and Whittington (2012) found that nurses

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“…Patients perceived “being subjected to professionals’ control” as an important part of initial reasons for coercion. This was associated with “negative patient‐perceived impact,” mainly characterized by powerlessness, anger, frustration and feelings of humiliation as patients believed they were coerced without justification and that it was a way for professionals to demonstrate power and control (Meehan, Vermeer, & Windsor, ; Haglund et al., ; Wynn, ; Haw et al., ; Sibitz et al., ; Kontio et al., ; Faschingbauer, Peden‐McAlpine, & Tempel, ; Ezeobele, Malecha, Mock, Mackey‐Godine, & Hughes, ; Riley, Høyer, & Lorem, ; Van Wijk, Traut, & Julie, ; Knowles, Hearne, & Smith, ). Other patients reported that professionals used IM inj.…”

Gendered experiences of physical restraint on locked wards for women

“…If staff know the women well, they are aware of their characteristics and how to be together in the safest possible way. This can work to reduce power imbalances when living in such close confinement (Knowles, Hearne, and Smith 2015). Supportive relationships were very important for women's progression in this research, and they also contributed to behavioural stability, the main quantifier of progression on the unit (Fish 2016;Travers and Reeves 2005).…”

Contentions mécaniques en psychiatrie : étude phénoménologique de l’expérience vécue du personnel infirmier

“…Strout (2010) a réalisé une recension des recherches qualitatives centrées sur l'expérience du patient « contentionné ». En matière d'impact psychologique, les thèmes communément exprimés par les patients sont la colère, la peur, l'humiliation, le découragement, la déshumanisation, l'impuissance, la détresse, et le sentiment de violation de l'intégrité personnelle (Bonner et al, 2002;Chien, Chan, Lam, & Kam, 2005;Johnson, 1998;Mérineau-Côté & Morin, 2014;Knowles, Hearne & Smith, 2015 (Bonner et al, 2002;Fish & Culshaw, 2005;Wynn, 2004).…”

“…D'autres ont affirmé que leurs besoins de base, tels l'hygiène, l'hydratation et l'alimentation, n'étaient pas comblés (Kontio et al, 2012). La majorité des patients sont également insatisfaits de leur interaction avec le personnel pendant et après leur contention (Meehan et al, 2000), et plusieurs ont ressenti que certaines pratiques des cliniciens pendant la contention étaient abusives ou non-éthiques (Bonner et al, 2002;Johnson, 1998;Wynn, 2004), entre autres, en percevant l'utilisation de la contention comme une mesure punitive, ou comme une conséquence d'avoir enfreint les « règles » (Evans et al, 2003;Gerolamo, 2006;Irving, 2002;Johnson, 1998;Knowles, Hearne & Smith 2015;Meehan et al, 2000;Sailas & Fenton, 2000;Wynn, 2004;). Effectivement, les participants de l'étude de Knowles et al (2015) (Knowles et al, 2015).…”

“…La majorité des patients sont également insatisfaits de leur interaction avec le personnel pendant et après leur contention (Meehan et al, 2000), et plusieurs ont ressenti que certaines pratiques des cliniciens pendant la contention étaient abusives ou non-éthiques (Bonner et al, 2002;Johnson, 1998;Wynn, 2004), entre autres, en percevant l'utilisation de la contention comme une mesure punitive, ou comme une conséquence d'avoir enfreint les « règles » (Evans et al, 2003;Gerolamo, 2006;Irving, 2002;Johnson, 1998;Knowles, Hearne & Smith 2015;Meehan et al, 2000;Sailas & Fenton, 2000;Wynn, 2004;). Effectivement, les participants de l'étude de Knowles et al (2015) (Knowles et al, 2015). Un tel climat représente nécessairement un obstacle significatif pour le travail thérapeutique collaboratif, les mesures restrictives étant connues pour avoir un impact négatif sur la relation infirmière-patient (Meehan et al, 2000;Mérineau-Côté & Morin, 2014;Winick, 2008 (Bonner et al, 2012;Sequeira & Halstead, 2002), de sorte que plusieurs ont rapporté être plus violents, agressifs et souffrant suite à la contention mécanique (Chien et al, 2005;Fish & Culshaw, 2005;Wynn, 2004).…”