A narrative inquiry: moving on from homelessness for individuals with a major mental illness

This narrative study explores the experience of 'moving on' from homelessness for individuals with major mental illnesses, after they have obtained permanent housing with supports. Twelve participants were interviewed up to three times over 6 months. There were various routes to homelessness, participants were homeless for varying lengths of time, and they described different journeys of 'moving on' in their lives. Place, and a series of places, were central for participants in this experience. The experience of homelessness for many could be described as 'on the move', in a circular pattern from shelter to shelter or street. Permanent housing and supports allowed participants to 'move on', reconnecting with family, getting jobs and planning for the future. Several participants wanted their stories used to send messages of hope, courage and survival. This study highlights the need for nurses to be aware of the concept of 'place' in the process of recovery from mental illness.     

Psychiatric nurses' thoughts and feelings about restraint use: a decision dilemma

Patients continue to be physically restrained in psychiatric in-patient units. Studies concerned with staff-related variables have suggested that the emotional reactions of professionals to violent or potentially violent patients may influence their use of restrictive measures. However, no research existed that described psychiatric nurses' thoughts and feelings while they were involved in restraint situations nor what effects their thoughts and feelings had on their decision to restrain. Therefore, an ethnographic qualitative study was conducted in order to describe systematically nurses' thoughts and feelings toward restraint use in the in-patient psychiatric setting. The conceptual approach guiding the study was Etzioni's (1992) theoretical work on the role of normative-affective factors in decision making. Following ethical approval of the study, ethnographic interviews were conducted with six nurses from an in-patient psychiatric unit who had participated in a situation involving the physical restraint of a patient. The analysis of the nurses' thoughts and feelings revealed that the restraint situation represented a decision dilemma for them. This overall finding was supported by four themes: (1) the framing of the situation: the potential for imminent harm; (2) the unsuccessful search for alternatives to physical restraints; (3) the conflicted nurse; and (4) the contextual conditions of restraint. The results indicated that restraint use is more complex than is currently conveyed in the literature in that normative-affective factors influenced nurses' restraint decisions. The findings advance our understanding of why restraints continue to be used in psychiatric units. Further research is necessary to examine the findings in other settings and with a larger and more diverse population in order to draw definitive conclusions about the continued use of physical restraints in the care of patients on psychiatric units in hospitals.     

Responding to a violent incident: physical restraint or anger management as therapeutic interventions

By finding more feasible alternatives to managing aggression which can be effectively used in health care settings, as well as expanding nursing knowledge on the detrimental effects of restraints, forensic clinicians can use their creativity and resources to enhance the quality of life for their patients using beneficial therapeutic alternatives to restraint. A closer examination of alternatives to managing aggressive behaviour leads the author to the introduction of a case study, promoting non-touch interventions. The importance of this paper lies in reorienting forensic clinicians away from the perceived ideologies of physical restraint as a primary intervention, moving towards the productive use of anger management.     

Perspectives on physical restraint in psychiatric hospital: A qualitative study of mentally ill patients

The use of physical restraint had caused a series of unexpected impacts on patients, particularly psychological trauma. This qualitative study aimed to identify perspectives on physical restraint among patients with mental health conditions and to seek effective interventions targeting the psychological trauma which is caused by physical restraint. A semi-structured interview was conducted in a public psychiatric hospital in China to explore perspectives on physical restraint among 26 patients who had undergone or witnessed physical restraint. The interview was conducted by experienced and qualified interviewers with mental health service backgrounds. The interviews were recorded and transcribed into words, and then preliminary themes were extracted and coded, finally thematic analysis was used to identify focused themes. Five themes were extracted: these were as follows: (1) The negative effects of physical restraint on patients; (2) The impairment of the relationship between nurse and patient due to physical restraint; (3) The decrease in patients' treatment adherence caused by physical restraint; (4) The positive outcomes of physical restraint; (5) The expectations of patients for improving the quality of nursing care. Conclusively, the use of physical restraint had critical impacts on patients, including psychological trauma, destruction of the nurse–patient relationship, and decreased adherence of treatment. These negative effects could impede clinical work.     

住院患者身体约束方法的研究进展

本文对身体约束的分类、器械约束装置的改良、患者活动监管装置以及约束的辅助方法进行综述,以期为身体约束的合理使用提供参考,从而降低住院患者身体约束的使用率和使用时间,减少伤害的发生。     

Dilemmas facing Japanese nurses regarding the physical restraint of elderly patients

Aim: The purpose of this study was to clarify the meaning of “dilemma” regarding the use of physical restraint on elderly persons as described by nurses in general wards at community hospitals. The questions asked included: to what extent has the dilemma of nurses regarding the restraint of elderly persons in the general ward been clarified?, which factor/s compose the dilemma?, what are the psychometric properties of the factors?, and how should nurses deal with the dilemma with regard to restraining elderly persons? Methods: The participants were 1477 nurses (12 male, 1463 female, and two: no answer) at 54 wards (excluding the emergency wards of psychiatry, pediatrics, obstetrics, outpatients, operating rooms, and intensive care units). The dilemma was measured by using a questionnaire consisting of 20 items previously developed by the author. Results: An explanatory factor analysis revealed four dilemma factors among 17 items investigated. These were “execution of treatment and security”, “characteristics in nursing of elderly patients”, “a cooperative relationship”, and “priorities in nursing”. The cumulative contribution ratio was 68.3%. In respect to the dilemma where nurses are faced with the physical restraint of elderly persons, four factors in the clarification of the dilemma were extracted: “execution of treatment and security”, “characteristic features in nursing”, “a cooperative relationship in nursing”, and “priorities in nursing”. Conclusions: Based on the psychometric properties, the Dilemma scale is a valid and reliable tool. The construction of four systems to cope with these dilemmas is suggested. These systems would enable practising nurses to communicate with comedical workers in order to reach a consensus about the elderly’s care, avoid restraining the elderly by allocating care specialists to the elderly, establish institutional policies and safety standards that establish the nurses’ responsibilities for patients’ decision‐making, and receive continuous and timely ethical education.     

Multidimensional approach to restraint minimization: The journey of a specialized mental health organization

The executive‐level witnessing and review of restraint events has been identified as a key strategy for restraint minimization. In the present study, we examined the changes in restraint practices at a tertiary‐level mental health‐care facility with implementation of an initiative, in which representatives from senior management, professional practice, peer support, and clinical ethics witnessed seclusion and restraint events, and rounded with clinical teams to discuss timely release and brainstorm prevention strategies. Interrupted time series analysis compared the change from pre‐implementation (14 months prior) to postimplementation (35 months’ following) in the number of incidents/month, total hours/month, and average hours/incident/month for each of seclusion and mechanical restraint. With implementation, there was a step decrease in average hours/seclusion (–28.3 hours/seclusion, P < 0.001) and total seclusion hours (–1264.5 hours, P = 0.002). The postimplementation rate of decrease of –0.9 hours/incident/month was different than the pre‐implementation rate of increase of 0.7 hours/incident/month for mechanical restraint (P = 0.03). Pre‐implementation, there was a rate of decrease of 6.1 incidents/month (P < 0.001) and 4.5 incidents/month (P = 0.001) for seclusion and mechanical restraint, respectively. Postimplementation, there was a rate of increase of 0.3 incidents/month and a rate of decrease of 0.05 incidents/month for seclusion and mechanical restraint, respectively, both of which were different than pre‐implementation (seclusion: P < 0.001, mechanical restraint: P = 0.002). In conclusion, the total hours of seclusion and average hours per seclusion and per restraint incident were reduced, demonstrating the value of leadership witnessing and daily rounds in promoting restraint minimization in tertiary‐level mental health care.     

国外住院患者身体约束使用指征的研究进展

本文通过对国外身体约束使用指征进行综述,为制定适用于我国的身体约束使用规范提供参考,从而降低患者身体约束的使用率。     

In harm's way: a postmodern narrative inquiry

Deliberate self-harm is a traumatic experience which has serious consequences at individual and social levels. Differing motivations for self-harm and different modes of injury require that therapeutic responses vary. Yet, according to the literature and personal observation, nursing responses tend to be uniform and inflexible. Not only are such responses inadequate for effectively dealing with individuals who self-harm, they also have unintended, hidden deleterious consequences for nurses and nursing. In this paper, a story about self-harm is analysed using a postmodern perspective that helps to illuminate multiple dimensions to this complex issue. The approach enriches understanding, opening up possibilities to improve the quality of the nurse--patient relationship.     

Nurses' and consumers' shared experiences of seclusion and restraint: A qualitative literature review

Seclusion and restraint are coercive practices associated with physical and psychological harm. International bodies have called for an end to these practices. However, these practices continue to be used. Elimination programmes have had some success in reducing the rates of these practices. Understanding coercive practices through the perspectives of involved individuals may facilitate a complete cessation of seclusion and restraint from the practice. Therefore, this qualitative review explored how nurses and consumers experienced seclusion and restraint events in mental health care. Five databases were searched. The search strategy resulted in the inclusion of fourteen qualitative papers. A thematic analysis was used to synthesize the findings. Six themes emerged under three main categories; shared experiences: disruption in care, disruption in the therapeutic relationship and shared negative impacts; nurses’ experiences: Absence of less coercive alternatives; and consumers’ experiences: overpowered, humiliated and punished. Considering these experiences during planning for seclusion and restraint prevention might facilitate more effective implementation of seclusion and restraint elimination programmes. Our findings suggested that consumers should receive recovery‐oriented, trauma‐informed and consumer‐centred care; while nurses should be better supported through personal, professional and organizational developmental strategies. Further research should focus on investigating shared interventions among consumers and nurses and exploring carers’ experiences with coercive practices.     

Physical restraint reduction in the acute rehabilitation setting: a quality improvement study.

A prospective, continuous quality improvement study was implemented at a hospital on two rehabilitation units: stroke and brain injury. The purpose of the study was to decrease restraint use by 25% and to maintain fall rates no greater than 10% over baseline. A multi-component restraint reduction program was implemented that focused on administrative support, education, consultation, and feedback. Monthly restraint rates and fall rates were monitored and compared to the previous year's rates. Both units reduced restraint use. Importantly, this reduction was accomplished at the same time as a decline in fall rates.     

Explorations of disgust: A narrative inquiry into the experiences of nurses working in palliative care

While feelings of disgust and repulsion are experienced and accepted as part of care practices of nurses who work in palliative care, they are often silenced. Working alongside two palliative care nurses in a hospice setting, we engaged in a narrative inquiry to inquire into their experiences of disgust. The study took place in a palliative care setting in a large urban city in Germany. We understand care practices as actions that follow a logic of care. According to a logic of care, actions are situated within a social context, given by specific relationships including power, and individual needs. Various aspects of disgust are visible in the experiences of the participants and highlighted in the narrative threads of disgust and silence, disgust and protection, and disgust and boundaries. Embedded in the experience of disgust of nurses working in palliative care, we see that there are borderlands of care that challenge who we are and are becoming. Opening discussion about disgust in nursing makes visible the complexity of care.     

护士对危重患者使用身体约束伦理认知与行为状况的调查

目的 了解护士对使用身体约束伦理的认知与行为状况.方法 采用自行设计的问卷,对147名护士进行危重患者使用身体约束的伦理认知和行为状况调查.结果 护士对危重患者身体约束的伦理行为得分为(28.04±3.85)分,态度得分为(33.41±4.51)分;不同科室护士对执行身体约束的评估行为得分差异具有统计学意义(P＜0.0...