industry & reform
at times to have restrictive practices, or contain someone’s
behaviour. I think they feel that there’s a need to keep everyone
safe, and so that’s paramount for them – the safety of the
individual they’re working with, and the safety of the individuals
around them.
They know that the outcome of seclusion and restraint is
traumatic for everybody involved. I think most nurses would
understand that the use of restrictive practices is in no way a
therapeutic intervention, so I think they spend their time weighing
up the need and the consequences all the time.
Nurses felt differently about the different types of restrictive
practices. Seclusion and physical restraint were seen as
more acceptable and effective than mechanical restraint, for
example. Those surveyed felt that eliminating mechanical
restraint was more likely than seclusion and physical restraint,
so what do you think that link points to?
What I would understand from that is that often people using
physical restraint do it at an immediate point in time to ensure
safety or containment.
Chemical restraint is probably something that’s not as
immediate in terms of its action, so I’m thinking that they probably
think there are opportunities to look at reducing or eliminating
chemical restraint as an adjunct often to physical restraint.
I think they’re saying that in the first instance, where they need
to ensure the safety of everybody, physical restraint will probably
be the thing they see less as likely, at this point in time, to be
eliminated.
The report looked into some of the enablers to seclusion and
restraint elimination. What were some of the most commonly
reported enablers, and do they align with the college’s
thoughts on a way forward for nurses?
The college does agree that we need to look at staffing levels, and
that we need to look at skill mix within mental health services. I
think design of mental health services, making sure that there are
alternatives available to people for practice, are all very important
things that in some of those outcomes of the report will obviously
take much more time to implement.
But certainly there are some things that could be implemented
quickly, and we need to ensure that all the nurses working in
mental health units, or in emergency departments, have ongoing
professional development so they understand opportunities, how
to de-escalate situations, and how they can understand from
a trauma-informed and recovery-orientated point of view how
to contain behaviour that may not necessarily be as a restrictiv e
practice as we understand it now.
So I think there are a number of things that we could look at
quickly that could probably produce some outcomes.
The National Mental Health Commission suggested a change
to reduce the use of restrictive practices by increasing the use
of the recovery approach to treatment and care. What does
that approach involve and how can services best support staff
to improve uptake?
Well, I think what we need to consider is that the use of restrictive
practices is in no way therapeutic. It is an intervention that’s
used, but it’s not therapeutic. It doesn’t take into consideration
past trauma that people have had to deal with. It certainly
doesn’t also look at person-centred care and what it is that the
individuals require.
I think when we start looking at recovery-orientated processes,
we need to consider each individual’s path to recovery, what it is
that is required for those individuals to ensure that they feel safe,
The use of restrictive practices is in
no way therapeutic . . . It doesn’t take into
consideration past trauma that people have
had to deal with.”
that they’re looked after, that there are alternatives within the
mental health setting or the emergency departments.
We need to look at ensuring there are options for people to
have other things available to them and look at what the individual
requires, as opposed to what the service requires in terms of
always doing the same things, the same way, without focusing on
individuals’ needs – and that’s what we need to start looking at.
What is it that is most appropriate for each individual as they come
in contact with services? n
The 4th Commonwealth Nurses and Midwives Conference
LEADING THE WAY: Nurses and midwives
for a safe, healthy and peaceful world
Saturday 10 and Sunday 11 March 2018
Royal College of Physicians, Regent’s Park, London, UK
Register now…
For more information and to register online go to:
www.commonwealthnurses.org/conference2018
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