Safeguarding patients while implementing mechanical restraints: A qualitative study of nurses and ward staff’s perceptions and assessment

Abstract

Aims and Objectives To explore nurses’ and ward staff's perceptions and assessments of patient care while implementing mechanical restraints. Background To prevent the risks associated with the use of restraints in psychiatry and ensure safe mental health care, it is necessary to know more about how the nursing staff experiences, comprehends and intervenes in managing patients subjected to coercive measures. Design This study employed a qualitative descriptive design, in accordance with the COREQ guidelines. Methods Semi‐structured interviews were conducted with 18 nurses and ward staff aged between 22 and 45 years old, who had experience implementing mechanical restraints. Data were digitally audio‐recorded and transcribed verbatim. Inductive thematic analysis was conducted using NVivo 12. Results The participants believed that mechanical restraints should be used as a last resort and that safeguarding patients during implementation is important; however, their assessments of the patients’ physical and mental conditions varied. A clear difference emerged in how management qualified professionals handled situations prior to and during the implementation of mechanical coercive measures. Conclusions The findings emphasise the need to focus on the assessment of patients prior to and during restraint, ensure the quality of safe implementation in a risk‐of‐harm situation, prioritise competence in education, and practice, and improve management. Relevance to clinical practice The findings highlight the importance of assessing the physical and mental condition of patients while implementing restraints, as well as aiding the management, nurses and ward staff in tailoring safety procedures.

Best practice recommendations on the application of seclusion and restraint in mental health services: An evidence, human rights and consensus‐based approach

“…The Delphi‐process resulted (1) in the confirmation of other study results, for example regarding teamwork, communication, humane treatment, observation and evaluation (e.g. Bachmann et al, 2022; Cusack et al, 2016; Dahan et al, 2018; Garriga et al, 2016; Manser, 2009; NICE, 2015; Pérez‐Revuelta et al, 2021; Vollm et al, 2018), (2) in recommendations on which the research literature and evidence‐based guidelines are inconclusive, for example regarding the preferable supine position, face up and age limits (Cusack et al, 2016; Masters et al, 2002; Meehan et al, 2022; NICE, 2015), and (3) in new recommendations that not have been studied before, for example regarding time limits, asking for second opinion, and registration. The recommendations on timeframes are crucial regarding ending the intervention as soon as possible, and to maintain safety during the intervention.…”

A comprehensive examination of research instruments utilized for assessing the attitudes of healthcare professionals towards the use of restraints in mental healthcare: A systematic review

“…In a previous article and part of an exploratory mixed‐method project, Bachmann et al. (2023) explored nurses' and ward staff's perceptions and assessments of patient care while implementing mechanical restraints. After a qualitative starting point, an exploratory sequential design should be followed by an interim development phase in which the survey is substantively relevant and culturally sensitive (Creswell & Clark, 2017).…”

Is physical restraint unethical and illegal?: a qualitative analysis of Korean written judgments

“…Physical restraint (PR) is a measure that restricts one’s freedom of movement [ 1 ] using a wrist strap, abdominal belt, or ankle brace [ 2 ]. It is primarily used for safety reasons in individuals [ 3 , 4 ] with low cognitive function or high care dependency [ 5 , 6 ], such as older adults with cognitive impairment or a high risk of falls [ 7 ], children with decision-making difficulties [ 8 ], patients with mental illnesses [ 9 , 10 ], and critically ill [ 11 ] or emergency patients [ 12 ] attached to life-sustaining or monitoring devices. However, even if PR is used with good intentions, it has a risk of causing physical and psychological damage [ 13 ] to care recipients, and it can sometimes be abused [ 14 ] for the convenience of health workers.…”