An attributional study of seclusion and restraint of psychiatric patients
University of Pennsylvania, School of Nursing, Philadelphia 19104-6096. Archives of Psychiatric Nursing
(Impact Factor: 0.85).
05/1994; 8(2):69-77. DOI: 10.1016/0883-9417(94)90036-1
This descriptive study used two attributional frameworks to examine the causes psychiatric inpatients and nurses gave for the seclusion and restraint of patients. Patients were interviewed in restraints. The reasons patients and nurses gave for the patients restraint were recorded verbatim. A nominal system using the recorded responses was developed by two attribution researchers and were also coded along the dimensions of locus, controllability, and stability. The findings supported attribution theory and research in that most patients and nurses gave causes for the patients' restraint. However, the data suggest more research is needed in this area.
Available from: Jyrki Korkeila
- "The recruitment process was explained in nine of the qualitative studies [35-37,8,14,12,41,43,44], and in ten of the quantitative studies [46,10,48-50,13,54-56,15]. In qualitative study recruitment was accomplished by staff (n = 1) and by researcher (n =4) or voluntary participation (n = 4) inviting participants by mail, information sessions or aided by the outpatient staff. Information was missing or imprecise in five of the qualitative studies [7,38-40,42]. "
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Despite improvements in psychiatric inpatient care, patient restrictions in psychiatric hospitals are still in use. Studying perceptions among patients who have been secluded or physically restrained during their hospital stay is challenging. We sought to review the methodological and ethical challenges in qualitative and quantitative studies aiming to describe patients’ perceptions of coercive measures, especially seclusion and physical restraints during their hospital stay.
Systematic mixed studies review was the study method. Studies reporting patients’ perceptions of coercive measures, especially seclusion and physical restraints during hospital stay were included. Methodological issues such as study design, data collection and recruitment process, participants, sampling, patient refusal or non-participation, and ethical issues such as informed consent process, and approval were synthesized systematically. Electronic searches of CINALH, MEDLINE, PsychINFO and The Cochrane Library (1976-2012) were carried out.
Out of 846 initial citations, 32 studies were included, 14 qualitative and 18 quantitative studies. A variety of methodological approaches were used, although descriptive and explorative designs were used in most cases. Data were mainly collected in qualitative studies by interviews (n = 13) or in quantitative studies by self-report questionnaires (n = 12). The recruitment process was explained in 59% (n = 19) of the studies. In most cases convenience sampling was used, yet five studies used randomization. Patient’s refusal or non-participation was reported in 37% (n = 11) of studies. Of all studies, 56% (n = 18) had reported undergone an ethical review process in an official board or committee. Respondents were informed and consent was requested in 69% studies (n = 22).
The use of different study designs made comparison methodologically challenging. The timing of data collection (considering bias and confounding factors) and the reasons for non-participation of eligible participants are likewise methodological challenges, e.g. recommended flow charts could aid the information. Other challenges identified were the recruitment of large and representative samples. Ethical challenges included requesting participants’ informed consent and respecting ethical procedures.
Available from: Marie Crowe
- "In challenging situations , the nurses tended to opt for correctional strategies rather than relational ones. The nature of nursing as a humanistic and caring activity and the requirement to practice physical restraint clearly sets the scene for some personal and ethical conflicts (Fisher 1994; McHugh et al. 1995; Marangos-Frost & Wells 2000; Morales & Duphorne 1995; Outlaw & Lowery 1994). There have been few studies exploring mental health nurses' perceptions of restraint, but there have been some that focus on the broader area of restrictive practices . "
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ABSTRACT: This paper examines mental health nurses' experiences of physical restraint in an acute inpatient psychiatric setting using Van Manen's descriptive hermeneutic phenomenological methodology. The aim was to understand the nurses' experiences of physical restraint. One overarching theme emerged from the analysis: It's part of the job. This theme had a subtheme of Control which was constituted by the Conflicted Nurse and the Scared Nurse. The findings suggest that mental health nurses are very uncomfortable with physical restraint despite it being taken-for-granted as integral to their role. The nurses experienced conflict and fear associated with the procedure and would prefer to utilize other de-escalation skills if it was possible. The main source of conflict related to the imperative to maintain control and the professional values of the therapeutic relationship. While the nurses could see no viable alternative in some situations, the paper concludes that while environmental issues impact on the practice of physical restraint mental health nurses need to practice it with as much care and humanity as possible.
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