industry & reform
industry & reform
Exercising restraint and seclusion
Mental health nurses on eliminating restraint and seclusion in services.
Kim Ryan interviewed by Dallas Bastian
Australia’ s mental health nurses want an emboldened approach to reducing or eliminating the use of seclusion and restraint in services.
The call, from the Australian College of Mental Health Nurses( ACMHN), comes with the release of its new research project, funded by the National Mental Health Commission, which explores the clinical factors that stand in the way of achieving a restraint-free environment.
The research examined nurse perceptions of barriers and enablers to eliminating seclusion and restraint use in psychiatric inpatient settings and emergency departments.
Research lead Professor Eimear Muir-Cochrane, from Flinders University, said inhibiting factors included insufficient resources, inadequate staffing levels, and nurses being time poor and having high workloads.
“ There are also concerns around safety and duty of care,” Muir‐Cochrane said.
One nurse who contributed to the study and who has worked in mental health for over 40 years said on one occasion a patient affected by drugs picked up a heavy exercise bike and smashed it through the nurses’ station window.
“ We had three females on duty and one HSA. You can only imagine the fear,” the nurse said.“ They retreated and a duress was instigated, but also due to the aggressive patient the police were called, and he was initially placed in seclusion and rapid sedation used. He was sedated and transferred to a higher secure unit.” Adjunct Associate Professor Kim Ryan, chief executive of the ACMHN, said there are inadequate practice development opportunities for staff and limited or no education for families about alternatives.
Ryan said other factors hindering a restraint-free environment include communication difficulties and conflicts between different staff approaches.
“ The improvements needed must include strong clinical leadership, trained and experienced staff, adequate staffing levels, the establishment of constructive staff-consumer rapport, and good therapeutic relationships with a focus on trauma-informed, empathic care and team collaboration and cohesion.
“ To achieve meaningful reform to reduce and ultimately eliminate seclusion, we need shared ownership of a national approach that reaches beyond mental health services to emergency departments and other health providers, schools, the justice sector and police and ambulance services,” Ryan said.
Nursing Review spoke with Ryan about the ways nurses viewed seclusion and restraint, and the approaches to treatment and care that counter their use.
NR: Almost all mental health nurses surveyed had at some point in their career been involved in the use of physical restraint and seclusion. Boiling down some of the findings of the report, why are we still seeing the use of seclusion and restraint in mental health services? KR: I think there a number of reasons. The service design and the support that people are being given in inpatient use particularly are not orientated towards the reduction of seclusion and restraint in some places.
The other thing we can’ t underestimate is that we’ re seeing increasing rates of drug and alcohol use within services – people who come into emergency departments or mental health units intoxicated.
We also need to consider that people who end up in acute mental health services these days are very acute and often highly aroused.
So, I think nurses are seeing seclusion and restraint as a practice that they’ re used to using, and I don’ t know that they always see there’ s an alternative. In some instances, there may not be an alternative.
We talk a lot about the reduction of it, but how do we actually put into place the strategies we need to ensure there are alternatives to the use of restrictive practices?
How did nurses in the study view seclusion and restraint in terms of need versus consequence? I think the nurses clearly understand the consequence of the use of restrictive practices. I think they see that there is a need
10 | nursingreview. com. au