‘Why didn't you just give them PRN?’: A qualitative study investigating the factors influencing implementation of sensory modulation approaches in inpatient mental health units

Abstract

Clinical guidelines and policies worldwide call for sensory modulation approaches to be incorporated into inpatient mental health care to assist in eliminating the use of restrictive practices. Although increasing evidence shows that these approaches reduce patient distress and the need for seclusion and restraint, sensory modulation approaches have been challenging to implement in many psychiatric units. Implementation strategies can effectively support inclusion of new approaches by addressing potential barriers to change and supporting likely enabling factors. This study aimed to gain a better understanding of the barriers and enablers influencing implementation of sensory modulation approaches in psychiatric inpatient units in one health region in Australia. A qualitative descriptive study design was used, with three focus groups and a total of 15 participants from nursing and allied health disciplines answering questions about the use of sensory modulation approaches. Framework analysis using the Theoretical Domains Framework and thematic analysis was used to analyse data. Overall, participants were positive about the use of sensory modulation approaches, particularly for reducing distress. Four domains (Social Influences; Belief about Consequences; Professional Role and Identify; and Environmental Context and Resources) were identified as the most salient. The key influencing factors were support from peers; beliefs about risks; belief it was part of their role; and availability of resources and materials. Numerous challenges and opportunities related to implementing sensory modulation approaches in mental health inpatient units, identified in this study, provide insights to support effective implementation of these approaches, underpinning more person‐centred, trauma‐informed, and recovery‐orientated care.

A realist evaluation of weighted modalities as an alternative to pro re nata medication for mental health inpatients

“…The findings from this research project strongly align with another recent Australian study that explored the prominent factors (using the TDF) influencing the implementation of sensory approaches in inpatient mental health units (Wright et al . 2020). The identified factors included the following: social influences; beliefs about consequences; roles; and environmental context/resources (Wright et al .…”

“…Wright et al . (2020) found that nursing handovers could support or impede uptake. Strategies to mitigate clinician scepticism or negativity and enhance motivation could include further education on the possible adverse effects of PRN medication (Molloy et al .…”

“…Thus, important strategy foci at the outset of the introduction of WMs would be those that enhance clinician motivation (Drake et al 2003). Wright et al (2020) found that nursing handovers could support or impede uptake. Strategies to mitigate clinician scepticism or negativity and enhance motivation could include further education on the possible adverse effects of PRN medication (Molloy et al 2012) and identifying lead clinicians (Wright et al 2020), from the disciplines of nursing and medical.…”

Sensory approaches in psychiatric units: Patterns and influences of use in one Australian health region

“…Evidence suggests that such sensory approaches are safe, effective, and valuable interventions for mental health consumers (Craswell et al, 2020). Despite emerging empirical support for the use of sensory approaches, and the recommendations for their use in government policies and guidelines, implementation and sustainability of sensory approaches in mental health settings have faced challenges (Australian College of Mental Health Nurses, 2017;Wright et al, 2017Wright et al, , 2020. The aim of this study is to investigate how sensory approaches are used in clinical practice in psychiatric units and explore clinical and demographic factors that influence their use.…”

“…In a New South Wales Government report by Wright et al (2017), sensory rooms were found to be poorly maintained and underutilised. Similarly, Wright et al (2020) found that some sensory rooms and sensory kits were no longer used due to poor maintenance and loss of sensory equipment. In Australia, national principles for the elimination of restrictive practices recommend the use of sensory approaches to manage distress and/or arousal in mental health settings, including the use of personal safety plans which identify warning signs, triggers, and individualised sensory strategies (Australian Health Ministers' Advisory Council, 2016).…”