'You get this conflict between you as a person and you in your role…that changes you': A thematic analysis of how inpatient psychiatric healthcare staff in the UK experience restraint, seclusion, and other restrictive practices

Abstract

A high proportion of psychiatric inpatients experience Restrictive Practice (RP) during admission. Numerous reports have highlighted adverse effects on patients and staff. However, qualitative research focussed on experience, impact, and coping mechanisms of healthcare staff in the UK is limited. Therefore, this study explored psychiatric healthcare staff experience of RP on inpatient wards in the UK. Eight semi‐structured, audio‐recorded interviews, of ~60 min, were conducted via telephone/Skype and transcribed verbatim. A critical realist epistemology was used to thematically analyse data. Three themes were identified: the coexistence of accountability, power and subjection; impacts on the individual and professional relationships, and coping with difficult experiences and emotions. Restrictive practice can negatively affect staff experience, working relationships, and wellbeing. Opportunities for support could mediate adverse effects. Future research could further explore coping mechanisms and organizational factors contributing to negative staff experiences.

Living with restraint: Reactions of nurses and lived experience workers to restrictions placed on the use of prone restraint

“…This was more of an issue for senior staff with greater experience in the system who felt that they should be able to decide when and how patients are restrained. The finding is in keeping with recent UK research which reports that while junior staff initially challenge the status quo, over time they accept restraint as usual practice (Mooney & Kanyerediz 2021).…”

“…The overarching theme to emerge from this and previous studies in Australia and elsewhere is the perceived need among nursing staff for the ongoing use of physical restraint in inpatient facilities (Mooney & Kanyeredzi 2021;Muir-Cohcrane et al 2018). However, nursing staff expressed a sense of disempowerment and anger that 'external controls' were being placed on their practice through policy change.…”

“…The overarching theme to emerge from this and previous studies in Australia and elsewhere is the perceived need among nursing staff for the ongoing use of physical restraint in inpatient facilities (Mooney & Kanyeredzi 2021; Muir‐Cohcrane et al . 2018).…”

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

“…These evaluations are included in the bigger picture of the assessments of patients’ readiness to be released from mechanical restraints (Nielsen et al, 2018 ). A recent qualitative study reported the impacts on the professional relationships when patients stopped engaging positively with healthcare professionals after restrictive practice, exacerbating the professionals` feelings of guilt (Mooney & Kanyeredzi, 2021 ). Today, the field of mental health nursing suggests different levels of assessments related to basic physiological needs, symptoms experienced (Barker, 2004 ), and elements such as risk, physical and mental status, symptomatology and effects of medication (Gamble & Brennan, 2005 ).…”

Workplace stressors and PTSD among psychiatric workers: The mediating role of burnout

“…In this case, strategies to reduce the use or duration of seclusion may be valuable. Researchers have begun investigating the adverse effect of restraint and seclusions on the psychiatric staff involved (e.g., Mooney & Kanyeredzi 2021), and the present study may further motivate such efforts.…”