Nurses Experiences of
Control & Restraint in an
Acute Mental Health Setting
By
Tiziana Portelli
Introduction
The overall purpose of this study was to explore nurses’
experiences of control & restraint in an acute mental
health setting.
Reasons for choosing this topic:
• Various researchers report that incidents of violence and
threats of violence have shown a considerable increase
over the last few years.
• Increased number of staff injuries whilst restraining
patients.
• Personal interest.
Aims & Objectives
…
• Develop a clear picture of how many nurses
had any form of training;
• Establish the understanding that nurses have
about C & R;
• Establish when & how C & R should be used;
• Establish knowledge of alternatives.
Literature Review
To identify from the literature:
• A definition of control & restraint
• When to use it
• Managing the process
• Alternatives
• Published research regarding nurses views &
experiences
Definition of control & restraint
Definitions lack consistency within the
literature.
(Johnson, 1998)
It is an intervention it involves a designated
system of techniques.
(Anderson et al., 1999)
Control & restraint interventions are a common
method for managing a range of clinical
situations.
(Steel, 2000)
Methodology
• Purposive, mixed method, correlational
design;
• Population – qualified nurses in acute
psychiatric setting;
• Sample – all acute wards;
• Self designed structured questionnaire;
• Data analysis – numerical and thematic.
Findings
• demographic data
• training
• control & restraint & other
techniques
• control & restraint & injuries
• post procedures
Findings …
• Demographics of sample …
• n = 56
• fairly evenly distributed sample
• majority were staff nurses
• 10 of these were RMN’s
• Majority had over 6 years service
Develop a clear picture of how many
nurses had a form of training
• Most participants had no training
• Those that did, received it after they were already
working in acute wards
• This could be because a large number of nurses are
general trained
• Also could be related to lack of resources
• There is no hospital policy indicating training as a
requirement
Establish the understanding that
nurses have about C & R
• Nurses clearly understood the
importance and need for training
• This may be because of their
experiences and their knowledge that
there is a high tendency for patients to
become violent & aggressive
• A high % felt anxious and lacked
knowledge in several key areas
Establish when & how C & R should
be used
• Participants did not have a clear
understanding of what it is and when and
how it should be used;
• Nurses lack de-escalation skills;
• Physical restraint is the first choice in nearly
all situations;
• Staff regularly incur injuries during C&R
Establish knowledge of alternatives
• Nurses had neither knowledge nor
training on alternatives
• Local mentality may be significant
• Nurses may lack confidence to use
other approaches.
MAIN CONCLUSION ….
• … there is an overwhelming lack of
knowledge and training concerning
control and restraint amongst nurses
working in acute wards within the
hospital where this research was
conducted.
• This fact might then result in the
frequent and inappropriate use of
control and restraint techniques being
applied to patients.
Limitations of the study
• Results can’t be generalised
• Few psychiatric nurse participants
• Small scale study
• A number of participants' did not
comment
Strengths of study
• Good response rate
• Good representation of nurses grade,
experience etc
• Use of questionnaires proved beneficial.
Recommendations
• Clinical practice
• Education
• Management
• Further research
References …
Johnson, M.E. (1998) Being restrained: a study of power and
powerlessness. Issues in Mental Health Nursing. 19:191-206
Anderson, L, N., Minarik, P, A., Dilmorth, J, M., Jones, J., Nash, K, P.,O’
Donell, K, P., & Steinmiller,E, A.(1999). Responding to difficult
patients. American Journal of Nursing, 99(12), 26-32
Steel, E.(2000). Seclusion and restraint practice standards: a review and
analysis.Retrieved October5,2011, from
http://www.ncstac.org/index.php?option=com_contentandview=article
andid=94%3Asecl
Thank you for your
attention.