Abstract

Restrictive interventions, such as physical restraint, should be a last resort for managing imminent risk. There has been growing recognition of the harmful effects of them, for both staff and service users. Limited research has considered the impact of physical restraint on the therapeutic relationship between staff and service users. The aim of this research was to address this gap in the literature and explore both service user and staff perspectives of the therapeutic relationship after physical restraint, in a UK-based service that provides low and medium secure care for adults. Ten semi-structured interviews were conducted with five service users and five staff members. All participants had been involved in at least one incident of physical restraint. Interpretative Phenomenological Analysis was used to analyze the data. Three master themes emerged from the service user experiences: emotional impact; changes to the therapeutic relationship; and appraisal of the necessity of physical restraint. A further three master themes were produced from the staff member experiences: emotional response; balancing professional roles and responsibilities within the relationship; and moving forward with the therapeutic relationship after physical restraint. Findings support the need to continue to reduce restrictive interventions including physical restraint in secure mental health services and consider the impact upon those involved, both emotionally and relationally. Contemporary approaches to reducing power imbalances between staff and services users, as well as those that would reduce the likelihood of (re)traumatising service users, are also recommended.

摘要

限制性干预措施，例如身体约束，应该是管理迫在眉睫的风险的最后手段。人们越来越认识到它们对员工和服务使用者的有害影响。有限的研究考虑了身体约束对工作人员和服务使用者之间治疗关系的影响。这项研究的目的是弥补文献中的这一空白，并探索服务使用者和工作人员对身体约束后治疗关系的看法，在英国的一项为成人提供中低安全护理的服务中。对五名服务使用者和五名工作人员进行了十次半结构化访谈。所有参与者都至少经历过一次身体束缚事件。使用解释现象学分析来分析数据。服务用户体验中出现了三个主要主题：情感影响；治疗关系的改变；并评估身体约束的必要性。另外三个主要主题是根据工作人员的经历产生的：情绪反应；平衡关系中的专业角色和责任；并在身体约束后继续推进治疗关系。研究结果支持需要继续减少限制性干预措施，包括安全心理健康服务中的身体约束，并考虑对相关人员的情感和关系影响。还建议采取现代方法来减少工作人员和服务用户之间的权力失衡，以及减少服务用户（再次）受到伤害的可能性。