Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses' Experience of Chemical Restraint Interventions
DOI:
https://doi.org/10.25071/2291-5796.75Keywords:
Chemical restraint, coercive medication, restraint practice, phenomenology, mental health nursingAbstract
While there is a growing body of research available on general restraint intervention in acute adult psychiatric settings, relatively little is known about nurses’ experiences of administering chemical restraint. The research question explored in this study was: what are mental health nurses’ experiences of using chemical restraint interventions in times of behavioural emergency on adult inpatient acute mental health units? Through this Canadian study understanding of direct care nurses’ first-hand experiences of the use of chemical restraint interventions was sought. Eight adult acute inpatient mental health nurses were interviewed using hermeneutic phenomenological method. Two major themes that emerged from data analysis are explored to illuminate the existing tension between therapeutic, person-centred care and coercive control to maintain safety: taking control to maintain safety and working within constraints. Integral ways that nurses make meaning from administering chemical restraint were found, as well as some of the complex clinical and ethical decision-making aspects involved in psychiatric nursing care. Implications for practice, education, and policy are discussed. Research findings indicated a need for further focus on medication best practice, policy development and nurse education. These exploratory research findings can be used to both inform and challenge dominant inpatient mental health practice to guide nurses, health care leaders, and policy makers by increased understanding of the complex ethical decision making required for use of chemical restraint interventions.
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References
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Anderson, W. H., & Reeves, K. R. (1991). Chemical restraint: An idea whose time has gone. Administration and Policy in Mental Health. https://doi.org/10.1007/BF00713806
Baker, J. A., Lovell, K., Harris, N., & Campbell, M. (2007). Multidisciplinary consensus of best practice for pro re nata (PRN) psychotropic medications within acute mental health settings: A Delphi study. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2007.01112.x
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Bowers, L., Alexander, J., Simpson, A., Ryan, C., & Carr-Walker, P. (2004). Cultures of psychiatry and the professional socialization process: The case of containment methods for disturbed patients. Nurse Education Today. https://doi.org/10.1016/j.nedt.2004.04.008
Bowers, L., Alexander, J., Simpson, A., Ryan, C., & Carr-Walker, P. (2007). Student psychiatric nurses’ approval of containment measures: Relationship to perception of aggression and attitudes to personality disorder. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2005.03.002
Brown, S., Chhina, N., & Dye, S. (2010). Use of psychotropic medication in seven English psychiatric intensive care units. Psychiatrist. https://doi.org/10.1192/pb.bp.108.023762
Canadian Institute for Health Information. (2014). Mental Health and Addictions Data and Information Guide , 2014 Standards and Data Submission. CIHI.
Cannon, M. E., Sprivulis, P., & McCarthy, J. (2001). Restraint practices in Australasian emergency departments. Australian and New Zealand Journal of Psychiatry. https://doi.org/10.1046/j.1440-1614.2001.00925.x
Converse, M. (2012). Philosophy of phenomenology: How understanding aids research. Nurse Researcher, 20(1).
Cowin, L., Davies, R., Estall, G., Berlin, T., Fitzgerald, M., & Hoot, S. (2003). De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing. https://doi.org/10.1046/j.1440-0979.2003.00270.x
Currier, G. W. (2003). The controversy over “chemical restraint” in acute care psychiatry. Journal of Psychiatric Practice, 9(1), 59–70. https://doi.org/10.1097/00131746-200301000-00006
Currier, G. W., & Allen, M. H. (2000). Physical and chemical restraint in the psychiatric emergency service. In Psychiatric Services. https://doi.org/10.1176/appi.ps.51.6.717
Dickinson, T., Ramsdale, S., & Speight, G. (2009). Managing aggression and violence using rapid tranquillisation. Nursing Standard (Royal College of Nursing (Great Britain) : 1987). https://doi.org/10.7748/ns2009.10.24.7.40.c7327
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Gelkopf, M., Roffe, Z., Behrbalk, P., Melamed, Y., Werbloff, N., & Bleich, A. (2009). Attitudes, opinions, behaviors, and emotions of the nursing staff toward patient restraint. Issues in Mental Health Nursing. https://doi.org/10.3109/01612840903159777
Georgieva, I., Mulder, C. L., & Wierdsma, A. (2012). Patients’ preference and experiences of forced medication and seclusion. Psychiatric Quarterly. https://doi.org/10.1007/s11126-011-9178-y
Gilburt, H., Rose, D., & Slade, M. (2008). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Services Research. https://doi.org/10.1186/1472-6963-8-92
Gonzalez, D., Bienroth, M., Curtis, V., Debenham, M., Jones, S., Pitsi, D., & George, M. (2013). Consensus statement on the use of intramuscular aripiprazole for the rapid control of agitation in bipolar mania and schizophrenia. In Current Medical Research and Opinion. https://doi.org/10.1185/03007995.2013.766591
Gray, J. E., Hastings, T. J., Love, S., & O’Reilly, R. L. (2016). Clinically significant differences among Canadian mental health acts: 2016. In Canadian Journal of Psychiatry. https://doi.org/10.1177/0706743716632524
Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in connection with the use of coercion: A focus group study of health care personnel in mental health care. BMC Medical Ethics. https://doi.org/10.1186/1472-6939-15-82
Hui, A., Middleton, H., & Völlm, B. (2013). Coercive Measures in Forensic Settings: Findings from the Literature. In International Journal of Forensic Mental Health. https://doi.org/10.1080/14999013.2012.740649
Innes, J., & Sethi, F. (2013). Current rapid tranquillisation documents in the UK: A review of the drugs recommended, their routes of administration and clinical parameters influencing their use. In Journal of Psychiatric Intensive Care. https://doi.org/10.1017/S174264641200026X
Knutzen, M., Bjørkly, S., Eidhammer, G., Lorentzen, S., Mjøsund, N. H., Opjordsmoen, S., Sandvik, L., & Friis, S. (2014). Characteristics of patients frequently subjected to pharmacological and mechanical restraint-A register study in three Norwegian acute psychiatric wards. Psychiatry Research. https://doi.org/10.1016/j.psychres.2013.10.024
Kvale, S. (1996). The Interview Situation. In Interviews: An Introduction to Qualitative Research Interviewing. https://doi.org/10.1037/0022-3514.90.4.644
Landeweer, E. G. M., Abma, T. A., & Widdershoven, G. A. M. (2010). The essence of psychiatric nursing: Redefining nurses’ identity through moral dialogue about reducing the use of coercion and restraint. Advances in Nursing Science. https://doi.org/10.1097/ANS.0b013e3181fb2ef9
Larsen, I. B., & Terkelsen, T. B. (2014). Coercion in a locked psychiatric ward: Perspectives of patients and staff. Nursing Ethics. https://doi.org/10.1177/0969733013503601
Lim, E., Wynaden, D., & Heslop, K. (2017). Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12378
Lind, M., Kaltiala-Heino, R., Suominen, T., Leino-Kilpi, H., & Välimäki, M. (2004). Nurses’ ethical perceptions about coercion. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2004.00715.x
M., K., S., B., G., E., S., L., N., H. M., S., O., L., S., & S., F. (2013). Mechanical and pharmacological restraints in acute psychiatric wards-Why and how are they used? In Psychiatry Research.
MacKey, S. (2005). Phenomenological nursing research: Methodological insights derived from Heidegger’s interpretive phenomenology. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2004.06.011
Manen, M. van. (1997). From meaning to method. Qualitative Health Research, 7(3), 345–369.
Mann-Poll, P. S., Smit, A., Van Doeselaar, M., & Hutschemaekers, G. J. M. (2013). Professionals’ attitudes after a seclusion reduction program: Anything changed? Psychiatric Quarterly. https://doi.org/10.1007/s11126-012-9222-6
McCain, M., & Kornegay, K. (2005). Behavioral health restraint: The experience and beliefs of seasoned psychiatric nurses. Journal for Nurses in Staff Development. https://doi.org/10.1097/00124645-200509000-00009
Mott, S., Poole, J., & Kenrick, M. (2005). Physical and chemical restraints in acute care: Their potential impact on the rehabilitation of older people. International Journal of Nursing Practice. https://doi.org/10.1111/j.1440-172X.2005.00510.x
National Consumer and Carer Forum. (2009). Ending seclusion and restraint in Australian mental health services: a position statement by the National Mental Health Consumer & Carer Forum (NMHCCF).
Olofsson, B., & Jacobsson, L. (2001). A plea for respect: Involuntarily hospitalized psychiatric patients’ narratives about being subjected to coercion. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1046/j.1365-2850.2001.00404.x
Perkins, E., Prosser, H., Riley, D., & Whittington, R. (2012). Physical restraint in a therapeutic setting; a necessary evil? International Journal of Law and Psychiatry. https://doi.org/10.1016/j.ijlp.2011.11.008
Registered Nurses’ Association of Ontario. (2012). Promoting Safety : Alternative Approaches to the Use of Restraints. Registered Nurses´Association of Ontario, February. http://abinetwork.ca/alternatives-to-restraint-use
Repique, R. J. R. (2014). Cloning in Electronic Mental Health Record: Understanding the Perils and Suggested Safeguards. In Journal of the American Psychiatric Nurses Association (Vol. 20, Issue 4, pp. 268–270). SAGE Publications Inc. https://doi.org/10.1177/1078390314542405
Rose, D., Evans, J., Laker, C., & Wykes, T. (2015). Life in acute mental health settings: Experiences and perceptions of service users and nurses. Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796013000693
Shattell, M. M., Andes, M., & Thomas, S. P. (2008). How patients and nurses experience the acute care psychiatric environment. Nursing Inquiry. https://doi.org/10.1111/j.1440-1800.2008.00397.x
Sheehan, K. A., & Burns, T. (2011). Perceived coercion and the therapeutic relationship: A neglected association? Psychiatric Services. https://doi.org/10.1176/ps.62.5.pss6205_0471
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4). https://doi.org/10.1111/nin.12199
Stastny, P. (2000). Involuntary psychiatric interventions: a breach of the Hippocratic oath? Ethical Human Sciences and Services : An International Journal of Critical Inquiry, 2(1), 21–41.
Stewart, D., Robson, D., Chaplin, R., Quirk, A., & Bowers, L. (2012). Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing, 21(6), 540–549. https://doi.org/10.1111/j.1447-0349.2012.00834.x
Streubert, H., & Carperter, D. (2011). Designing Data Generation and Management Strategies. In Qualitative Research in Nursing:Advancing The Humanistic Imperative.
Wilson, C., Rouse, L., Rae, S., & Kar Ray, M. (2017). Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12382
Allison, L., & Moncrieff, J. (2014). “Rapid tranquillisation”: An historical perspective on its emergence in the context of the development of antipsychotic medications. History of Psychiatry. https://doi.org/10.1177/0957154X13512573
Anderson, W. H., & Reeves, K. R. (1991). Chemical restraint: An idea whose time has gone. Administration and Policy in Mental Health. https://doi.org/10.1007/BF00713806
Baker, J. A., Lovell, K., Harris, N., & Campbell, M. (2007). Multidisciplinary consensus of best practice for pro re nata (PRN) psychotropic medications within acute mental health settings: A Delphi study. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2007.01112.x
Bigwood, S., & Crowe, M. (2008). “It’s part of the job, but it spoils the job”: A phenomenological study of physical restraint: Feature Article. International Journal of Mental Health Nursing. https://doi.org/10.1111/j.1447-0349.2008.00526.x
Bowers, L., Alexander, J., Simpson, A., Ryan, C., & Carr-Walker, P. (2004). Cultures of psychiatry and the professional socialization process: The case of containment methods for disturbed patients. Nurse Education Today. https://doi.org/10.1016/j.nedt.2004.04.008
Bowers, L., Alexander, J., Simpson, A., Ryan, C., & Carr-Walker, P. (2007). Student psychiatric nurses’ approval of containment measures: Relationship to perception of aggression and attitudes to personality disorder. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2005.03.002
Brown, S., Chhina, N., & Dye, S. (2010). Use of psychotropic medication in seven English psychiatric intensive care units. Psychiatrist. https://doi.org/10.1192/pb.bp.108.023762
Canadian Institute for Health Information. (2014). Mental Health and Addictions Data and Information Guide , 2014 Standards and Data Submission. CIHI.
Cannon, M. E., Sprivulis, P., & McCarthy, J. (2001). Restraint practices in Australasian emergency departments. Australian and New Zealand Journal of Psychiatry. https://doi.org/10.1046/j.1440-1614.2001.00925.x
Converse, M. (2012). Philosophy of phenomenology: How understanding aids research. Nurse Researcher, 20(1).
Cowin, L., Davies, R., Estall, G., Berlin, T., Fitzgerald, M., & Hoot, S. (2003). De-escalating aggression and violence in the mental health setting. International Journal of Mental Health Nursing. https://doi.org/10.1046/j.1440-0979.2003.00270.x
Currier, G. W. (2003). The controversy over “chemical restraint” in acute care psychiatry. Journal of Psychiatric Practice, 9(1), 59–70. https://doi.org/10.1097/00131746-200301000-00006
Currier, G. W., & Allen, M. H. (2000). Physical and chemical restraint in the psychiatric emergency service. In Psychiatric Services. https://doi.org/10.1176/appi.ps.51.6.717
Dickinson, T., Ramsdale, S., & Speight, G. (2009). Managing aggression and violence using rapid tranquillisation. Nursing Standard (Royal College of Nursing (Great Britain) : 1987). https://doi.org/10.7748/ns2009.10.24.7.40.c7327
Emmanuel, L., Taylor L, Hain A, Combes, J., Hatlie, M., Karsh, B., Lau, D., Shalowitz, J., Shaw, T., & Walton, M. (2013). Module 13d: Mental Health Care: Seclusion and Restraint: When All Else Fails.
Gelkopf, M., Roffe, Z., Behrbalk, P., Melamed, Y., Werbloff, N., & Bleich, A. (2009). Attitudes, opinions, behaviors, and emotions of the nursing staff toward patient restraint. Issues in Mental Health Nursing. https://doi.org/10.3109/01612840903159777
Georgieva, I., Mulder, C. L., & Wierdsma, A. (2012). Patients’ preference and experiences of forced medication and seclusion. Psychiatric Quarterly. https://doi.org/10.1007/s11126-011-9178-y
Gilburt, H., Rose, D., & Slade, M. (2008). The importance of relationships in mental health care: A qualitative study of service users’ experiences of psychiatric hospital admission in the UK. BMC Health Services Research. https://doi.org/10.1186/1472-6963-8-92
Gonzalez, D., Bienroth, M., Curtis, V., Debenham, M., Jones, S., Pitsi, D., & George, M. (2013). Consensus statement on the use of intramuscular aripiprazole for the rapid control of agitation in bipolar mania and schizophrenia. In Current Medical Research and Opinion. https://doi.org/10.1185/03007995.2013.766591
Gray, J. E., Hastings, T. J., Love, S., & O’Reilly, R. L. (2016). Clinically significant differences among Canadian mental health acts: 2016. In Canadian Journal of Psychiatry. https://doi.org/10.1177/0706743716632524
Hem, M. H., Molewijk, B., & Pedersen, R. (2014). Ethical challenges in connection with the use of coercion: A focus group study of health care personnel in mental health care. BMC Medical Ethics. https://doi.org/10.1186/1472-6939-15-82
Hui, A., Middleton, H., & Völlm, B. (2013). Coercive Measures in Forensic Settings: Findings from the Literature. In International Journal of Forensic Mental Health. https://doi.org/10.1080/14999013.2012.740649
Innes, J., & Sethi, F. (2013). Current rapid tranquillisation documents in the UK: A review of the drugs recommended, their routes of administration and clinical parameters influencing their use. In Journal of Psychiatric Intensive Care. https://doi.org/10.1017/S174264641200026X
Knutzen, M., Bjørkly, S., Eidhammer, G., Lorentzen, S., Mjøsund, N. H., Opjordsmoen, S., Sandvik, L., & Friis, S. (2014). Characteristics of patients frequently subjected to pharmacological and mechanical restraint-A register study in three Norwegian acute psychiatric wards. Psychiatry Research. https://doi.org/10.1016/j.psychres.2013.10.024
Kvale, S. (1996). The Interview Situation. In Interviews: An Introduction to Qualitative Research Interviewing. https://doi.org/10.1037/0022-3514.90.4.644
Landeweer, E. G. M., Abma, T. A., & Widdershoven, G. A. M. (2010). The essence of psychiatric nursing: Redefining nurses’ identity through moral dialogue about reducing the use of coercion and restraint. Advances in Nursing Science. https://doi.org/10.1097/ANS.0b013e3181fb2ef9
Larsen, I. B., & Terkelsen, T. B. (2014). Coercion in a locked psychiatric ward: Perspectives of patients and staff. Nursing Ethics. https://doi.org/10.1177/0969733013503601
Lim, E., Wynaden, D., & Heslop, K. (2017). Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12378
Lind, M., Kaltiala-Heino, R., Suominen, T., Leino-Kilpi, H., & Välimäki, M. (2004). Nurses’ ethical perceptions about coercion. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1111/j.1365-2850.2004.00715.x
M., K., S., B., G., E., S., L., N., H. M., S., O., L., S., & S., F. (2013). Mechanical and pharmacological restraints in acute psychiatric wards-Why and how are they used? In Psychiatry Research.
MacKey, S. (2005). Phenomenological nursing research: Methodological insights derived from Heidegger’s interpretive phenomenology. International Journal of Nursing Studies. https://doi.org/10.1016/j.ijnurstu.2004.06.011
Manen, M. van. (1997). From meaning to method. Qualitative Health Research, 7(3), 345–369.
Mann-Poll, P. S., Smit, A., Van Doeselaar, M., & Hutschemaekers, G. J. M. (2013). Professionals’ attitudes after a seclusion reduction program: Anything changed? Psychiatric Quarterly. https://doi.org/10.1007/s11126-012-9222-6
McCain, M., & Kornegay, K. (2005). Behavioral health restraint: The experience and beliefs of seasoned psychiatric nurses. Journal for Nurses in Staff Development. https://doi.org/10.1097/00124645-200509000-00009
Mott, S., Poole, J., & Kenrick, M. (2005). Physical and chemical restraints in acute care: Their potential impact on the rehabilitation of older people. International Journal of Nursing Practice. https://doi.org/10.1111/j.1440-172X.2005.00510.x
National Consumer and Carer Forum. (2009). Ending seclusion and restraint in Australian mental health services: a position statement by the National Mental Health Consumer & Carer Forum (NMHCCF).
Olofsson, B., & Jacobsson, L. (2001). A plea for respect: Involuntarily hospitalized psychiatric patients’ narratives about being subjected to coercion. Journal of Psychiatric and Mental Health Nursing. https://doi.org/10.1046/j.1365-2850.2001.00404.x
Perkins, E., Prosser, H., Riley, D., & Whittington, R. (2012). Physical restraint in a therapeutic setting; a necessary evil? International Journal of Law and Psychiatry. https://doi.org/10.1016/j.ijlp.2011.11.008
Registered Nurses’ Association of Ontario. (2012). Promoting Safety : Alternative Approaches to the Use of Restraints. Registered Nurses´Association of Ontario, February. http://abinetwork.ca/alternatives-to-restraint-use
Repique, R. J. R. (2014). Cloning in Electronic Mental Health Record: Understanding the Perils and Suggested Safeguards. In Journal of the American Psychiatric Nurses Association (Vol. 20, Issue 4, pp. 268–270). SAGE Publications Inc. https://doi.org/10.1177/1078390314542405
Rose, D., Evans, J., Laker, C., & Wykes, T. (2015). Life in acute mental health settings: Experiences and perceptions of service users and nurses. Epidemiology and Psychiatric Sciences. https://doi.org/10.1017/S2045796013000693
Shattell, M. M., Andes, M., & Thomas, S. P. (2008). How patients and nurses experience the acute care psychiatric environment. Nursing Inquiry. https://doi.org/10.1111/j.1440-1800.2008.00397.x
Sheehan, K. A., & Burns, T. (2011). Perceived coercion and the therapeutic relationship: A neglected association? Psychiatric Services. https://doi.org/10.1176/ps.62.5.pss6205_0471
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Nursing Inquiry, 24(4). https://doi.org/10.1111/nin.12199
Stastny, P. (2000). Involuntary psychiatric interventions: a breach of the Hippocratic oath? Ethical Human Sciences and Services : An International Journal of Critical Inquiry, 2(1), 21–41.
Stewart, D., Robson, D., Chaplin, R., Quirk, A., & Bowers, L. (2012). Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing, 21(6), 540–549. https://doi.org/10.1111/j.1447-0349.2012.00834.x
Streubert, H., & Carperter, D. (2011). Designing Data Generation and Management Strategies. In Qualitative Research in Nursing:Advancing The Humanistic Imperative.
Wilson, C., Rouse, L., Rae, S., & Kar Ray, M. (2017). Is restraint a ‘necessary evil’ in mental health care? Mental health inpatients’ and staff members’ experience of physical restraint. International Journal of Mental Health Nursing. https://doi.org/10.1111/inm.12382
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Published
2020-12-30
How to Cite
Danda, M. (2020). Putting Restraint on Chemical Restraint: Exploring the Complexity of Acute Inpatient Mental Health Nurses’ Experience of Chemical Restraint Interventions. Witness: The Canadian Journal of Critical Nursing Discourse, 2(2), 29–53. https://doi.org/10.25071/2291-5796.75
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