Evidence-based practice (EBP) lays the foundation for improvement in patient care through the application of research findings in care delivery. Among the most controversial and often misunderstood practices is mental care for patients is physical restraint. Hence research into the risks involved for patients and staff in using physical restraint will improve the understanding of the practice and help in creating improvement. This research will be guided by the PICOT question, on an acute psychiatric unit (P), what are the risks of physically restraining patients (I) for prevention of aggression (O) compared to nonphysical methods (C) during the time in restraints (T)? Hence, this research identifies the risks involved in physically restraining mentally ill patients and creates a comparison with other non-physical methods.
Previous research on the use of physical restraints on mentally ill patients yielded multiple results. Criticism for the techniques majors mainly on the use of violence by the nurses and lack of consent from the patient (Fereidooni, Fallahi, Khoshknab & Pazargadi, 2014). Use of restraints introduces an ethical dilemma where restraints are known to cause physical harm and distress to patients while at the same time protecting staff from harm (Junrong, et al. 2018). However, healthcare facilities continue to apply the practice due to staffing shortages and lack of alternatives in their situations.
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Two research approaches are viable for this study; qualitative and quantitative approach. By assessing two research articles on a related topic, it is possible to select the most suitable approach for the study. A qualitative approach provides deeper insights into the research topic but is subject to author bias. A quantitative approach, on the other hand, relies on the ability of the researcher to select the best sampling and data analysis techniques. Qualitative research is better applicable in this case since it subjects the data collected to testing that facilitates informed conclusions.
Introduction: Research Problem
Improvement in patient care, especially in mental health facilities relies on the ability of the care provider to apply Evidence-based practice (EBP) in their activities. Research is therefore crucial in developing techniques and procedure that improve patient outcomes in mental health facilities. Physical restraint for mentally ill patients poses risks to both the caregiver and the patients. Hence, the purpose of this research is to identify risks that physical restraint causes to staff and patients in an inpatient unit. Currently, there is lack of consensus among stakeholders on whether the practice should be eliminated in delivering care to mentally ill patients or the practice should continue considering the staffing issues faced by a majority of these facilities. This research will be guided by the following PICOT question, on an acute psychiatric unit (P), what are the risks of physically restraining patients (I) for prevention of aggression (O) compared to nonphysical methods (C) during the time in restraints (T)? Research variables are derived from the PICOT questions. Hence, the variables for the study include mental disorders in patients, the use of physical restraint and comparison between physical and non-physical methods of restraint.
Focus on mental health care in this study is informed by the unique challenges encountered by caregivers in delivery care to mentally ill patients in inpatient units. These challenges include stigma directed towards patients in societal settings, limit research on mental health and lack of government support as compared to other illnesses. Consequently, facilities offering mental health care have resource constraints resulting in the application of care methods that may not seem convenient for patients and staff. A comparison of the risks in physically restraining patients as compared to other non-physical means will provide a deeper understanding of the technique and improve patient outcomes with the application of the method. The raging debate on whether physical restraints can be reduced or eliminated in inpatient psychiatric wards without increasing the risk of harm to staff will also be addressed in this research. Developing evidence-based methods of improving care delivery to mentally ill patients is critical in bridging the gap between mental healthcare and care delivery to patients with other illnesses (Chow & Priebe, 2013).
The PICOT system of research provides a working framework that guides the research process. By adhering to the elements of the PICOT question, the researcher is able to meet the objectives of the study through a critical analysis of all the elements. Derailment in the process of research is a common occurrence while conducting studies. The PICOT system guards against such cases by limiting the researcher to the requirements of the research question. By remaining within the scope of the study, the researcher is able to adhere to time and also utilize data that is relevant to the research topic. In this case, it is crucial that the research answers the research questions with regard to the risks in using physical restrains in inpatients units of mental healthcare and provides a comprehensive comparison of physical versus non-physical methods.
Literature Review
This literature review explores the existing research with regard to the use of physical constraints in psychiatric healthcare units (Polit & Beck, 2017). Literature relevant to the research topic identifies the risks in physically restraining mentally ill patients and methods of preventing aggression towards staff. In a study to assess the perceptions of psychiatric nurses towards the use of physical restraints, Fereidooni, Fallahi, Khoshknab & Pazargadi (2014) found that nurses viewed the technique as challenging since they were often required to use force. The staff in these settings were in consensus that restraints improved patient access to pharmaceutical interventions and eased the treatment process. They were however presented with the dilemma of either applying the method without the patient's consent of considering other alternatives. Incidentally, the use of physical restraints increased the chances of injury to nurses as they used force to administer medication to patients (Fereidooni, Fallahi, Khoshkna & Pazargadi, 2014). Owing to the issues in staffing, nurses continued to use physical restraints in psychiatric wards to ease the care delivery process.
Junrong et al. (2018) explore the controversies surrounding the use of physical restraints in inpatients psychiatric wards. Owing to the adverse effects of the practice to patients, a lot of criticism is directed towards its use. However, due to limited staff and underdeveloped resources in mental healthcare, caregivers are forced to apply the controversial method. Maximizing the benefits of the practice and ensuring consent before its use is among the mitigating measures that mental health facilities are adopting (Junrong et al. 2018). An assessment of the risks associated with physical restraints found that there is a 25% increased risks of injury when restraints are used (Moyo & Robinson, 2012). Lack of proper coordination during the restraining process is among the leading causes of injury. Seemingly, mental health facilities will continue to apply the practice, hence the need for proper training for staff on risk management and prevention of aggressive behavior in patients (Moyo & Robinson, 2012).
Another study highlighted the need for risk management strategies in providing care to mentally ill patients (Slemon, Jenkins & Bungay, 2017). Current perspectives and practices do not accord adequate focus to techniques that help staff as well as patients to avoid injuries. Seclusion of patients, locking of doors and defensive nurses practices are prevalent but have proven ineffective in guaranteeing safety for staff. While safety to staff is a priority, patient safety is also critical hence a review of the current practices must aim to cover actual and potential risks (Slemon, Jenkins & Bungay, 2017). Restrain use must fulfill the ethical and safety requirements in psychiatric settings. Implying that caregivers must obtain consent from the patients and ensure that the patients are calm before applying physical constraints (Lanthen, Rask & Sunnqivst, 2015). The physical presence of the caregiver even after application of the constraint enhances patient safety by reducing the risk involved. Ultimately, staff training is pivotal to the application of physical constraint practices.
Analysis of Quantitative and Qualitative Research Approaches
Two research approaches are viable for this study; qualitative and quantitative approach. By assessing two research articles on a related topic, it is possible to select the most suitable approach for the study. The qualitative article, ‘Reducing the Stigma of Mental Illness: Current Approaches and Future Directions’ by Casados (2017) explore the currently applicable and future techniques of eliminating stigma directed towards mentally ill patients. Information deficiency in the public is a contributing factor towards the prejudice towards mental illness. Research gaps also exist in understanding mental illness mainly due to the application of limited variables and poor selection of research methodologies (Casados, 2017). The quantitative article, ‘Reducing Mental Illness Stigma: Effectiveness of Hearing about the Normative Experiences of others’ by Hackler, Cornish & Vogel (2016) sought to determine whether the elimination of stigma through separation from family and friend is an effective intervention in treating mental illness. The authors performed a randomized trial for patients with results revealing that stigma reduction has a positive impact on the recovery process. A critique of the two articles aids in shaping the decision on the best approach for this research.
Critique of the Qualitative Research Article
The author relies on existing data on stigma reduction in cases of mental illness to further his research on the challenges encountered in overcoming stigma directed towards mentally ill patients. By utilizing literature relevant to the research topic, the reader develops a wider perspective of the issue and approaches the next parts of the research with this enhanced knowledge. The design of this research facilitates the exploration of various literature on stigmatization before making conclusions. Evidently, reduction of contact can help in eliminating the negative effects of stigma although further research on behavioral contribution is necessary.
Critique of the Quantitative Study
The researcher sought to ascertain whether indirect contact with friends and family members impact on the effects of stigma on the mentally ill patient. Through a review of existing literature, the reader is able to develop a greater understanding of the topic with regard to contact and stigma towards mental health patients. In a randomized trial involving psychology college students, the researchers assessed the willingness of the students to interact with mentally ill individuals. The limitation of this technique is that the study was not fully randomized. The findings, however, provide useful insights into the impact of stigmatization in assessing cases of mental illness.
Selection of the Best Approach
Both qualitative and quantitative approaches are applicable to the research topic on the risks involved in physically restraining mentally ill patients. Depending on the above assessment, it is apparent that a qualitative study more viable since the approach allows for identification of weaknesses in previous studies and development of a strategy that not only addresses the research topic but also allows for comparison with other non-physical methods of restraint hence fulfilling the purpose of the study.
References
Casados, A. (2017). Reducing the s tigma of m ental i llness: Current a pproaches and f uture d irections . Clinical Psychology: Science and Practice , 24 (3), 306-323. Retrieved from the Walden Library databases.
Chow, W. S., & Priebe, S. (2013). Understanding psychiatric institutionalization: a conceptual review. BMC Psychiatry, 13 (1), 1–14. https://doi.org/10.1186/1471-244X-13-169
Fereidooni M, M., Fallahi Khoshknab, M., & Pazargadi, M. (2014). Psychiatric n urses’ p erceptions about p hysical r estraint; A q ualitative s tudy. International Journal of Community-based Nursing and Midwifery, 2 (1), 20-30.
Fouka, G., & Mantzorou, M. (2011). What are the major ethical issues in conducting research? Is there a conflict between the research ethics and the nature of nursing? Health Science
Journal, 5 (1), 3–14.
Hackler, A. H., Cornish, M., & Vogel, D. (2016). Reducing m ental i llness s tigma: Effectiveness of h earing about the n ormative e xperiences of others. Stigma and Health , 1 (3), 201-205.
Retrieved from the Walden Library databases.
Junrong, Y., Axiang , X., Lin, Y., Hongmei, W., Chen, W., & Tianyun, L. (2018). Physical r estraints: An e thical d ilemma in m ental h ealth s ervices in China. International Journal of Nursing Science, 5 (1), 68-71.
Lanthen, K., Rask, M., & Sunnqivst, C. (2015). P sychiatric p atients e xperiences with m echanical r estraints: An i nterview st udy. Psychiatry Journal, 2015 , 1-8 p
Moyo, N., & Robinson, P. (2012). The s afety of n urses d uring the r estraining of a ggressive p atients in an a cute p sychiatric u nit. Australian Journal of Advanced Nursing, 29 (3), 5-13.
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer.
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in Psychiatric Inpatient Care: The Impact of Risk Management Culture on Mental Health Nursing Practice. Nursing Inquiry, 24 (4), e12199.
