Fear and blame in the use of restrictive practices: reflections and recommendations

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. Research into restrictive practices is at an all-time high but reducing and eliminating these practices remains a significant challenge. In this presentation, I will discuss the latest research into restrictive practices and possible meanings that can be taken to illuminate the complexities of balancing the provision of care and maintaining safety. I will also discuss my recent research investigating nurses’ perceptions regarding reducing and eliminating the use of these practices with psychiatric consumers. Inter alia, we found that nurses saw seclusion and restraint as a necessary last resort to maintain staff and consumer safety and tended to disagree that restrictive practices could be eliminated from practice. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. Overall, nurses expressed significant fear about the potential elimination of restrictive practices and saw themselves as being blamed for both the use of these practices and the consequences should they be eliminated. Change initiatives need to take into account nurses’ deep concerns about the consequences of eliminating all forms of restrictive practice in hospitals. The paper will explore potential new ways of revisioning seclusion/restraint reduction and addressing the safety concerns of health professionals working in acute settings.


TERP focuses on identifying, avoiding and reducing harm across all environments in which the care of people with mental ill health is provided. TERP inforces Australia’s commitment to reduce the use of, and eliminate restrictive practices as a priority for action. Each jurisdiction, in conjunction with the Safety and Quality Partnership Standing Committee and the Commonwealth Government, works towards this vision by holding a series of forums providing an opportunity to learn and grow from local and national initiatives to eliminate restrictive practices and create a dialogue for future care.

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