1. Nurses Experiences of Control & Restraint in an Acute Mental Health Setting By Tiziana Portelli

2. Introduction The overall purpose of this study was to explore nurses’ experiences of control & restraint in an acute mental health setting. Reasons for choosing this topic: Various researchers report that incidents of violence and threats of violence have shown a considerable increase over the last few years. Increased number of staff injuries whilst restraining patients. Personal interest.

3. Aims & Objectives … Develop a clear picture of how many nurses had any form of training; Establish the understanding that nurses have about C & R; Establish when & how C & R should be used; Establish knowledge of alternatives.

4. Literature Review To identify from the literature: A definition of control & restraint When to use it Managing the process Alternatives Published research regarding nurses views & experiences

5. Definition of control & restraint Definitions lack consistency within the literature. (Johnson, 1998) It is an intervention it involves a designated system of techniques. (Anderson et al., 1999) Control & restraint interventions are a common method for managing a range of clinical situations. (Steel, 2000)

6. Methodology Purposive, mixed method, correlational design; Population – qualified nurses in acute psychiatric setting; Sample – all acute wards; Self designed structured questionnaire; Data analysis – numerical and thematic.

7. Findings demographic data training control & restraint & other techniques control & restraint & injuries post procedures

8. Findings … Demographics of sample … n = 56 fairly evenly distributed sample majority were staff nurses 10 of these were RMN’s Majority had over 6 years service

9. Develop a clear picture of how many nurses had a form of training Most participants had no training Those that did, received it after they were already working in acute wards This could be because a large number of nurses are general trained Also could be related to lack of resources There is no hospital policy indicating training as a requirement

10. Establish the understanding that nurses have about C & R Nurses clearly understood the importance and need for training This may be because of their experiences and their knowledge that there is a high tendency for patients to become violent & aggressive A high % felt anxious and lacked knowledge in several key areas

11. Establish when & how C & R should be used Participants did not have a clear understanding of what it is and when and how it should be used; Nurses lack de-escalation skills; Physical restraint is the first choice in nearly all situations; Staff regularly incur injuries during C&R

12. Establish knowledge of alternatives Nurses had neither knowledge nor training on alternatives Local mentality may be significant Nurses may lack confidence to use other approaches.

13. MAIN CONCLUSION …. … there is an overwhelming lack of knowledge and training concerning control and restraint amongst nurses working in acute wards within the hospital where this research was conducted. This fact might then result in the frequent and inappropriate use of control and restraint techniques being applied to patients.

14. Limitations of the study Results can’t be generalised Few psychiatric nurse participants Small scale study A number of participants' did not comment

15. Strengths of study Good response rate Good representation of nurses grade, experience etc Use of questionnaires proved beneficial.

16. Recommendations Clinical practice Education Management Further research

17. References … Johnson, M.E. (1998) Being restrained: a study of power and powerlessness. Issues in Mental Health Nursing. 19:191-206 Anderson, L, N., Minarik, P, A., Dilmorth, J, M., Jones, J., Nash, K, P.,O’ Donell, K, P., & Steinmiller,E, A.(1999). Responding to difficult patients. American Journal of Nursing, 99(12), 26-32 Steel, E.(2000). Seclusion and restraint practice standards: a review and analysis.Retrieved October5,2011, from http://www.ncstac.org/index.php?option=com_contentandview=article andid=94%3Asecl

18. Thank you for your attention.