Restraint and Seclusion: The Perspective of Service Users and Staff Members

“…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]. Staff and patient post-incident debriefs may therefore serve as a crucial forum to promote healthy coping strategies, buffer against (re)traumatisation and fear and increase the effectiveness of de-escalation.…”

Section: Discussionmentioning

confidence: 99%

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

Goodman

Brooks

Price

et al. 2020

Preprint

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Background: Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours.Methods: Semi-structured individual interviews (n=12) and focus groups (n=3) were conducted with eight patients, four carers and twenty-five staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results: Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions: This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.

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“…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).…”

Section: Impacts Et Efficacitéunclassified

“…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). Ceci enclenche du même coup un cycle « agression-coercition » entre les patients et le personnel (Paterson & Duxbury, 2007).…”

Section: Impacts Et Efficacitéunclassified

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

Corneau¹,

Jacob²,

Holmes³

et al. 2017

Recherche en Soins Infirmiers

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L’usage des contentions mécaniques dans les milieux psychiatriques fait aujourd’hui l’objet de nombreuses controverses éthiques. Toutefois, on note l’absence des voix des patients et du personnel infirmier en regard de cette intervention controversée. L’objectif de cette étude qualitative était d’examiner l’expérience vécue du personnel infirmier exerçant en psychiatrie faisant usage de la contention mécanique. Vingt-et-un(e) infirmier(e)s travaillant sur les unités de psychiatrie et d’urgence psychiatrique d’un centre hospitalier universitaire canadien ont participé à des entrevues semi-dirigées, qui ont ensuite été transcrites, codées et analysées selon la méthode d’analyse interprétative phénoménologique (AIP). Trois thèmes principaux ont été identifiés : 1) contexte de pratique ; 2) processus de contentions ; et 3) recourir à la contention mécanique. Les résultats de cette recherche phénoménologique mettent en lumière les défis organisationnels et émotionnels auxquels est confronté le personnel infirmier exerçant en psychiatrie. Les perspectives de Foucault et Goffman ont été les sources théoriques primaires qui ont guidé le processus d’analyse critique mené lors de cette recherche qualitative.

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Restraint and Seclusion: The Perspective of Service Users and Staff Members

Abstract: This study sheds further light on how persons with intellectual disabilities and staff experience the application of restrictive measures. Debriefing sessions with service users and staff may help minimize negative consequences.

Cited by 29 publications

References 20 publications

‘It's made all of us bond since that course…’ – a qualitative study of service users' experiences of a CBT anger management group intervention

‘It's made all of us bond since that course…’ – a qualitative study of service users' experiences of a CBT anger management group intervention

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

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

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