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The Impact of ‘Being There’: Psychiatric Staff Attitudes on the Use of Restraint

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Abstract

The practice of mechanically restraining psychiatric patients is constantly under debate, and staff attitudes are considered a central factor influencing restraining practices. The aim of this study was to explore associations between psychiatric staff members’ presence and participation in incidences of restraint and attitudes towards mechanical restraints. Methods: Staff members (psychiatrists, nurses, paramedical staff; N = 143 working in a government psychiatric hospital in Israel) completed a questionnaire including personal information, participation in incidents of restraint and attitudes towards mechanical restraints. Items were categorized into the following categories: security and care; humiliation and offending; control; order; education and punishment. Results: Compared to those who were not present during restraint, staff members who were present agreed significantly less with statements indicating that restraints are humiliating and offending and agreed more with statements indicating that restraints are used primarily for security and care (p < .05). Among those present in incidences of restraint, staff members who physically participated in restraint agreed significantly more with statements indicating that restraints are a means for security, care and order, and less with statements indicating restraints are humiliating and offending, compared to those present but not physically participating in restraint (p < .05). Conclusions: These findings highlight the importance of proximity of staff members to incidences of restraints. This may have implications in understanding the professional and social discourse concerning mechanical restraints.

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References

  1. Lepping P, Masood B, Flammer E, Noorthoorn EO. Comparison of restraint data from four countries. Soc Psychiatry Psychiatr Epidemiol. 2016;51(9):1301–9. doi:10.1007/s00127-016-1203-x.

    Article  PubMed  Google Scholar 

  2. Kaltiala-Heino R, Tuohimäki C, Korkeila J, Lehtinen V. Reasons for using seclusion and restraint in psychiatric inpatient care. International Journal of Law and Psychiatry. 2003;26(2):139–49.

    Article  CAS  PubMed  Google Scholar 

  3. Iversen VC. Mechanical restraint–A philosophy of man, a philosophy of care, or no philosophy at all? Journal of Psychiatric Intensive Care. 2009;5(01):1–4.

    Article  Google Scholar 

  4. Steinert T, Birk M, Flammer E, Bergk J. Subjective distress after seclusion or mechanical restraint: one-year follow-up of a randomized controlled study. Psychiatric Services. 2013;64(10):1012–7.

    Article  PubMed  Google Scholar 

  5. Glover RW. Special section on seclusion and restraint: Commentary: Reducing the use of seclusion and restraint: A NASMHPD priority. Psychiatric Services. 2005;56(9):1141–2.

    Article  PubMed  Google Scholar 

  6. Madan A, Borckardt JJ, Grubaugh AL, Danielson CK, McLeod-Bryant S, Cooney H et al. Efforts to reduce seclusion and restraint use in a state psychiatric hospital: a ten-year perspective. Psychiatric Services. 2014;65(10):1273–6.

    Article  PubMed  Google Scholar 

  7. Freeman M, Pathare S. WHO resource book on mental health, human rights and legislation. World Health Organization; 2005.

  8. Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W et al. Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Social psychiatry and psychiatric epidemiology. 2010;45(9):889–97.

    Article  PubMed  Google Scholar 

  9. Raboch J, Kališová L, Nawka A, Kitzlerová E, Onchev G, Karastergiou A et al. Use of coercive measures during involuntary hospitalization: findings from ten European countries. Psychiatric Services. 2010;61(10):1012–7.

    Article  PubMed  Google Scholar 

  10. Beghi M, Peroni F, Gabola P, Rossetti A, Cornaggia CM. Prevalence and risk factors for the use of restraint in psychiatry: a systematic review. Rivista di psichiatria. 2013;48(1):10–22.

    PubMed  Google Scholar 

  11. Bowers L. Association between staff factors and levels of conflict and containment on acute psychiatric wards in England. Psychiatric Services. 2009;60(2):231–9.

    Article  PubMed  Google Scholar 

  12. Klinge V. Staff opinions about seclusion and restraint at a state forensic hospital. Psychiatric Services. 1994;45(2):138–41.

    Article  CAS  Google Scholar 

  13. Suen LK, Lai C, Wong T, Chow S, Kong S, Ho J et al. Use of physical restraints in rehabilitation settings: staff knowledge, attitudes and predictors. Journal of Advanced Nursing. 2006;55(1):20–8.

    Article  PubMed  Google Scholar 

  14. Van Doeselaar M, Sleegers P, Hutschemaekers G. Professionals’ attitudes toward reducing restraint: The case of seclusion in The Netherlands. Psychiatric Quarterly. 2008;79(2):97–109.

    Article  PubMed  Google Scholar 

  15. Tateno M, Sugiura K, Uehara K, Fujisawa D, Zhao Y, Hashimoto N et al. Attitude of young psychiatrists toward coercive measures in psychiatry: a case vignette study in Japan. International journal of mental health systems. 2009;3(1):20.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hendel T, Fradkin M, Kidron D. Physical restraint use in health care settings: Public attitudes in Israel. Journal of gerontological nursing. 2004;30(2):12–9.

    Article  PubMed  Google Scholar 

  17. Gelkopf M, Roffe Z, Behrbalk P, Melamed Y, Werbloff N, Bleich A. Attitudes, opinions, behaviors, and emotions of the nursing staff toward patient restraint. Issues in Mental Health Nursing. 2009;30(12):758–63.

    Article  PubMed  Google Scholar 

  18. Barton SA, Johnson MR, Price LV. Achieving restraint-free on an inpatient behavioral health unit. Journal of Psychosocial Nursing and Mental Health Services. 2009;47(1):34–40.

    Article  PubMed  Google Scholar 

  19. De Benedictis L, Dumais A, Sieu N, Mailhot M-P, Létourneau G, Tran M-AM et al. Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. Psychiatric Services. 2011;62(5):484–91.

    Article  PubMed  Google Scholar 

  20. Kinner S, Harvey C, Hamilton B, Brophy L, Roper C, McSherry B et al. Attitudes towards seclusion and restraint in mental health settings: findings from a large, community-based survey of consumers, carers and mental health professionals. Epidemiology and Psychiatric Sciences. 2016:1–10.

  21. Whittington R, Bowers L, Nolan P, Simpson A, Neil L. Approval ratings of inpatient coercive interventions in a national sample of mental health service users and staff in England. Psychiatric Services. 2009;60(6):792–8.

    Article  PubMed  Google Scholar 

  22. Pollard R, Yanasak EV, Rogers SA, Tapp A. Organizational and unit factors contributing to reduction in the use of seclusion and restraint procedures on an acute psychiatric inpatient unit. Psychiatric Quarterly. 2007;78(1):73–81.

    Article  PubMed  Google Scholar 

  23. Foster C, Bowers L, Nijman H. Aggressive behaviour on acute psychiatric wards: prevalence, severity and management. Journal of Advanced Nursing. 2007;58(2):140–9.

    Article  PubMed  Google Scholar 

  24. Duxbury J. An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: a pluralistic design. Journal of psychiatric and mental health nursing. 2002;9(3):325–37.

    Article  CAS  PubMed  Google Scholar 

  25. Marangos-Frost S, Wells D. Psychiatric nurses’ thoughts and feelings about restraint use: a decision dilemma. Journal of Advanced Nursing. 2000;31(2):362–9.

    Article  CAS  PubMed  Google Scholar 

  26. Festinger L, Carlsmith JM. Cognitive consequences of forced compliance. The Journal of Abnormal and Social Psychology. 1959;58(2):203.

    Article  CAS  Google Scholar 

  27. Myers DG, Spencer SJ. Social Psychology. McGraw-Hill Ryerson, Limited; 2006.

    Google Scholar 

  28. Chambers M, Kantaris X, Kontio R, Kuosmanen L, Scott A, Botelho MAR et al. The feelings and thoughts of mental health nurses concerning the management of distressed and disturbed in-patients: a comparative qualitative European study. Open Journal of Nursing. 2013;3(06):426.

    Article  Google Scholar 

  29. Hall JE. Restriction and control: the perceptions of mental health nurses in a UK acute inpatient setting. Issues in mental health nursing. 2004;25(5):539–52.

    Article  PubMed  Google Scholar 

  30. Husum TL, Bjørngaard JH, Finset A, Ruud T. Staff attitudes and thoughts about the use of coercion in acute psychiatric wards. Social psychiatry and psychiatric epidemiology. 2011;46(9):893–901.

    Article  PubMed  Google Scholar 

  31. Sailas EE, Fenton M. Seclusion and restraint for people with serious mental illnesses. The Cochrane Library. 2000.

  32. Fisher WA. Restraint and seclusion: a review of the literature. American Journal of Psychiatry. 1994;151(11):1584–91.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Lev Hasharon Mental Health Center, POB 9000, Netanya, Israel

    Sagit Dahan, Galit Levi, Pnina Behrbalk, Israel Bronstein, Shmuel Hirschmann & Shaul Lev-Ran

  2. Sackler Faculty of Medicine, Tal Aviv University, Tel Aviv, Israel

    Shaul Lev-Ran

Authors
  1. Sagit Dahan
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  2. Galit Levi
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  3. Pnina Behrbalk
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  4. Israel Bronstein
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  5. Shmuel Hirschmann
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  6. Shaul Lev-Ran
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Correspondence to Sagit Dahan.

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The authors declare that they have no conflict of interests.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Was obtained from all individual participants included in the study.

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Dahan, S., Levi, G., Behrbalk, P. et al. The Impact of ‘Being There’: Psychiatric Staff Attitudes on the Use of Restraint. Psychiatr Q 89, 191–199 (2018). https://doi.org/10.1007/s11126-017-9524-9

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  • DOI: https://doi.org/10.1007/s11126-017-9524-9

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