"It's not a nice thing to do, but…": A phenomenological study of manual physical restraint within inpatient adolescent mental health care.

AIM

To explore nursing staff's experiences of using manual (physical) restraint within inpatient adolescent mental health care.

DESIGN

This was a descriptive phenomenological study.

METHODS

Individual semi-structured interviews were conducted with 12 nursing staff between March 2021 and July 2021. The nursing staff were recruited from four inpatient adolescent mental health hospitals across three National Health Service Trusts in England. Interviews were transcribed verbatim and analysed using Braun and Clarke's reflexive approach to thematic analysis.

RESULTS

Four themes were generated from the analysis: (1) it needs to be done sometimes; (2) it's not a nice thing to do; (3) it does not really damage the therapeutic relationship; and (4) importance of team support. Despite strongly reporting that it was sometimes necessary to manually restrain young people for substantial safety reasons, participants spoke with dislike about its use, and described consequential aversive experiences of emotional distress, patient aggression, pain and injury, and physical exhaustion. Participants reported relying on each other for emotional and practical support. Three participants reported observing premature restraint use by non-permanent staff.

CONCLUSION

The findings detail a paradoxical picture of the nursing staff's experiences where restraint is experienced as psychologically and physically aversive yet deemed as sometimes necessary to prevent significant harm.

REPORTING METHOD

The Standards for Reporting Qualitative Research (SRQR) checklist was used to guide reporting.

IMPACT

This study suggests a need for the targeting of non-permanent staff for restraint minimization interventions, and highlights how the treatment of non-permanent staff by permanent staff may contribute to avoidable restraint practices. The findings indicate several ways in which the staff-young person therapeutic relationship can be preserved in the context of restraint. However, this needs to be treated with caution given that young people's voices were missing from this study.

PATIENT OR PUBLIC CONTRIBUTION

This study focused on nursing staff's experiences.