Post-incident review after restraint in mental health care -a potential for knowledge development, recovery promotion and restraint prevention. A scoping review

Abstract

Background Use of physical restraint is a common practice in mental healthcare, but is controversial due to risk of physical and psychological harm to patients and creating ethical dilemmas for care providers. Post-incident review (PIR), that involve patient and care providers after restraints, have been deployed to prevent harm and to reduce restraint use. However, this intervention has an unclear scientific knowledge base. Thus, the aim of this scoping review was to explore the current knowledge of PIR and to assess to what extent PIR can minimize restraint-related use and harm, support care providers in handling professional and ethical dilemmas, and improve the quality of care in mental healthcare. Methods Systematic searches in the MEDLINE, PsychInfo, Cinahl, Sociological Abstracts and Web of Science databases were carried out. The search terms were derived from the population, intervention and settings. Results Twelve studies were included, six quantitative, four qualitative and two mixed methods. The studies were from Sweden, United Kingdom, Canada and United States. The studies’ design and quality varied, and PIR s’ were conducted differently. Five studies explored PIR s’ as a separate intervention after restraint use, in the other studies, PIR s’ were described as one of several components in restraint reduction programs. Outcomes seemed promising, but no significant outcome were related to using PIR alone. Patients and care providers reported PIR to: 1) be an opportunity to review restraint events, they would not have had otherwise, and 2) promote patients’ personal recovery processes, and 3) stimulate professional reflection on organizational development and care. Conclusion Scientific literature directly addressing PIR s’ after restraint use is lacking. However, results indicate that PIR may contribute to more professional and ethical practice regarding restraint promotion and the way restraint is executed. The practice of PIR varied, so a specific manual cannot be recommended. More research on PIR use and consequences is needed, especially PIR’s potential to contribute to restraint prevention in mental healthcare.

Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: A qualitative study

“…Staff fears may result in a reluctance to engage with de-escalation techniques and an overreliance on restrictive practices, increasing the potential for physical and/or psychological harm to those involved. This study, as others [54,55], highlights the importance of post-incident debrie ng on emotional regulation for staff. Patient debriefs were not discussed, perhaps because they are not routinely used, but may minimise negative emotions in patients and mitigate against the breakdown of therapeutic staff-patient relationships [56,57].…”

Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study

“…Staff fears may result in a reluctance to engage with de-escalation techniques and an overreliance on restrictive practices, increasing the potential for physical and/or psychological harm to those involved. This study, as others [53,54], highlights the importance of post-incident debriefing on emotional regulation for staff. Patient debriefs were not discussed, perhaps because they are not routinely used, but may minimise negative emotions in patients and mitigate against the breakdown of therapeutic staff-patient relationships [55,56].…”

Post-incident reviews—a gift to the Ward or just another procedure? Care providers’ experiences and considerations regarding post-incident reviews after restraint in mental health services. A qualitative study

“…In previous research, patients and care providers described PIRs as an arena for knowledge development, ethical reflection and recovery promotion [11]. Care providers also saw PIRs as beneficial as they increase professional reflexivity, which, in turn, results in improved care [11,13,20].…”

“…In addition, ethical and professional imperatives urge developing reflexive practices aimed at limiting the use of coercion in morally justified cases and helping patients maintain hope and identity during crises, including the use of restraint [9,10]. 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].…”

“…PIRs have recently been mandated by guidelines and laws in several countries, including Norway, even though their knowledge base is vague and does not require descriptions of the services' value [2,4]. The few studies conducted indicate that PIRs are usually implemented in services with defined care philosophies that are recovery based, strength based, person centred and trauma informed [11,13]. These care philosophies are all founded on human values that emphasise a supportive environment, recognition of individual needs in care, and user participation by patients and care providers, both of whom are viewed as experts [9,14,15].…”