Wilson et al-2018-Journal of Psychiatric and Mental Health Nursing
This peer‑reviewed article reports a qualitative strand of the UK PROMISE project that explored how adult mental health in‑patients and ward staff think physical restraint could be reduced on acute psychiatric wards. Semi‑structured one‑to‑one interviews were conducted with 13 current or former patients (aged 18‑65) and 22 staff members (nurses, healthcare assistants, occupational therapists, managers) who had lived experience of being restrained, witnessing restraint, or applying restraint. Thematic analysis (Braun & Clarke) identified four overarching suggestion themes: (1) improving communication and relationships – getting to know patients, informing and explaining care, showing compassion and empathy, and spending more time with patients; (2) staffing factors – increasing staff numbers and time, learning from experienced staff, and developing staff skills through training and mentorship; (3) ward environment and space – creating specific de‑escalation or activity rooms, improving the physical/aesthetic ambience, and addressing practical constraints such as line‑of‑sight and cleaning requirements; (4) activities and distraction – providing individual one‑to‑one and group activities that are meaningful, stimulating and tailored to patient interests. Across these themes participants also highlighted feasibility barriers, chiefly a lack of time, chronic understaffing, high staff turnover, limited financial resources, and organisational hurdles that impede environmental changes. The authors compare the suggestions to existing restraint‑reduction interventions, notably the Safewards model, noting partial overlap (e.g., “Know each other”, “Soft words”) but also gaps (e.g., staffing levels, environmental modifications). The paper concludes that while many practical ideas exist, systemic issues must be addressed before such suggestions can be implemented, and further research should focus on feasibility and practical integration of restraint‑reduction strategies in mental health care.
Topics
Communication & Relationships: Knowing, Explaining, Empathy, and Time
Participants emphasized that staff should get to know each patient’s triggers, background, and preferences; clearly explain rights, care plans, and medication; communicate with compassion and empathy; and spend more time on the ward to build therapeutic relationships.
Staffing Factors: Numbers, Experience, Skill Development, and Training
Suggestions focused on increasing staff head‑count and allocated time, leveraging experienced staff to mentor newcomers, and providing targeted training (de‑escalation, confidence building, spirituality, patient‑perspective) to develop a skilled workforce capable of preventing restraint.
Ward Environment & Space: Dedicated Rooms, Aesthetic Improvements, and Practical Constraints
Ideas included creating specific de‑escalation or sensory rooms, art/music spaces, and improving lighting, colour, and sound‑proofing, while acknowledging barriers such as line‑of‑sight requirements, cleaning standards, and costly procurement processes.
Activities & Distraction: Individual, Group, and Meaningful Engagement
Both groups advocated for a richer activity programme—one‑to‑one hobbies, exercise, music, arts, cooking, and structured group sessions—to occupy patients, reduce boredom, and provide therapeutic distraction.
Methodological Approach: Qualitative Interviews within the PROMISE Project
The study employed semi‑structured interviews with 13 patients and 22 staff, grounded in a realist epistemology, and analysed using Braun & Clarke’s thematic analysis, adhering to COREQ reporting standards.
Implementation Barriers: Time, Resources, Understaffing, and Organisational Hurdles
Across all suggestion themes participants highlighted systemic constraints—insufficient staff time, chronic understaffing, high turnover, limited budgets, and bureaucratic delays—that impede the feasibility of proposed changes.
Implications for Practice & Policy: Alignment with Safewards and Need for Systemic Change
The authors map participant suggestions onto existing interventions (e.g., Safewards) noting partial coverage, and argue that broader organisational reforms (staffing, environment, resources) are prerequisite for successful restraint‑reduction implementation.
Limitations & Scope: Generalisability and Population Coverage
The study acknowledges that findings are limited to adult acute wards in one NHS Trust, excluding child/adolescent, older‑person, learning‑disability, and eating‑disorder settings, which may affect transferability.