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

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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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…

12. Contact Professor Eimear Muir-Cochrane School of Nursing and Midwifery
Flinders University
Adelaide, South Australia