KNOWLEDGE AND PERCEPTION OF NURSES ON THE USE OF RESTRAINTS AT ACCRA PSYCHIATRIC HOSPITAL

ABSTRACT

The purpose of this study was to examine the knowledge and perception of mental health nurses on the use of restraint methods among mentally ill. Although there are different restraints used in other areas of health, the primary focus was on the use of seclusion, mechanical restraints, and involuntary medication.

A non- experimental descriptive cross-sectional research design was used. Stratified random sampling and then simple random sampling were used to select 108 participants from 8 wards. A researcher-developed pretested instrument was used in the data collection. Approval from the Institutional Review Board of the University of Cape Coast and informed consent were sought from the participants before the commencement of the study.

Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 22, descriptive statistics cross-tabulation a chi-square test was also used. Chi square test indicated that there were no significant difference in knowledge and use of restraint between nurses on the acute wards and chronic wards.

In conclusion majority (65%) of participants indicated to often rely on restraints method to reduce aggression on the wards. 69.4% commonly used seclusion as compared to other forms of restraints. Some reasons for application of restraints as indicated by participants were restraints is used for the safety of the patients staff and significant others. It was also identified that there were no significant difference in the knowledge and use of restraints between nurses on the acute and chronic wards.

CHAPTER ONE

INTRODUCTION

This chapter introduces the research study on the knowledge and perception of nurses on the use of restraints among mentally ill patients. This chapter includes the background of the study, problem statement, purpose of the study, objectives, research questions, significance, delimitations, limitations and operational definitions.

Background

Mental health problems are an international and national concern. More than 27% of adult Europeans were estimated to experience at least one form of mental ill health during any one year (Wittchen & Jacob, 2005). The increased demands in mental health care services have caused stress and pressure among mental health care personnel (nurses) (Xianyu & Lambert, 2006). Despite the development of out-patient psychiatric care, a number of patients need in-patient psychiatric care due to the nature of mental illness; a patient may be a danger to him or herself or to other people (Salize & Dressing, 2004). These patients may also be hospitalized against their will and their right to self-determination may be restricted or they may be subjected to restraints during the interventions period (Tuohimäki, Kaltiala-Heino, Välimäki & Touri, 2004). Restraints include seclusion, physical or mechanical restraint and forced or involuntary medication, restrictions on movement inside or outside the hospital ward. (Tuohimäki, Kaltiala-Heino, Välimäki & Touri, 2004) These are ethically sensitive interventions violating human rights and dignity during psychiatric hospital stays. At the same time, evidence of effectiveness of restraint use in managing patient aggressive behavior (Wright, 2003) or serious mental disorders (Sailas & Fenton, 2000; Sailas & Wahlbeck, 2005) is still missing. There is accordingly a growing need for ethical discussion of the use of restraints and patient violence and aggression in psychiatric care in Europe (Marangos-Frost, 2000; Kuosmanen, 2006; Olofsson & Nordberg, 2005). However, a lack of structured and evidence-based good practices, inadequate knowledge and lack of guidelines increase pressures and ethical dilemmas among nurses (Marangos-Frost, 2000; Kuosmanen, 2006; Olofsson & Nordberg, 2005).

Mental health care (MHC) can be said to be a link between care and control (Norvoll, 2007; Vatne, 2003). Restraint uses are seen in both the delivery of interventions and in the handling of aggressive and violent behavior during hospitalization. Individual freedom and integrity are fundamental values of the western world. The United Nations Universal Declaration of Human Rights was proclaimed in 1948; Article 1 stated “all human beings are born free and equal in dignity and rights. They are endowed with reason and conscience and should act toward one another in a spirit of brotherhood” (United Nations Universal Declaration of Human Right, 1948, p. 54). This emphasis on the individual human rights has also influenced health services. In the last decades there have heightened focus on service users rights, empowerment and participation (Helgesson & Sjorstrand, 2008; Lewis, 2009). The theme is currently of interest and there has been a recurring debate in the media, within service user’s organization and among mental health professionals, about the use of restraints in mental health care (Cutcliffe & Hannigan, 2002; Hoyer, Janbu & Kallert, 2008). In 2006, the Norwegian Health politicians launched a National Health plan to ensure quality and reduce the use of restraints in MHC (Sosial-og Helsedirektolrelet, 2006). However, patients claim their fundamental human rights are violated in the traditional-medical oriented mental health care (Thune, 2008). This therefore stresses the need to understand the process of restraint use. There are consistent findings about differences between relatively comparable wards, hospitals and geographical areas in the amount and types of restraints use (Salize & Dressing, 2004).

According to the World Psychiatry Association (2002), involuntary interventions should be used in the patient’s best interest. The frequency with which involuntary interventions is required varies among countries. According to findings involuntary interventions is not entirely dependent on patient symptoms or behaviors (World Psychiatry Association, 2002). The use of seclusion, mechanical restraints and involuntary medication must be strictly prescribed by the doctor. It is left to the discretion of medical and nursing staff to choose the type of strategy to implement. While the use of each restraint methods in some cases may prevent injury and reduce patients’ agitation, the use of the restraint method may constitute an infringement of the patients’ autonomy, it may worsen the therapeutic relationship and increase the occurrence of violent episodes and physical injuries (Schwatrz, Vingiano & Perez, 2000).

Globally, 450 million people suffer from mental health problems with 1 in 4 having experienced mental health services at some point in their life (Healthcare Commission, 2007). At the World health organization (WHO) European Ministerial Conference on Mental Health (2005), emphasis was given to the promotion of voluntary admission and interventions as the basis of services and involuntary interventions being the exception. Common forms of restraints used during in-patient interventions include seclusion and mechanical restraints, and forced or involuntary medication (Healthcare Commission, 2007).

Problem Statement

The use of involuntary medication, mechanical restraint and seclusion as restraint methods, are used to prevent injury when dealing with patients who become aggressive. Most literature talks about the patients’ feelings towards the use of restraints rather than the personnel or service provider who implements these interventions (Lewman, 2000). McCue (2004) stated that the use of involuntary medication, mechanical restraint and seclusion are acknowledged as being one of the most controversial practices used in the mental health service delivery worldwide. He also reported that the interventions stimulate an on-going debate and ethical dilemma among service providers especially nurses. Theories on how to help those who struggle with emotional problem have been developed that emphasizes people resources, network, empowerment and participation (Baybrook, 2003). Restraint as an intervention is still used worldwide. The continuous use of restraints stresses the need to understand more about the process of these interventions and it’s use as a whole (Thune, 2008).

The Royal College of Psychiatrists’ National Audit of Violence (n.d.) found that 36% of inpatients reported that they have been personally attacked, threqatened, or made to feel unsafe while in hospital. This figure increased to 41% for clinical staff and 77% for nursing staff. Eighteen (18%) of visitors to the units reported that they have been personally attacked, threatened, or made to feel unsafe (Royal College of Psychiatrists’ National Audit of Violence (n.d.). Seclusion is one of a few restraint measures used to control these violent patient behaviors (Mason & Whitehead, 2001; & Parks, 2003). In Ghana, the use of involuntary medication, mechanical restraints and seclusion are allowed in the cases of emergency, where non-forceful interventions have been used unsuccessfully. According to the Mental Health Act, (2012) of Ghana, the use of restraints is also allowed in the situation where the client is admitted based on a court order.

There were inadequate published documents in Ghana on the knowledge of nurses, in the use of involuntary medication, mechanical restraints and seclusion. Though there were inadequate published studies, there have been individual comments in the daily newspapers and journals with regards to the care delivered at the mental health facilities, mostly with reference to the use of restraints on the mentally ill (Basic needs, 2012). Individuals have reported use of restraints in prayer camps and herbal centers. There are no reports on the knowledge and perception of nurses on the use of restraints.

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Item Type: Ghanaian Topic  |  Size: 124 pages  |  Chapters: 1-5

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