Quantitative Research Proposal Cohort Mental Health Students Case Study

INTRODUCTION - A case for the 2024 Cohort Mental Health Students

Background of the study

The use of physical restraints [PR] within clinical setting specifically in mental health area remains one of the debatable topics. The knowledge and practices of healthcare professional towards PR develops impacts on its application which further raises concerns regarding balancing individual rights and patient safety (Glezer and Brendel, 2020). Nevertheless, using restraints breaches the principle of autonomy as it contravenes patient’s freedom. Henceforth, it is essential to obtain informed consent from patients (Wong et al, 2020). However, it is impossible in varied circumstances specifically, during involuntary admission of patients. Different factors such as informed consent, confidentiality and patient safety requires to be consider during the procedure of restraints and subsequently, evidence-based decision making must be implemented. The current research proposal will shed light on the factors that are impacting decision-making related to use of restraints in mental health setting (Migon et al, 2020). The problem statement, objectives, hypothesis and scope will be highlighted. Furthermore, a comprehensive literature review will be conducted and consequently, in-depth analysis would be done. Moreover, methodology will be shown along with providing justification.

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Problem statement

Restraints uphold the notion of controversial practice due to impacting ethical domains in mental health setting. It is influenced by varied components such as patient acuity, organizational policies and staff training. Understanding these factors are crucial for adhering with evidence-based practices and developing patient guidelines which prioritise ethical practices and patient safety (Foster et al, 2021). Patients who are suffering from mental illness has severe life-threatening risks as they can harm themselves and others, they can often opt for suicide under such extreme complexity, physical restraints are used for managing conflicts and decreasing physical movement of patient. Despite the controversy that PR is essential for protecting staff and patient safety, there are certain restrictions undermined within therapeutic alliance which makes it a debatable topic.

Research question

What are the crucial factors influencing decision to use restraints within Mental Health Settings?

Objectives and hypothesis

Objectives

1. To assess the key factors impacting the decision to use restraints in mental health settings.
2. To measure how these factors can create positive and negative impact on decision making related to using restraints in mental health setting.
3. To estimate the perceptions of MSc mental health students regarding the use of restraints.

Hypothesis

H1- Internal factors influences the decision related to using Physical Restraint.

H0- Internal factors does not impact decision making process aligned with Physical Restraint

[Internal factors representing Patient Acuity, staff training, organisational policies and ethical factors]

Scope

The study will focus on mental health setting of a university [Sheffield Hallam University] and prior focus would be emphasised on MSc Mental Health Nursing students, January 2024 and January 2025 cohorts. The research will focus on exploring the current practices and perceptions related to using restraints in mental health settings. Furthermore, factors that impacts decision making process related to restraint use will be analysed in detailed manner.

LITERATURE REVIEW

Physical restraints in mental health settings

In the study of Doedens et al, (2020) it has been analysed that Physical restraints are used in medical services significantly in mental health settings. It proves to be a coercive approach that aligns with the administration of treatment via reducing patient’s physical movement. It is considered as last options which should be only used by the qualified personnel, antecedents of PR are categorised in violence, disturbance, self-harm and improper behaviour of patient. However, implication of restraints must be adhered with legislation that assures patient safety. Patient with mental illness suffers from significant risk of hurting themselves and others. Severe mental disorders associates with likelihood of agitation and autolesion. Therefore, healthcare practitioners implied alternative approaches such as- crisis management and de-escalation technique for alleviating the critical. On the other hand, Barbui et al, (2021) stated that implication of physical restraint develops ethical and practical controversies as it impacts patients in unexpected ways. Nevertheless, physical restraints prove to be an effective approach for avoiding patient’s physical movements and potential future injury and therefore, healthcare professional implies it in urgent circumstances.

Hence, physical restraints impact varied factors that ultimately influences patient safety and ethics. Thereby, diverse controversies are developed in this context.

Patient Acuity

Studies have shown that patient acuity proves to be a major predictor of restraint use; a study by Mahindru et al, (2023) disclosed that patients who suffers from severe behavioural issues are likely to be restrained as a response towards acute psychiatric symptoms. Subjected to physical restraints lead to self-stigma and feeling of shame due to which individuals have negative belief about others and themselves. This act as a major barrier in seeking support from healthcare provider. Asphyxiation considered as the major prevalent cause behind PR as it is related to severe complexity. Paradis‐Gagné et al, (2021) stated that PR should be undertaken as last step when the situation becomes extremely severe. Restraints within psychiatric settings needs to be used for managing aggressive behaviour of patients. However, it remains as a complex issue that impacts the balance between patient safety and the ethical domains. Aggressive behaviour is determined as the main reason for using restraint as this behavioural pattern creates complexities for staff and patient. Restraints develops negative psychological impact on patient and provokes the feelings of anger, fear and embarrassment due to which patient mental health condition get worsen. As a result, patient does not interact with healthcare practitioner that drastically influences relationship between patient and healthcare practitioner.

Staff training

In the article of Krieger et al, (2021) it has been analysed that staff training develops profound effects on restraints practices, providing facilities with comprehensive training programs related to de-escalation techniques reduces the use of restraints. Such trainings enhance the knowledge and skills of mental health professionals and further empower them in managing complex situations without considering restraints. Organizing training program is crucial as it reduces the likelihood of restraints. Training aims to acquire front line staff so they can manage aggressive behaviour of patients, it involves both practical and theoretical components. It is concerned with understanding the causes that lead to aggressive behavioural pattern and further it detects the early signs in patient. Thus, staff training can make create significant impact on patient safety as it reduces the probability of using restraints. Thus, it is important to retrain staff so they can take preventive measures for tackling triggering people within care and they can further use de-escalation techniques. There is need to avoid the un-therapeutic interactions which can further trigger patient and makes situation critical. Howard and Khalifeh (2020) elucidated that restraint training is specifically for mental health workers and caregivers so they can handle the patients suffering from behavioural issues. Therefore, staff training at the setting should be organised and consequently, healthcare professionals should be made aware about the ways in which they can tackle patient aggressive behaviour without using restraints.

Organisational policies

Organisational policies play pivotal role in shaping the restraint practices within setting, strict and restrictive policies in setting decreases the extent of PR. The study of Gooding, et al, (2020) depicted that setting with robust strict policies and standard policies reduces the incidence of restraint. Specific and clear guidance to staff decreases the ambiguity within decision-making process and further encourage to comply with ethical practices. It is important to maintain patient dignity during restraint procedure and this must be included in organisational policies. Leniency in this context can increase the chances of PR and therefore, it is important that organisation must focus on implementing strict policies so healthcare practitioner does not consistently prefer PR. It should be only implied when there is extreme crucial situation. The patient must tackle via de-escalation technique and when there is no option left and situation becomes critical then only, restraints should be preferred. A detailed guidelines by organisation enables healthcare practitioner to take decisions regarding restraints. Therefore, detailed protocols should be used and implied in clinical setting so that evidence-based decision can be taken.

Ethical factors

Informed consent

The ethical consideration related to informed consent considered as paramount in treatment procedure. Specifically in using restraints, it is essential to develop awareness in patient regarding available treatment along with the risk comprised with restraint. Using restraints without patient permission breaches the autonomy and this is further considered as illegal. The staff can be judged for violating the patient’s autonomy and there is further risk to the image of setting. However, Schnitzer et al, (2020) revealed that informed consent is essential for non-emergent restraint use, health professional who performs restraint must obtain consent of patient and they should be made aware about whole situation. When patient becomes agree then only restraint requires to be performed. In case patient denies then in such situation restraint should be avoided. Different treatment options must be communicated with patients and consequently, decision should be taken. In this manner, patient dignity can be maintained further they can be empowerment. During this procedure, healthcare practitioner requires to reflect on the harm and benefits of restraints, it assures respects towards autonomy my prioritising human dignity. Nor adhering with informed consent can risk patient lives and breaches safeguarding by creating harm towards patient. Healthcare professional should take the consent of patient before proceeding with restraint procedure. In case patient is not in the condition to take decision then, in such situation consent of the family members is needed.

Confidentiality

The confidentiality of the patient during whole procedure needs to be maintained, discussion related to restraint and treatment must be undertaken in private setting for ensuring the privacy and trust. Due to restraint patient suffers from the sense of embarrassment and therefore, it is important to keep discussion confidential. Healthcare professional should develop trust and this can be done by maintaining patient confidentiality and dignity. There might be possibility that patient is unable to take decision due to severity of illness. During this situation discussion with family members must be done and only they can be made aware about the whole context. McKeown et al, (2020) revealed that it is important to ensure that confidential information has been recorded and it is secured and protected from any kind of unauthorised use and access. The patient confidentiality build trust and enable practitioner to select best interest decision, it saves healthcare professionals reputation and develops a sense of belongingness in the patient. Therefore, it is essential to maintain the confidentiality of patient during restraint discussion, it must be undertaken in private area and patient should be empowered during procedure and no disclosure of the personal information should be done with any staff members.

Minimizing harm

In the paper of Thomann et al, (2021) it has been analysed that “do not harm” principle must be prioritise by healthcare practitioner. There is need to implement the strategies related to minimising restraints use and this can be done by organising training in the setting. In UK there are certain legal requirement have been set and this must be checked before proceeding with restraint. It should be used only when the behaviour of patient is creating harm for themselves or others. Furthermore, if patient requires legal order under Mental Health Act, then, in such situation restraint must be performed under the supervision of healthcare expert. Moreover, if patient need urgent life-saving treatment then, in such situation it is important to undertake restraint procedure. As per NHS physical restraints should be carried out by staff while emphasising on patient’s well-being (NHS UK, 2023). The consideration of restraint requires to be done from the perspective of trauma informed care and human rights.

Based on the literature review, this can be said that physical restraint must be used only in certain condition. Staff must be trained regarding de-escalation techniques as this decreases the chances of applying restraints procedure. Furthermore, organisational policies need to be made strict so the chances of restraints can be reduced. Most importantly, emphasis must be implied on ethical aspects such as informed consent, confidentiality and minimizing harm for patient. These are the topmost factors which should be considered before undertaking decision related to using restraints for patient within mental health setting.

RESEARCH METHODOLOGY

Research design

Research design refers to the over-all strategy that has been undertaken for conducting he study. It is pivotal to select appropriate research design as the efficacy of outcomes is further based upon this (Pandey and Pandey, 2021). Longitudinal and cross survey these are two types of research design, in longitudinal deign researcher consistently assess same individual for detecting the changes. Whereas cross-sectional designs are based on undertaking population-based surveys that assess the prevalence of disease, treatment and diagnosis by undertaking clinical based samples. In current research, analyst will use cross-sectional quantitative research design, rational behind selecting this design concerned with the allocation of authentic evidence that integrates clinical experience, perceptions and evidence.

Research strategy

It refers to step by step plan and action that provides direction to researcher for conducting the study. Mainly, there are two types of strategies categorised in qualitative and quantitative. The qualitative strategy is aligned with allocation of theoretical data which is further easy to understand. On the other hand, quantitative strategy focuses on allocating numerical information for developing final outcomes. The researcher will use quantitative strategy, and accordingly numerical information will be gathered. Numerical data assures higher objective and accuracy further research can be conducted on wider population. Therefore, researcher will prefer quantitative research strategy and consequently, numerical data would be gathered.

Research approach

This is delineated as the set of series which should be performed for performing research practices. Inductive and Deductive these are the two types of approaches, inductive is suitable for analysing theoretical information (Dzwigol, 2022). On the other hand, deductive is appropriate for assessing quantitative data. The analyst will prefer deductive approach for conducting the study. This approach will enable researcher to explain the main concepts and factors that are related to each other. The ethical domains will be assessed and its implication in decision related to restraint use would be understand by analysing them main concepts. Furthermore, researcher will be able to evaluate qualitative information and ideas.

Research philosophy

Research philosophy is explicated as the faith and belief of individuals entails with research context. Interpretivism philosophy is concerned with incorporating human opinions in research outcomes. Whereas positivism philosophy aligns with evaluation of existing theories and philosophies for developing research outcomes. The analyst will use positivism philosophy in current research context and accordingly evaluation of clinical experience would be done. For examining hypotheses positivism philosophy proves to be appropriate and therefore, researcher will prefer this philosophy. This supports in developing authentic and relevant outcomes that assess the factors that are important in taking decision related to restraint.

Sampling

It refers to approaching the group and samples for collecting the data, it is important to approach appropriate samples who are aware about the research context. This supports in developing realistic findings (Dubey and Kothari, 2022). There are two ways in which sampling can be done, probability sampling associates with random selection of candidates and non-probability sampling method entails with approaching participants on the basis of subjective elements. The researcher will approach purposive sampling, it is the part of non-probability sampling method. This will be ensured that all candidates have relevant exposure and knowledge in the field of mental health. 50 MSc students from January 2024-2025 of Anglia Ruskin University will be approached and data will be collected from them.

Data collection

Data collection refers to the method of allocating information for developing research outcomes. Primary and secondary these are two ways in which data can be collected, primary method is concerned with allocating first hand information. Whereas, secondary method is based on gathering information from secondary sources. The researcher will use primary method and accordingly data will be collected through online self-administered questionnaire, this will include Likert-scale questions. In this manner, analyst will be able to gather primary information from medical students and this data would be used for developing final outcomes.

Data analysis

This is considered as that technique through which gathered information has been analysed. It is crucial to select appropriate data analysis technique so that effective outcomes can be developed. Thematic analysis is preferrable for qualitative information while statistical analysis is appropriate for quantitative data (Kumari et al, 2023). The researcher will undertake statistical analysis and accordingly, SPSS would be used. The descriptive statistics and inferential statistics techniques such as- regression analysis will be done. Regression would be implied for exploring the influence of independent variable on the likelihood of using restraints.

Ethical consideration

Ethics plays vital role in research procedure and therefore, it is important to focus on this area so that mandatory ethics can be performed (Kumari et al, 2023). The researcher will perform all the ethics and subsequently, informed consent form will be given to participants. They will be made aware regarding research context and afterwards, their responses would be considered. Furthermore, confidentiality of the candidates will be maintained and accordingly, their privacy would be prioritised. No harm towards anyone will be developed and ethical practices would be undertaken. Hence, it can be said that researcher will imply prior focus on performing ethics and subsequently, research practices would be performed.

Timeline

Phase Duration

Literature Review 2 months

Data Collection 4 months

Data Analysis 2 months

Report Writing 2 months

Total Duration 10 months

Budget

Personnel costs

Data collection materials

Participant incentives

Travel expenses for interviews

Miscellaneous costs

EXPECTED OUTCOMES

The expected outcomes of the research will be concerned with identification of the key components impacting the restraint use in mental health setting. In-depth analysis will be done for assessing the influence of each factor. This supports in developing insights related to consideration of contextual domains in ethical decision making. Furthermore, understandings related to relationship exist between independent [patient acuity, staff training, organisational policies, ethical factors] and dependent variable [restraint use] will be developed. The outcomes will specify the components which creates influence on physical restrain decision making process in mental health setting. Furthermore, recommendations related to minimizing harm will be provided which can be implied in clinical setting. Thus, expected outcomes of the research will cover each of the domain in detailed manner and subsequently, research questions will be addressed.

REFERENCES

Books and Journals

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• Doedens, P., Vermeulen, J., Boyette, L.L., Latour, C. & de Haan, L., (2020). Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services—A systematic review. Journal of psychiatric and mental health nursing, 27(4), pp.446-459. https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12586
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• Dzwigol, H., (2022). Research methodology in management science: Triangulation. Virtual Economics, 5(1), pp.78-93.
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• Glezer, A. and Brendel, R.W., 2020. Beyond emergencies: the use of physical restraints in medical and psychiatric settings. Harvard review of psychiatry, 18(6), pp.353-358.
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• McKeown, M., Thomson, G., Scholes, A., Jones, F., Downe, S., Price, O., ... & Duxbury, J. (2020). Restraint minimisation in mental health care: legitimate or illegitimate force? An ethnographic study. Sociology of Health & Illness, 42(3), 449-464. https://onlinelibrary.wiley.com/doi/full/10.1111/1467-9566.13015
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• NHS UK, (2023). Online. Available through: < https://www.nhs.uk/ >
• Pandey, P. & Pandey, M.M., (2021). Research methodology tools and techniques. Bridge Center.
• Paradis‐Gagné, E., Pariseau‐Legault, P., Goulet, M. H., Jacob, J. D., & Lessard‐Deschênes, C. (2021). Coercion in psychiatric and mental health nursing: a conceptual analysis. International journal of mental health nursing, 30(3), 590-609.https://onlinelibrary.wiley.com/doi/abs/10.1111/inm.12855
• Schnitzer, K., Merideth, F., Macias‐Konstantopoulos, W., Hayden, D., Shtasel, D. & Bird, S., (2020). Disparities in care: the role of race on the utilization of physical restraints in the emergency setting. Academic Emergency Medicine, 27(10), pp.943-950.
• Thomann, S., Zwakhalen, S., Richter, D., Bauer, S., & Hahn, S. (2021). Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. International journal of nursing studies, 114, 103807. https://www.sciencedirect.com/science/article/pii/S0020748920302935
• Wong, A.H., Ray, J.M., Rosenberg, A., Crispino, L., Parker, J., McVaney, C., Iennaco, J.D., Bernstein, S.L. & Pavlo, A.J., (2020). Experiences of individuals who were physically restrained in the emergency department. JAMA network open, 3(1), pp.e1919381-e1919381.