Nielsen, L.D., Gildberg, F.A., Dalsgaard, J.L., Munksgaard, G., Beck, P., Hounsgaard, L. 2016. Forensic mental health clinician´s experiences with and assessment of alliance regarding the patient´s readiness to be released from mechanical restraint. International Journal of Mental Health Nursing. doi: 10.1111/inm.12300 Research: Article, Peer reviewed. Status: Published.
One of the main reasons for prolonged duration of mechanical restraint is patient
behaviour in relation to the clinician-patient alliance. This article reports on the forensic mental
health clinicians experiences of the clinician-patient alliance during mechanical restraint, and their
assessment of parameters of alliance regarding the patientâs readiness to be released from restraint.
We used a qualitative, descriptive approach and conducted focus group interviews with nurses,
nurse assistants and social and healthcare assistants. The results show that a pre-established
personal clinician-patient alliance formed the basis for entering into, and weighing the quality of,
the alliance during mechanical restraint. In consideration of the patientâs psychiatric condition, the
clinicians observed and assessed two quality parameters for the alliance: âthe patientâs insight into or
understanding of present situationâ (e.g. the reasons for mechanical restraint and the behaviour
required of the patient to discontinue restraint) and âthe patientâs ability to have good and stable
contact and cooperation with and across clinicians. These assessments were included, as a total
picture of the quality of the alliance with the patientâ, in the overall team assessment of the patientâs
readiness to be released from mechanical restraint. The results contribute to inform the development
of a short-term risk assessment instrument, with the aim of reducing the duration of mechanical
restraint.
