Restrictive practice in relation to self-harm:necassary or unnessary?

Background Despite the use of restrictive measures in mental healthcare to keep patients and staff safe is a highly controversial issue, this practice is still ongoing in inpatient mental healthcare. A possible explanation is that mental healthcare providers and psychiatric patients have different understandings on what is perceived as restrictive. Objective Within the framework of the nurse patient relationship in relation to measures that were taken to reduce or limit self-injurious behaviour, this study was designed to explore: 1) What measures were perceived as restrictive and (2) Why these measures were perceived as restrictive? Method: A qualitative research was conducted. Data were collected from 10 patients and 6 nurses. The participants were selected using purposive sampling. Data were analysed using the constant comparative method influenced by the grounded theory approach. Rigour was achieved through audit trail, peer debriefing, data-saturation and research triangulation. Results: Beside measures that ‘re experienced as restrictive due to the already restrictive nature of the measure, the participants described a variety of atypical restrictive measures, like being insisted to take care themselves for their self-inflicted wounds. With regard to their own recovery, all participants described conflicting perceptions and an ambivalent position towards the appropriateness of the mentioned measures. These ambivalence was not only related to the measures that ‘re taken to withhold them to self-injure, but also in relation to their urge to self-harm and the way how they dealt with it and how help was offered by nurses. Analysis of the data gathered from the patients showed how the use of restrictive measures increased their perceived ambivalence towards their own self harm-related behaviour. Analysis of the data from the nurses showed how exposure to self-injurious behaviour evoked strong and overwhelming feelings, resulting in protective responses which enhanced the use of restrictive measures. Conclusion: Instead of focussing on the use of restrictive practice, patients whom self-harm want nurses being sensitive with respect to their ambivalent feelings and thoughts. By exploring and normalising these experienced ambivalence, nurses can help patients to maintain themselves. Education goals: Participants will…. 1. Have an understanding about how restrictive measures are experienced by hospitalised self-harming patients and their primary nurses 2. Realise how interpersonal attitudes and skills of health care providers contribute to help self-harming patients to maintain themselves in disturbing conditionsstatus: publishe