13 research outputs found
An integrative review exploring decision-making factors influencing mental health nurses in the use of restraint
Introduction: While mechanical and manual restraint as an institutional method of control within mental health settings may be perceived to seem necessary at times, there is emergent literature highlighting the potential counter-therapeutic impact of this practice for patients as well as staff. Nurses are the professional group who are most likely to use mechanical and manual restraint methods within mental health settings. In-depth insights to understand what factors influence nurses’ decision-making related to restraint use are therefore warranted.
Aim: To explore what influences mental health nurses’ decision-making in the use of restraint. Method: An integrative review using Cooper’s framework was undertaken. Results: Eight emerging themes were identified: ‘safety for all’, ‘restraint as a necessary intervention’, ‘restraint as a last resort’, ‘role conflict’, ‘maintaining control’, ‘staff composition’, ‘knowledge and perception of patient behaviours’, and ‘psychological impact’. These themes highlight how mental health nurses’ decision-making is influenced by ethical and safety responsibilities, as well as, interpersonal and staff-related factors.
Conclusion: Research to further understand the experience and actualization of ‘last resort’ in the use of restraint and to provide strategies to prevent restraint use in mental health settings are needed
The 'Choice and Autonomy Framework' : implications for occupational therapy practice
Introduction
This paper presents findings from a PhD study exploring
autonomy of adults with physical disability. The plethora
of descriptions of autonomy in psychological, occupational
therapy and rehabilitation literature (e.g. Ryan and Deci 2000,
Rogers 1982, Cardol et al 2002) detracts from the centrality
of autonomy and results in difficulty incorporating it into
occupational therapy practice. This paper presents a framework
providing an integrated, clinically useful approach to autonomy.
Methods
Sixteen people were recruited, based on age, gender,
impairment and living circumstances (community/residential
settings). All have significant physical disability, use a wheelchair
and require personal assistance for some/all self-care activities.
Qualitative methods were used for data collection, including
life-history narrative, diary information and extensive interview.
An integrated method of analysis was used, including content
analysis and bracketing.
Results
The ‘Choice and Autonomy Framework’ consists of five strands,
including:
• the meaning of autonomy
• whether or not autonomy is a goal or value
• the experience of autonomy
• personality factors that impact autonomy
• environmental features that enhance or negate autonomy.
This paper will describe each strand, as derived from the
research. The results suggest that, contrary to common wisdom (Hmel and Pincus 2002), autonomy is not necessarily a universal
goal for people with physical disability; an understanding of the
person’s own perspective will enhance person-centred practice
and enable therapists to further recognise individuality of clients.
It will argue that the concept of autonomy needs to be further
understood and incorporated into occupational therapy practice