Promoting positive and safe care in forensic mental health inpatient settings: Evaluating critical factors that assist nurses to reduce the use of restrictive practices.

Authors:
Lesley Barr
Lesley Barr
Curtin University
Forensic mental health nursing
Perth , Western Australia | Australia

Int J Ment Health Nurs 2019 Aug 27;28(4):888-898. Epub 2019 Mar 27.

Curtin University (Nursing & Midwifery), Perth, Western Australia, Australia.

Reducing and eliminating the use of restrictive practices, such as seclusion and restraint, is a national priority for Australia's mental health services. Whilst legislation, organization and practice changes have all contributed to a reduction in these practices, forensic mental health services continue to report high rates. This paper details the findings of research that examined the experiences of nurses working in the inpatient forensic mental health setting. The research aimed to (i) document the experiences of nurses working in the forensic mental health setting, (ii) articulate their perceived unique skill set to manage challenging patient behaviours, and (iii) determine how their experiences and skill set can inform practice changes to reduce the use of restrictive practices. Thirty-two nurses were recruited from one Australian forensic mental health service. Data were collected using semi-structured interviews and analysed using inductive content analysis. Four categories were identified that influenced practice experiences: (i) working in a challenging but interesting environment, (ii) specialty expertize, (iii) exposure to aggression and resilience as a protective factor, and (iv) the importance of effective teamwork and leadership. Forensic mental health care is complex, highly specialized, and often delivered in an unpredictable environment. Whilst high rates of restrictive practices may be linked to the unique characteristics of forensic patients, training, teamwork, and leadership are critical factors influencing their use in this setting. Nurses working in this area need to be educated and supported to work confidently and safely with this high-risk patient cohort.

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Source
https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12588
Publisher Site
http://dx.doi.org/10.1111/inm.12588DOI Listing
August 2019
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References

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Commonwealth Department of Health and Ageing et al.
2013

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