The use of seclusion and restraint remain a significant concern for health professionals in acute psychiatric units in maintaining safety when patients are harming themselves or other people.
Restrictive measures are to be used only as a last resort but often there are no other readily available measure which staff can utilise to main safety for all concerned. Although it is the ideal for nurses and doctors to make decisions jointly regarding the use of restraint practices, decisions are often made solely by nursing staff due to the emergency nature of aggressive incidents and restraint practices happening out of normal business hours when medical staff are not present on the unit.
In other situations, medical staff may instruct nursing staff on the use of specific restrictive practices rather than collaborate. I believe that are many more opportunities for medical and nursing staff to work together than currently utilised, in providing care that is least restrictive.
Yet, there remain significant barriers to the implementation of practices to reduce restrictive practices across Australia. Ward design and overcrowding in acute psychiatric units, poor leadership, inadequate or non-existent training and shortage of adequately trained staff, both from medical and nursing professional groups all collude to prevent acute psychiatric inpatient units from being therapeutic, calm places for consumers to heal.
It is time for medical and nursing staff to confer on a shift by shift, day by day, week by week basis to unpack all restraint events, examine the precursors to consumers being secluded and restrained and to identify close collaborative practices that involve consumers to improve the experience of care and reduce restrictive practices.
We can do it, but it takes courage and humility to work together and accept differing points of view!