Communication and Restraint Reduction (CARR) study
Research type
Research Study
Full title
The Role of Staff and Team Communication in Reducing Seclusion, Restraint and Forced Tranquilisation in Acute Inpatient Mental Health Settings
IRAS ID
306290
Contact name
Mary Lavelle
Contact email
Sponsor organisation
East London NHS Foundation Trust
Duration of Study in the UK
1 years, 11 months, 31 days
Research summary
This is an NIHR funded research project. The overall aim of the study is to identify the staff communication that characterises successful de-escalation of patients displaying aggressive behaviour in acute mental health settings, avoiding the need to use physical restraint (held to prevent movement), seclusion (locked in isolation),and forced tranquilisation (involuntarily injected with psychotropic medication).
Background:
Over 100,000 patients are admitted to acute mental health wards annually, 40% involuntarily. Wards are under incredible pressure due to high bed occupancy rates and staff shortages. Patients are only admitted if they are extremely unwell, experiencing symptoms of psychosis (hearing voices), mania or severe depression. In England, 80% of nurses report experiencing patient aggression.
Staff manage patient aggression using communication, known as de-escalation. However, one in three de-escalations are unsuccessful and staff use restrictive practices including: restraint, seclusion and forced tranquilisation. In England 60,000 restraints occur annually, leading to patient harm (even death), trauma, fear and feelings of being disempowered and dehumanised. Staff experience harm, anxiety and burn out costing the U.K. £69M annually.
De-escalation practice varies and training is not evidence based. Communication is clearly important in de-escalation but we don’t know what communication is effective.Design and methods
Four adult acute inpatient mental health wards will be recruited.
- Sixty-four de-escalations will be audio-visually recorded.
- Staff and team communication will be analysed from video using established tools.
- Statistical analysis will identify what specific communication predicts successful de-escalation.
- Ethnographic observations will examine how teams discuss and plan for patient aggression.
- One-to-one interviews with patients (n=16), ward staff (n=16) and Trust leads (n=4) will examine their experience of de-escalation.This study will generate much needed empirical evidence to inform professional training of clinical staff in de-escalation and aggression management. Collaborations with educational partners will speed the translation of these findings into practice, improving patient care, staff wellbeing and overall safety.
REC name
Wales REC 3
REC reference
22/WA/0066
Date of REC Opinion
16 Mar 2022
REC opinion
Favourable Opinion