How do psychiatric healthcare workers prevent the use of restraint and seclusion?

The purpose of this grounded theory method study was to understand the complex, interactive, and interrelated processes that psychiatric healthcare workers engage in to prevent the use of restraint and seclusion. Without supporting evidence of therapeutic validity, restraint and seclusion are commonly used by psychiatric healthcare workers to control disruptive patients. The Substance Abuse and Mental Health Services Administration issued a call for the elimination of restraint and seclusion use in psychiatric care settings in 2003. Workplace violence, another major public health concern, is both a cause and effect of the restraint and seclusion use. Individuals continue to be needlessly injured due to the use of these practices. Understanding the restraint and seclusion prevention processes, within the changing political and social contexts of mental healthcare policy, is an important focus for organizations striving to improve the quality of psychiatric care and patients’ experiences of such care. Grounded theory methodology centers on how views and actions are constructed, and focus on how these processes occur. Data obtained from 21 interviews of psychiatric healthcare workers, administrators, and policy texts were analyzed concurrently. The broad philosophical lens of Bourdieu’s critical theory of practice (1977) was used as an organizing framework for the analysis. Ongoing training and education were seen as facilitating preventive actions such as reading the signs, knowing what to do, de-escalating, distracting from fixation, talking to people, listening with intent and self-regulating. Barriers to prevention were: not feeling listened to, not knowing what to do, feeling de-valued, not having resources, working with inexperienced staff, being unaware of prevention policies, status quo culture and uncomfortable spaces. The nature of the business encompasses a theoretical analysis on the practice, institutional and policy levels.