Patient centred physical restraint: a case study of two NHS mental health inpatient wards

The nursing staffs who work in the NHS mental health in-patient wards sometimes physically restrain their patients. Whilst there are studies that have looked at the different aspects of the use of physical restraint, none has specifically investigated the experiences and perceptions of the staff on the use of the patient centred model of physical restraint in managing untoward incidents in the setting. As a trainer on the General Services Association model of physical intervention, I worked collaboratively with staff from two NHS mental health inpatient wards, users of physical restraint techniques, to explore their experiences, perspectives and indeed the effectiveness of the patient centred approach to physical restraint in their respective wards. Following a review of the relevant literature, the choice of a qualitative type of investigation based on the unmodified Husserlian phenomenological framework was made. To complement this style of investigation, focus group and semi-structured interviews were used to collect primary data from the study participants. Phenomenological recommendations were adopted in the analysis of data. Six core themes including: physical restraint of a patient is for safety and patient centred practices during restraint process emerged from the huge data. The findings confirmed that patient centred approach to physical restraint was effective with the patient groups in the participating wards. Participants emphatically stated that the model enabled a quick retrieval of the therapeutic relationship with their patients. This is in keeping with the ethos of mental health care which is reliant on therapeutic relationship with the patient

An exploration of mental health service users’ experience of being manually restrained in local NHS in-patient wards

Physical intervention is often used to manage incidents involving service users in mental health in-patient wards. Yet, little effort has been channelled into finding out the views of such individuals regarding the experience. This study aimed to document the experiences and perceptions (good and bad) of local mental health service users who had the experience of being restrained whilst in admission. A qualitative research approach adopting the phenomenological strategy was employed. Semi-structured interviews were used to collect data from five service users with seven experiences of manual restraint and who either volunteered, were contacted purposively or recruited through snowball sampling. Service users identified two contrasting moods (anger and concern) of the staff restraint team. These moods they said, determined how the procedure was carried out. Twenty nine categories of restraint team practices were identified including: non-pain compliant holds, early intervention, post incident review including debriefing, pain compliant holds, angry orders/no communication, abandoned after being restrained. The categories clustered under the six core themes that emerged from the data including: build-up to physical restraint, power imbalance, communication, staff training. The themes were discussed. One of the areas suggested for further research was how staff mood and feelings towards the person being restrained affect their practice during the process. The implications for future physical intervention training were considered

Impacts of service user involvement in mental health nurse training on management of aggression: a qualitative description research

The involvement of mental health service users in a Higher Institution prevention and management of violence and aggression (PMVA) team’s training delivery is a recognition of the contribution that the unique insights of people’s lived experience can make to the development of practitioners. This research aimed to determine whether or not their contribution to PMVA training delivery influenced the staff management of patients’ anger or aggression on mental health wards. The qualitative description research design was adopted for the study. Focus group interviews were used to collect data from final year mental health students and new trust staff, while semi-structured interviews were employed to collect data from experienced trust staff. A sample of feedback from previous training records was reviewed. The findings showed that: the students and new trust staff were determined to translate lessons learnt into practice; the experienced staff were reflecting lessons in ward practices; the feedback records held expressed intentions to translate lessons into practice; there were hindrances in practicing as discussed with service users. The findings confirmed those from other studies claiming that service user involvement in the education of professionals has the potential to improve practice

Involving service users in training in the management of aggression

Involving service users in the education of current & future mental health practitioners is seen as important. It provides the opportunity for developing greater awareness and understanding through the unique insights of people’s lived experience of mental health conditions and of their contact with mental health services. The growing understanding of the contribution this makes to the improvement of services and in developing the mental health practitioners of the future fuels the increase in its practice. In particular, the pre-registration training of mental health professionals such as: social workers, nurses and psychologists. This workshop describes the involvement of service user trainers in the development and delivery of a short training course on physical restraint for mental health practitioners. It considers the impact of including service users who themselves have experience of being restrained in acute mental health settings, from the perspective of course participants, tutors and the service user trainers themselves. A key element of this involvement is the creation of a forum where service users’ contributions are intently listened to and valued by practitioners. Both parties put heads together to critically analyse the good and bad experiences of restraint practices and, the lessons learnt are powerful as evidenced in course participants’ feedback: “Service user involvement makes it real. I appreciate this very much”. “Service user involvement is very relevant and thought provoking – a good way to see how our work affects/impacts patients” In sharing this experience, it is hoped that the physical restraint trainers who are considering involving service users would feel reassured, and that those yet to do so would be encouraged to try