Psychological adjustment in care providers following restraint of psychiatric patients

Abstract

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes. K E Y W O R D Sevent centrality, meaning-making, mechanical restraint episodes, mental healthcare providers, psychological adjustment | INTRODUCTIONMental healthcare providers (care providers) play an integral role in mitigating suffering among psychiatric patients, but are themselves regularly exposed to stressful episodes in their work that challenge their sense of self and well-being (Kelly, Fenwick, Brekke, & Novaco, 2016). The performance of care providers is linked to their psychological adjustment (Needham, Abderhalden, Halfens, Fischer, & Dassen, 2005). If we wish to prevent burnout and ensure highquality care of patients, the adjustment of care providers' needs to be a priority in research (Hunter & Carmel, 1992;Jackson, Clare, & Mannix, 2002). Furthermore, in order to train and supervise care providers, it is essential to understand how stressful encounters with patients affect them. Recent theoretical models suggest that highly stressful events can increase the risk of post-traumatic stress disorder (PTSD) and other mental health problems, if they are interpreted as having had a central influence on self-understanding (Gehrt, Berntsen, Hoyle, & Rubin, 2018). This implies that not only the mere exposure to stressful encounters with patients, but also the interpretation of such episodes is important for psychological adjustment. In the present study, we used mechanical restraint episodes as an outset to study this relationship.While the majority of psychiatric patients are not assaultive, it is well-documented that nurses and other professionals working in