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PROactive Management of Integrated

Services & Environments


Qualitative Study - Research Protocol

PROMISE qualitative strand: an exploration of staff and patient experience of physical intervention on mental health wards and their suggestions for reducing its use

Introduction: There are fundamental contradictions at the heart of mental health, between care and control, risk and recovery. It can be argued that there is no place for force in supporting an individual’s recovery journey, however many aspects of the work of front-line mental health practitioners in reality involves the control and containment of people who may pose a risk to themselves or others. Thus the use of physical restraint, albeit viewed by most as a practice incompatible with the vision of recovery, carries on. Guidelines issued from the Department of Health in the “Positive and Proactive Care: reducing the need for restrictive interventions” document sets out the expectations for services, however there is very little guidance/evidence for what proactive care entails at the frontline. The present research study aims to bridge this knowledge gap by exploring staff and patient experiences of physical restraint, their suggestions for reducing restraint, and their suggestions for promoting proactive care in Cambridgeshire and Peterborough NHS Foundation Trust (CPFT) mental health services.

Methods and analysis: The current project will use a participatory qualitative approach to explore:

1. the experience of physical intervention in mental health wards from the perspective of patients and frontline ward staff within CPFT and

2. CPFT patient and staff suggestions of how to reduce restraint in mental health wards.

Study participants will take part in one-to-one semi-structured interviews which will aim to explore and answer the following questions:

What are patient and staff experiences of physical intervention?

What impact has physical intervention had on patients and staff?

What do patients and staff perceive as alternatives to physical intervention?

What does a service that does not use physical intervention look like to staff and patients?

What are staff and patients’ views on proactive management of services?

How can services meet Department of Health guidelines to reduce reliance on physical intervention?

Interviews will be digitally voice-recorded, transcribed verbatim and analysed using thematic analysis to bring out key themes to answer the research questions.

This study is based on a partnership model in which the key stakeholders, service users, and staff, play a full and active role. Working with key stakeholders as co-researchers ensures that the perspectives and expertise of service users and professionals are all influential throughout the research and development process.

Dissemination: The findings of the study will inform the development of a proactive care framework aimed at reducing the need for physical intervention. This framework will influence training of CPFT staff and staff practice development. The findings of this study will feed in to the framework alongside other strands of the PROMISE project. In addition to informing a framework, findings will be shared through the publication of papers in peer-reviewed journals and presented at conferences, seminars and workshops on the reduction of restraint in mental healthcare.

The PROMISE study has been funded by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) East of England.

The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.