Year one review: Staff perception on the implementation of the chair restraint on an adolescent psychiatric inpatient unit

Abstract

This pediatric psychiatric mental health hospital implemented a new mechanical restraint, the chair restraint, as an additional safety management intervention, to join the already utilized six‐point board. Purpose The purpose of this project was to assess perceptions, thoughts, and feelings of psychiatric mental health nursing staff when utilizing the chair restraint on an adolescent unit. Furthermore, to explore decision making related to choosing the chair restraint verses choosing to use the six‐point board as a safety management intervention. Methodology This was a phenomenological qualitative study, utilizing semistructured interviews to explore the experiences of nursing staff, consisting of behavioral health specialists, and direct‐care staff nurses who work on an adolescent psychiatric unit utilizing both chair restraint and the six‐point board. Ten nursing staff were interviewed. Using thematic analysis, staff perceptions, thoughts, and feelings when using mechanical restraints for safety management were explored. Demographics were collected however, there was no variability in the responses and saturation was reached. Findings Five themes emerged from the interviews. The Five themes that emerged were: Restraint chair was less traumatic and preferred, feelings of defeat when de‐escalation was not successful, pushing away emotions as protection, units were short staffed, and patient behaviors were seen as a potential barrier to eliminating the six‐point board. Conclusion The results of this study will be used to guide to further develop behavioral health education, orientation for new staff, and to understand ways to support staff through their experiences in managing a patient's unsafe behaviors.

Nurses should respond to critical quality questions of child/adolescent inpatient treatment

“…Chung's research demonstrates the need to examine factors that contribute to longer length of stay and to adjust the unit's approach to these youth. Seney and Safford (2023) present information on using a chair restraint as one alternative to dealing with the escalated behavior when all other interventions have failed and the child is at imminent risk. They note that while any restraint holds decisional dilemmas for nurses and significant risk for children, a chair restraint may be less traumatizing and hold several advantages such as being able to talk to child eye-to-eye and allowing for more dignity and respect.…”