Anglia Ruskin University, Faculty of Health, Social Care and Education, Department of Adult and Mental Health Nursing, Chelmsford, UK.
Cambridgeshire and Peterborough NHS Foundation Trust, Fulbourn Hospital, Fulbourn, UK.
J Psychiatr Ment Health Nurs. 2018 Apr;25(3):188-200. doi: 10.1111/jpm.12453. Epub 2018 Feb 8.
WHAT IS KNOWN ON THE SUBJECT?: Restraint has negative psychological, physical and relational consequences for mental health patients and staff. Restraint reduction interventions have been developed (e.g., "Safewards"). Limited qualitative research has explored suggestions on how to reduce physical restraint (and feasibility issues with implementing interventions) from those directly involved. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This paper explores mental health patients' and staff members' suggestions for reducing physical restraint, whilst addressing barriers to implementing these. Findings centred on four themes: improving communication and relationships; staffing factors; environment and space; and activities and distraction. Not all suggestions are addressed by currently available interventions. Barriers to implementation were identified, centring on a lack of time and/or resources; with the provision of more time for staff to spend with patients and implement interventions seen as essential to reducing physical restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. Fundamental issues related to understaffing, high staff turnover, and lack of time and resources need addressing in order for suggestions to be successfully implemented.
Introduction Physical restraint has negative consequences for all involved, and international calls for its reduction have emerged. Some restraint reduction interventions have been developed, but limited qualitative research explores suggestions on how to reduce physical restraint (and feasibility issues with implementation) from those directly involved. Aims To explore mental health patients' and staff members' suggestions for reducing physical restraint. Methods Interviews were conducted with 13 inpatients and 22 staff members with experience of restraint on adult mental health inpatient wards in one UK National Health Service Trust. Results Findings centred on four overarching themes: improving communication and relationships between staff/patients; making staff-related changes; improving ward environments/spaces; and having more activities. However, concerns were raised around practicalities/feasibility of their implementation. Discussion Continued research is needed into best ways to reduce physical restraint, with an emphasis on feasibility/practicality and how to make time in busy ward environments. Implications for Practice Improving communication and relationships between staff/patients, making staffing-related changes, improving ward environments and providing patient activities are central to restraint reduction in mental healthcare. However, fundamental issues related to understaffing, high staff turnover and lack of time/resources need addressing in order for these suggestions to be successfully implemented.
背景：约束对精神健康患者和医护人员都有负面影响。已经开发了约束减少干预措施（例如“安全保障”）。有限的定性研究探索了直接参与者关于如何减少身体约束的建议（以及实施干预措施的可行性问题）。
本研究的意义：本文探讨了精神健康患者和工作人员减少身体约束的建议，同时解决了实施这些建议的障碍。研究结果主要集中在四个主题上：改善沟通和人际关系；人员配备因素；环境和空间；以及活动和分散注意力。并非所有建议都可以通过现有的干预措施来解决。确定了实施的障碍，主要是缺乏时间和/或资源；为工作人员提供更多与患者相处和实施干预措施的时间被认为是减少身体约束的关键。
对实践的意义：改善工作人员/患者之间的沟通和关系，进行人员配备相关的改变，改善病房环境，提供患者活动，这些对于减少精神卫生保健中的约束至关重要。为了成功实施建议，需要解决人员配备不足、员工 turnover 率高以及缺乏时间和资源等基本问题。
