Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint

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Abstract

Restrictive practices continue to be used in mental health care despite increasing recognition of their harms and an international effort to reduce and ultimately eliminate their use. The aim of this qualitative study was to explore mental health nurses’ views of the potential elimination of these practices. Nine focus groups were conducted with 44 mental health nurses across Australia, and the data analysed using thematic analysis. Overall, the nurses expressed significant fear about the potential elimination of restrictive practices and saw themselves as being blamed for both the use of these practices and the consequences should they be eliminated. Findings detail the conflicts facing staff in balancing the need for ward safety for everyone present while at the same time providing person-centred care. Nurses described the changing role of the mental health nurse in acute settings, being more focussed on risk assessment and medication while at the same time attempting to practise in trauma-informed person-centred ways. The impact on ward safety with increasing acuity of consumers plus the presence of forensic consumers and those affected by methamphetamine was emphasized. Change initiatives need to take into account nurses’ deep concerns about the consequences of eliminating all forms of control measures in hospitals and respond to the symptoms and behaviours consumers present with and associated unpredictable and concerning behaviours. Attempts to eliminate restrictive practices should, therefore, be carefully considered and come with a clear articulation of alternatives to ensure the safety of consumers, visitors, and staff.

Original languageEnglish
Pages (from-to)1511-1521
Number of pages11
JournalInternational Journal of Mental Health Nursing
Volume27
Issue number5
DOIs
Publication statusPublished - Oct 2018

Bibliographical note

©2018 The Authors International Journal of Mental Health Nursing published by John Wiley & Sons Australia, Ltd on behalf of Aus-tralian College of Mental Health Nurses Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Keywords

  • mental health nursing
  • restraint
  • restrictive intervention
  • seclusion

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