Using restraint with restraint! Professor Eimear Muir-Cochrane Professor of Nursing Chair of Nursing (Mental Health)

Context of restraint in health care Long and chequered history Physical Environmental Emotional Ethical issues Legal issues Humanitarian issues

Definitions of chemical restraint Involuntary administration Psychotropic medications Intramuscular or intravenous mode Emergency context Last resort after other options considered Minimal dose with maximum effect

Working definition in Australia Chemical restraint is the administration of medication in an emergency situation and on an involuntary basis to control the behaviour of a person to prevent them from harming themselves of others. It includes circumstances where sedation is provided t ensure safe transport of the person to or between health care settings

Aims of the research Explore a broad range of stakeholders perspectives and understandings bout chemical restraint Examine their reflections on the draft definition of chemical restraint Expand the evidence base of the use of chemical restraint

Research methods 28 participants 6 states and territories in Australia Interviews, focus groups and online surveys Nurses, psychiatrists, consumers, carers, peer support workers, government and nongovernment officials, advocates, educators, researchers and managers 28 participants 6 states and territories in Australia 10 months in 2015

Response to the definition What is an emergency? PRN as ‘coerced’ medication Chemical restraint as a behavioural control Chemical restraint use in ambulances Sedation versus treatment issues

Reasons for the use of chemical restraint Overcrowding Lack of beds Lack of appropriate resources Poor environment Lack of knowledge of the person Lack of time Lack of adequately trained staff Lack of education

Experiences of chemical restraint Feeling punished Lack of collaboration Not used as a last resort Physical and emotional assault Not in consumers’ best interest Risk based treatment not individualised

Where to from here? ‘Acute injectables’ Involvement of consumer carer groups in ongoing debates about restraint Individualised care planning required All patients have complex needs Coordinated response between services (ED. Ambulance Psych units) ‘Acute injectables’ Use of clinical guidelines about medication protocols Need for further research…

Contact Professor Eimear Muir-Cochrane School of Nursing and Midwifery Flinders University Adelaide, South Australia Eimear.muircochrane@flinders.edu.au www.flinders.edu.au/nursing/mhc