Alternatives to Seclusion and Restraint in Psychiatry and in Long-Term Care Facilities for the Elderly: Perspectives of
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ORIGINAL RESEARCH ARTICLE
Alternatives to Seclusion and Restraint in Psychiatry and in Long-Term Care Facilities for the Elderly: Perspectives of Service Users and Family Members Marie-Pierre Gagnon • Marie Desmartis • Myle`ne Tantchou Dipankui • Johanne Gagnon Miche`le St-Pierre
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Published online: 16 August 2013 Springer International Publishing Switzerland 2013
Abstract Background There is growing interest in involving patients in decisions regarding healthcare technologies. This research project was conducted in collaboration with decision makers and health technology assessment agents in order to involve healthcare service users (and their loved ones) in the assessment of alternatives to seclusion and restraint in short-term psychiatric wards and long-term care facilities for the elderly. Objective This paper explores the viewpoints and suggestions of service users and service users’ families about alternatives to restraint and seclusion, as well as conditions under which they could be used among adults in short-term psychiatric care and residents in long-term care facilities. Methods Using a semi-structured guide, we held eight focus groups: five with mental health service users and three with family members of elderly people in long-term care facilities. Focus group discussions were digitally recorded and transcribed verbatim, and we performed content analysis using NVivo 8 software. Results In both care environments, participants emphasized the importance of communicating with service users, as well as assessing their needs and their particular situation, for reducing the use of restraint and seclusion. A better welcome and
M.-P. Gagnon M. Desmartis Centre hospitalier universitaire de Que´bec Research Centre, Hoˆpital Saint-Franc¸ois d’Assise, 10 rue de l’Espinay, Que´bec, QC G1L 3L5, Canada M.-P. Gagnon (&) M. T. Dipankui J. Gagnon Faculty of Nursing, Universite´ Laval, Que´bec, Canada e-mail: [email protected] M. St-Pierre Department of Management, Universite´ Laval, Que´bec, Canada
accompaniment of people admitted for short-term psychiatric care emerged also as key approaches to reduce the use of restraint and seclusion. Long-term care facilities could also reduce the need for restraint and seclusion by creating a stimulating home environment and individualized occupational therapy programs. Participants in both groups suggested that caregivers other than healthcare staff could be more involved, especially peer-support workers in the case of psychiatric care and volunteers in the case of long-term care facilities. Conclusion Participants suggested that changes were needed at a broader and more systemic level than simply replacing current measures of restraint and seclusion with alternative techniques. They favored an approach focused more on the person than on the techniques: they suggested that listening to and communicating with the service user could reduce the use of restraint and seclusion in both healthcare environments.
Key Points for Decision Makers • Foster a more sy
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