Patient and relativs

In order to reduce the use and duration of mechanical restraint in forensic settings and ensure evidence-based patient care, the projects below aimed to generate knowledge about forensic psychiatric patients’ and their relativs subjective experiences and perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Articles are only posted in abstract but can be found at pubmed.

Collaboration contacts:
Ellen B. Tingleff: ebti[a]ucl.dk
Frederik A. Gildberg: fgildberg[a]health.sdu.dk
Center for Psychiatric Nursing and Health Research (CPS), Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark, Odense, DenmarkAvailable Literature

Tingleff, EB, Hounsgaard, L., Bradley, SK., Wilson, R., Gildberg, FA. 2019. A Matter of Trust and Distrust: A qualitative investigation of parent perceptions about the use of mechanical restraint on their adult children in a forensic psychiatric setting. Journal of Forensic Nursing.15/2. Doi: 10.1097/JFN.0000000000000237 Article, Peer reviewed. Status: Published!

Introduction: Increased knowledge about forensic psychiatric patients’ relatives’ perceptions in regard to the
use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in
the use and frequency of MR. However, a specific knowledge deficit about relatives’ perspectives on the use of
MR limits the evidence base considerably.
Aim: The aimof this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients’
including factors impacting its use and duration.
Method: Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting
and thematically analyzed.
Findings: Two main themes were identified, namely, “care and protection” and “inclusion and involvement,”
and one subtheme, “information.” These themes revealed the framework used by parents to construct a sense
of “trust or distrust” about the ability of staff to provide adequate and safe care for their adult children in the
forensic psychiatric setting.
Conclusion: Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection.
However, most parents held strong negative perceptions regarding the use of MR and the quality and
safety of care provision. It is apparent that parents in this study believed they should be included and involved
in the care in situations associated with the use of MR, because they considered that this could reduce its use.
Further research is required to target interventions to reduce the use and duration of MR episodes and to improve
clinical practice in forensic psychiatry.

Tingleff, EB., Hounsgaard, L., Bradley, SK., Gildberg, FA. 2018. Forensic psychiatric patients’ perceptions of situations associated with mechanical restraint: a qualitative interview study. International Journal of Mental Health Nursing. doi: 10.1111/inm.12549 Article, peer review. Status: Published!

To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence-based patient care, we need more knowledge about patients’ subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients’ perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: ‘overt protest reactions’, ‘silent protest reactions’, ‘illness-related behaviour’, and ‘genuinely calm’, which together characterize patients’ perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: ‘pattern of protest’ and ‘pattern of illness’. Further research is needed to illuminate the associations between patients’ perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.

Tingleff, EB., Bradley, SK., Gildberg, FA., Munksgaard, G., Hounsgaard, L., 2017 “Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion”  Journal of Psychiatric and Mental Health Nursing, 17, pp.1-18 DOI: 10.1111/jpm.12410. Research: Article, Peer reviewed. Status: Published.

Introduction: There is a lack of research into psychiatric patients’ perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients’ perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical practice. Aims: To review existing research literature in order to investigate adult psychiatric patients’ reported perceptions of situations before, during and after specific and defined types of coercive measures, and to investigate what patients perceive as moderating factors, in regard to the use of these coercive measures. Method: A systematic review and thematic analysis of 26 peer-reviewed studies was undertaken. Results: The analysis identified six themes and additional subthemes, where “interactions with professionals” and “communication” were predominant themes across the timeline of coercion. Altogether, themes were associated with either “positive or negative patient-perceived impact.” Implications for practice: Increased sensitivity to patients’ views of the situation at each point in the process is desirable in order to respond to the patients’ individual needs. Professionals also need to articulate concern and empathy towards the patient and to improve communication skills before, during and after a coercive incident. Use of de-escalation and noncoercive strategies is required. Relevance statement: Coercion within psychiatric/mental health care remains controversial, and repeated international calls have recommended a reduction of their use. This review indicates that greater attention to how patients perceive the use of coercive measures (before, during, and after incidents) needs to be considered in order to improve the evidence-based and clinical practice.

PhD Project: Reduction of mechanical restraint in forensic psychiatry – Patient and relatives’ perceptions and perspectives on mechanical restraint in forensic psychiatry (From 1.9 2015 to 31.8. 2018)

PhD-Student & project responsible: Ellen Boldrup Tingleff, Ph.d-student, MScN ,RN, Institute of Clinical Research, OPEN, Faculty of Health Science, University of Southern Denmark

Head Supervisor: Lise Hounsgaard, PhD. Professor OPEN, Institute of Clinical Research, Faculty of Health Science, University of Southern Denmark and Docent, University College Lillebaelt

Supervisor: Frederik A.Gildberg, Ph.d., Professor (Associate) & Head of Research, Lecturer in Forensic Mental Health, PhD, MScN, RN. CPS, Institute of Regional Health Research, Faculty of Health Science, University of Southern Denmark. Lecturer & Head of Research, Dept. of Psychiatry Middelfart, Region of Southern Denmark.

Supervisor: Stephen Bradley, Dr. Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork.

English Abstract:

Background: In Denmark, the objective is to reduce coercion in psychiatric settings by 50 % in 2020. However, the number of prolonged episodes of mechanical restraint (MR) is currently increasing, especially among forensic psychiatric patients. Research suggests that involvement of patients and relatives contributes to reduction in coercion, including MR. However, research into forensic psychiatric patients and relatives’ perceptions of situations before, during and after MR episodes and their perspectives on what can help reduce use and duration of MR is very sparse.

Aim: To generate knowledge about what characterizes the meaning forensic psychiatric patients and relatives’ ascribe to perceptions of situations before, during and after MR episodes and to develop knowledge about what can reduce use and duration of MR.

Method: The project is carried out as a systematic literature review, qualitative semi-structured single interview with forensic psychiatric patients and qualitative semi-structured single and focus group interviews with relatives of forensic psychiatric patients. The investigation is epistemologically and methodologically informed by the assumptions of Symbolic Interactionism.

Anticipated Results: Increased knowledge about patients and relatives perceptions on situations connected with MR episodes and perspectives on what can reduce use and duration of MR will contribute to the development of interventions with the aim of reducing MR.

Danish Abstract:

Baggrund: I Danmark skal tvang reduceres med 50 % inden år 2020. Samtidig er antallet af langvarige bæltefikseringer stigende, specielt blandt retspsykiatriske patienter. Inddragelse af patienter og pårørende, kan jævnfør forskning, bidrage til at nedbringe tvang, herunder bæltefikseringer. Men forskning i retspsykiatriske patienter og pårørendes opfattelser af situationer før, under og efter bæltefikseringer og deres perspektiver på hvad der kan reducere antallet og varigheden af bæltefikseringer, er meget sparsom.
Formål: Formålet er at udvikle viden om hvad der karakteriserer den mening retspsykiatriske patienter og pårørende tillægger opfattelser af situationer før, under og efter bæltefikseringer og deres perspektiver på hvad der kan reducere antallet og varigheden heraf.
Metode: Projektet gennemføres som et systematisk litteraturstudie, kvalitative semi-strukturerede interviews med retspsykiatriske patienter og kvalitative semi-strukturerede enkelt- og fokusgruppe interviews med pårørende til retspsykiatriske patienter, inden for rammerne af symbolsk interaktionisme.

Forventede resultater: De forventede resultater om retspsykiatriske patienter og pårørendes opfattelser af situationer i forbindelse med bæltefikseringer og perspektiver på hvad der kan reducere antallet og varigheden af bæltefikseringer, skal anvendes til at udvikle interventioner med formålet om at reducere bæltefikseringer.­