Nurses sound off on eliminating restraint, seclusion

Australia’s mental health nurses want an emboldened approach to reducing or eliminating the use of seclusion or restraint in services.

The call, from the Australian College of Mental Health Nurses (ACMHN), comes with the release of its new research project, funded by the National Mental Health Commission, which explores the clinical factors that stand in the way of achieving a restraint-free environment.

The research examined nurse perceptions of barriers and enablers to eliminating seclusion and restraint use in psychiatric inpatient settings and emergency departments.

Research lead Professor Eimear Muir-Cochrane from Flinders University said inhibiting factors included insufficient resources, inadequate staffing levels and nurses being time poor and having high workloads. “There are also concerns around safety and duty of care,” Muir-Cochrane said.

One nurse who contributed to the study and has worked in mental health for over 40 years said on one occasion a patient affected by drugs picked up a heavy exercise bike and smashed it through the nurses station window. "We had three females on duty and one HSA. You can only imagine the fear," the nurse said. "They retreated and a duress was instigated, but also due to the aggressive patient the police were called and he was initially placed in seclusion and rapid sedation used. He was sedated and transferred to a higher secure unit."

Chief executive of the ACMHN, Adjunct Associate Professor Kim Ryan, said there are inadequate practice development opportunities for staff and limited or no education for families about alternatives. Ryan said other factors hindering a restraint-free environment include conflicts between staff approaches and communication difficulties.

“The improvements needed must include strong clinical leadership, trained and experienced staff, adequate staffing levels, the establishment of constructive staff-consumer rapport and good therapeutic relationships with a focus on trauma-informed, empathic care and team collaboration and cohesion.

“To achieve meaningful reform to reduce and ultimately eliminate seclusion, we need shared ownership of a national approach that reaches beyond mental health services to emergency departments and other health providers, schools, the justice sector and police and ambulance services,” Ryan said.

Nursing Review spoke with Ryan about the ways nurses viewed seclusion and restraint, and approaches to treatment and care that counter their use.

Get the news delivered straight to your inbox

Receive the top stories in our weekly newsletter Sign up now