Impact Of Restrictive And Defensive Practices On Mental Health Nursing

Mental health nursing is known to be a skilled profession wherein well-positioned professionals support patients towards their recovery of mental health problems with the help of evidence-based therapeutic interventions (Paradis?Gagné, et al, 2021). Restrictive practices and defensive nursing measures have long been used in mental health care. However, there is a growing recognition of the adverse impact of these measures on clients and staff.  It has been found that the profession of mental health nursing continues to be challenging because of the tensions and worries surrounding the delivery of the restrictive practices along with the concerns over tendencies towards defensive practices (Lawrence, et al, 2022). In addition to this, it has been found that organizational culture which tends to overvalue the metrics as well as administrative tasks tend to create restrictions in the form of barriers for therapeutic engagement while contributing to the role of stress and confusion within the field of nursing (Muir?Cochrane, O’Kane & Oster, 2018). The essay will discuss the restrictive and defensive practices in mental health and alternate management strategies for the containment of aggression and violence in impatient psychiatric settings (Cusack, et al, 2018).

To begin with, restrictive practices are known to be the practices that make people do something that they do not want to do or stop someone from doing something that wants to do especially in mental health settings (Power, Baker & Jackson, 2020).

Each individual in the world adjusts to life’s obstacles in their unique way, however, some individuals are unable to establish coping mechanisms, resulting in mental diseases in the form of a chain of harmful behavioural images. In a broad sense, a mental disorder is defined as the failure to deal with various stressors that are created by the surroundings, either externally or internally. One such failure to cope manifests itself as incommensurate emotions, opinions, as well as behaviours with municipal or societal standards, while also interfering with a person’s ability to operate socially, physiologically, as well as occupationally (Jadhakhan, et al, 2019). Many ways have been established by mental and behavioural science to regulate these damaging behaviours, including medication, restraint, as well as seclusion. The problem here is whether or not seclusion is appropriate from an ethical and legal standpoint. Seclusion is described as the forced confinement of a person in a particular room, known as a contained environment, which has several characteristics focused on a non-stimulating environment, such as being locked, overseen by a window, as well as containing safety measures such as a hole. The psychiatric committee, on either hand, defines seclusion as a space with a shut door that prevents access to the outside world, where a patient is all alone and for a set period (Mangaoil, Cleverley & Peter, 2020)

One of the major restrictive practices used by nurses in mental health settings is seclusion. Restrictive And Defensive Practices In Mental Health Nursing Essay Paper  Seclusion is regarded as the tool which is used by psychiatrists primarily to handle and manage disturbed and aggressive behaviour which is often presumed to be because of the mental disorders of the patients. It has been found that in most parts of the world, there exist guidelines for using the tool of seclusion which is designed to maximize the freedom of the patients as well as protect their liberty while providing a safe environment. Seclusion is often used as a restrictive practice and arguments against the usage of seclusion practice tend to revolve around the deprivation of liberty. Moreover, patients often view seclusion as a bad, forceful experience due to the possibility of exploitation as well as the notion of isolation as a kind of social control. In addition to this, the researchers have stated that although the data is varied in this area, there is no evidence that seclusion produces long-term advantages in terms of alleviating symptoms or lowering hostility (Al-Maraira & Hayajneh, 2019). To lower isolation rates, experts advocate a mixture of national policy, ward administration, and patient-centered interventions. Additionally, it has been found that the practice of seclusion which is a restrictive practice in the mental health settings tends to result in various negative impacts on the patients and hence they must be used as a last resort only (Power, Baker & Jackson, 2020).

Alternate Management Strategies For Containing Aggression And Violence

Another most used restrictive practice in mental health settings is restraint. Restraint refers to the use of pharmacological, mechanical, or physical techniques to impede a patient’s capacity to move freely. It is known to be tightly connected to the deprivation of the freedom of patients. Again, this kind of restrictive practice is used as a defensive measure for addressing the behaviours of patients which could harm or damage them or other people around them. This method or restrictive practice has been in use for more than three centuries according to the researchers (Ye, et al, 2019). However, from the beginning of the 21^st century, such restrictive practices like seclusion and restraint have seen a great decline but still are in use, especially in mental health settings. Moreover, the current main drivers of the use of seclusion and restraint as restrictive and defensive measure practices include the verbal threats of the patients expressing objectives to cause physical damage to the practitioners and the medical professionals or other patients present in those mental health settings (Cusack, et al, 2018).

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Coming to the causes of the restrictive practices like seclusion and restraints then it can include self-harm attempts as well as suicide, property damage, especially in the mental health wards, and elopement intention according to the study of the researchers. Additionally, the majority of the restrictive practices such as restraint and seclusion in mental health settings result in the lack of physical harm, especially to the patients but includes a significant amount of stress. Some of the major emotions or feelings reported by the mental health patients who have gone through such restrictive practices include fear, rage, terror, feeling of being in the upper hands as well as dehumanized (Braun, et al, 2020). Additionally, the health care system of the United States is likely to spend approximately 375 million dollars on an annual basis over the outcomes and the results of containment in mental health facilities including the cases of patient-patient or patient-staff conflicts. As a consequence, it can be stated that the effect of using such restrictive practices and defensive measures by the nurses in the mental health settings is massive and it is of high importance for every medical facility where restraint and seclusion are practices.

As a result, it can be stated that such restrictive practices and defensive measures in the mental health settings lead to violence and aggression in the inpatient psychiatric settings which further leads to violence and aggression. Aggression and violence further lead to severe physical, psychological ad economic negative consequences for the institutions, victims, and society as a whole. Patient-initiated verbal and physical aggressiveness is indeed a long-standing issue for nurses practicing in psychiatric hospitals, according to scientific evidence (Lenk-Adusoo, et al, 2022). From 2015 to 2017, about 88 percent of members of staff at the worksite reported being attacked by mentally ill patients in the admissions wards at a certain point during the delivery of care. It is recommended to the nurses to use educational programs as a preventative strategy in managing violence and aggression rather than just solely relying on restrictive practices and defensive measures such as seclusion and restraints (Haefner, Dunn & McFarland, 2021).

Seclusion As A Restrictive Practice And Its Negative Impact

Furthermore, not only care professionals but also scholars, the press, as well as healthcare organizations routinely emphasize the widespread and worldwide problem of aggressiveness and violence in a healthcare setting. Even though all medical care personnel is in danger of having aggressive encounters with clients as well as their families, researchers have found that physicians are the most common perpetrators of professional physical as well as verbal violence. Violence and aggression towards nursing personnel have been documented across the healthcare industry, not only in psychiatric hospitals but mostly in hospital settings (Slemon, Jenkins & Bungay, 2017). As the Eastern Seaboard Inner City Mental health hospital’s staff employees are frequently exposed to, patient aggressiveness, as well as workplace violence, are big issues. Providing treatment to patients comes with its own set of difficulties, which are exacerbated when they are aimed towards caretakers and thus are life-threatening. Mentally ill patients are, by definition, not of reasonable intelligence, stigmatized, and sometimes violent. Because the caregivers are aware that mentally ill patients may become hostile, they rely primarily on control techniques including restraint, seclusion, and medication to prevent violent attacks (Baker, et al, 2021).

Nevertheless, these measures in particular (restraint as well as seclusion) are dangerous to patients and workers, and must not be used in the DNP environment. Throughout post-event debriefing, several clients at the location revealed that restraint constituted not to be a treatment modality, but rather a punitive strategy that serves as a trigger for unpleasant emotions. Furthermore, in mental health settings, patient and nurse accidents occur throughout the seclusion and restraint procedure. Notwithstanding the use of isolation and restraints, the prevalence of violent assault and hostile incidents at the worksite has increased, indicating that new measures of interventions are required to limit the assaults on on-site workers. Considering the use of seclusion as well as restraint, the high levels of violence in the workplace reflect a lack of competence in the avoidance and treatment of patient hostility (Haefner, Dunn & McFarland, 2021).

Employees shall not be subjected to any sort of risk, particularly one that could be perpetrated by consumers of their services, according to the Universal Declaration of Labour Law. In psychiatry, most nursing professionals believe that the nurse-patient connection is critical to client healing, rehabilitation, as well as adherence to therapy. To ensure the safety of both staff as well as clients, it is critical to train caregivers on violence prevention techniques such as risk evaluation, de-escalation, interpersonal skills, as well as interpersonal interactions. As per studies, in an elevated business, the security of both patients and workers will increase the level of care delivered. Analysts think that RS should be used as little as possible (Andersen, et al, 2017). Under certain circumstances, the use of RS is interpreted as a reluctance to offer adequate treatments. In sequence to decrease the occurrence of Restraints and Seclusion, it is suggested that a mixture of behaviour be used, like the formation of a nationwide policy trying to regulate the utilization of RS, the improved performance of wards in medical facilities, as well as patient-focused intervention strategies, with RS strategies being used only as a final resort. The former can be discovered by a literature study aimed at identifying acceptable EBPs (Haefner, Dunn & McFarland, 2021).

Restraint As A Defensive Practice And Its Decline

Some of the alternative strategies which can be used for restraints in the mental health settings include minimizing the changes in the regular schedules of the patients, advocating regularization of activities, easing the daily living activities for mental health patients, reducing pains as well as feeding regularly can work best. The nurses can also focus on providing the medications to the patients along with educating them regarding the side effects of those medications which can reduce the aggression and the need for restraint. In medical settings, the 6 Fundamental Approaches have been demonstrated to decrease restraint and seclusion.  Such techniques involve an emphasis on management, data-driven practice, youth and family participation, employment services, prevention tool utilization, and reprocessing (Blair, et al, 2017).

Furthermore, a program leader’s goal as well as a role in enacting change, particularly an emphasis on prevention, are critical. First, rules and procedures must be reviewed to build a strategic strategy for preventing and reducing restraint and seclusion. Teaching de-escalation skills to calm as well as support teenagers in crisis is beneficial, as it avoids the usage of physical interventions. Seclusion Restraint and/or restraint are only used as a final resort after a regular evaluation of incidences of restraint and/or seclusion confirms that fewer restrictive options are explored (Gooding, McSherry & Roper, 2020). Furthermore, Staff can be motivated by praising progress and promoting positive behaviours as well as adjustments. Clinical reviews for kids who have been subjected to many restrictive measures should provide non-judgmental and helpful input to staff to develop methods to prevent and avoid such events throughout the long term. This also aids in identifying staff training requirements to improve outcomes (Duxbury, et al, 2019).

Conclusion

From the above essay, it can be concluded that restrictive practices and defensive nursing measures have long been used in mental health care. However, there is a growing recognition of the adverse impact of these measures on clients and staff. Patients in the mental health hospital experience restrictive practice such as seclusion and restraints which makes people do something that they do not want to do or stop someone from doing something that wants to do especially in the mental health settings. Hence, there are many adverse effects faced by those psychiatric patients such as deleterious psychological or physical consequences. Not only this but restrictive practices and defensive measures in the mental health settings leads to violence and aggression in the inpatient psychiatric settings which further leads to violence and aggression. Aggression and violence further lead to severe physical, psychological ad economic negative consequences for the institutions, victims, and society as a whole. It was observed that such practices are important to be reduced with the help of various strategies. Strategies that can work in reducing such practices include an emphasis on management, data-driven practice, youth and family participation, employment services, prevention tool utilization, and reprocessing.

References

Al-Maraira, O. A., & Hayajneh, F. A. (2019). Use of restraint and seclusion in psychiatric settings: A literature review. Journal of Psychosocial Nursing and Mental Health Services, 57(4), 32-39.

Causes And Effects Of Restrictive Practices In Mental Health Settings

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Blair, E. W., Woolley, S., Szarek, B. L., Mucha, T. F., Dutka, O., Schwartz, H. I., … & Goethe, J. W. (2017). Reduction of seclusion and restraint in an inpatient psychiatric setting: a pilot study. Psychiatric Quarterly, 88(1), 1-7.

Braun, M. T., Adams, N. B., O’Grady, C. E., Miller, D. L., & Bystrynski, J. (2020). An exploration of youth physically restrained in mental health residential treatment centers. Children and Youth Services Review, 110, 104826.

Cusack, P., Cusack, F. P., McAndrew, S., McKeown, M., & Duxbury, J. (2018). An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International journal of mental health nursing, 27(3), 1162-1176.

Duxbury, J., Baker, J., Downe, S., Jones, F., Greenwood, P., Thygesen, H., … & Whittington, R. (2019). Minimising the use of physical restraint in acute mental health services: The outcome of a restraint reduction programme (‘REsTRAIN YOURSELF’). International Journal of Nursing Studies, 95, 40-48.

Gooding, P., McSherry, B., & Roper, C. (2020). Preventing and reducing ‘coercion’in mental health services: an international scoping review of English?language studies. Acta Psychiatrica Scandinavica, 142(1), 27-39.

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Jadhakhan, F., Lindner, O. C., Blakemore, A., & Guthrie, E. (2019). Prevalence of common mental health disorders in adults who are high or costly users of healthcare services: protocol for a systematic review and meta-analysis. BMJ open, 9(9), e028295.

Lawrence, D., Bagshaw, R., Stubbings, D., & Watt, A. (2022). Restrictive practices in adult secure mental health services: a scoping review. International Journal of Forensic Mental Health, 21(1), 68-88.

Lenk-Adusoo, M., Hürden, L., Tohvre, R., Tretjakov, I., Evert, L., & Haring, L. (2022). Healthcare professionals’ and patients’ attitudes toward the causes and management of aggression in Estonian psychiatric clinics: a quantitative cross-sectional comparative study. Journal of mental health, 1-10.

Mangaoil, R. A., Cleverley, K., & Peter, E. (2020). Immediate staff debriefing following seclusion or restraint use in inpatient mental health settings: a scoping review. Clinical Nursing Research, 29(7), 479-495.

Muir?Cochrane, E., O’Kane, D., & Oster, C. (2018). Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint. International journal of mental health nursing, 27(5), 1511-1521.

Paradis?Gagné, E., Pariseau?Legault, P., Goulet, M. H., Jacob, J. D., & Lessard?Deschênes, C. (2021). Coercion in psychiatric and mental health nursing: A conceptual analysis. International journal of mental health nursing, 30(3), 590-609.

Power, T., Baker, A., & Jackson, D. (2020). ‘Only ever as a last resort’: Mental health nurses’ experiences of restrictive practices. International Journal of Mental Health Nursing, 29(4), 674-684.  Restrictive And Defensive Practices In Mental Health Nursing Essay Paper