An exploration of registered mental health nurses (RMNs) perceptions of restrictive practices in forensic men’s medium secure services

Purpose: Many aspects of men’s forensic medium secure hospitals involve containment and control of the patients, who are considered a risk to themselves and others. This entails the use of a range of restrictive measures. However, use of restrictive practices is a prevalent concern impacting not only the recovery of individuals admitted in Men’s Forensic Medium Secure Services but also the wellbeing of the staff members. The purpose of this study was to research the perceptions of Registered Mental Health Nurses (RMN), with regards to restrictive practices in men’s medium secure services. The aim was to situate the RMN staff, as the primary source of knowledge to gain an understanding of concerns regarding the implementation of restrictive practice derived from experience. Methods: Thirteen semi-structured individual interviews and a focus group comprising of six participants were conducted with individuals who were identified as RMNs, permanently employed within a men’s medium secure hospital, and who had worked for at least six months in this position. The study excluded all RMNs who were directly managed by the researcher, to avoid bias. A descriptive phenomenological approach was used because not much was known about RMNs’ perceptions on restrictive practices. Data was analysed using qualitative thematic analysis to gain insight into the issues. The focus group discussion was used to validate (and expand on) the data from interview transcripts. Main Findings: Five superordinate themes emerged from the RMN’s narratives and the focus group discussion; RMNs’ understandings of restrictive practices, the significance of care and control and the tension between those aspects of the work, negotiable and non-negotiable restrictive practices, the importance of RMNs’ experience, and unwanted and unexpected effects. These themes reflect the RMNs perceptions and experience of restrictive practice in forensic men’s medium secure services and highlight some of the tensions and contradictory demands on how they implemented restrictive measures. Conclusions: The findings reflected RMNs’ reports of the benefits and hindrances of restrictive practices in forensic men’s medium secure services, and the impact of restrictive practice on delivering quality patient care. They also highlight the inconsistent nature of restrictive practices in different wards. The study supports current recommendations that the services should encourage restrictive practices to be used as a last resort; but findings indicate also the need to review and revise current policy and practice to take account of the realities of ward cultures and the impact of staff capacity and resources on the aim of reducing the use of restrictive approaches. The findings also highlighted the need for further development of supportive frameworks and training to enable RMNs to manage restrictive practices more effectively. Future research directions are also discussed.

Name dc:type.qualificationname

DProf

Level dc:type.qualificationlevel

DProf thesis

Grantor dc:publisher.institution

Middlesex University

Year dc:date.issued

2025

Author dc:creator

• Mapfumo, T.

• Medium secure services
• forensic mental health
• mental health professionals
• registered mental health nurse (RMN)
• experiences
• restrictive practice

Identifier

oai:repository.mdx.ac.uk:367y0z

OAI identifier oai:identifier

oai:repository.mdx.ac.uk:367y0z