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A Matter of Trust and Distrust

A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting

Tingleff, Ellen Boldrup, PhD, MScN, RN1–5; Hounsgaard, Lise, PhD, MScN, RN1,4–6; Bradley, Stephen K., PhD, BSc, RMN7; Wilson, Rhonda L., PhD, MNSc (Hons), BNSc, RN1,5; Gildberg, Frederik A., PhD, MScN, RN2,5

doi: 10.1097/JFN.0000000000000237
Original Articles

Introduction: Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably.

Aim: The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration.

Method: Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed.

Findings: Two main themes were identified, namely, “care and protection” and “inclusion and involvement,” and one subtheme, “information.” These themes revealed the framework used by parents to construct a sense of “trust or distrust” about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting.

Conclusion: Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.

Author Affiliations:1OPEN: Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark;

2Research & Development Unit, Department of Psychiatry, Middelfart, Region of Southern Denmark;

3Nursing Education, UCL University College;

4Health Sciences Research Center, UCL University College;

5Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark;

6Institute of Nursing & Health Science, University of Greenland; and

7Hope Trust, Roscommon, Ireland.

The authors disclose receipt of the following financial support for the research and authorship of this article: The Psychiatric Research Fund in the Region of Southern Denmark, UCL University College, and The Novo Nordisk Foundation.

The authors declare no conflict of interest.

Correspondence: Ellen Boldrup Tingleff, PhD, MScN, RN, Research & Development Unit, Department of Psychiatry, Øestre Hougvej 70, 5500 Middelfart, Denmark, and Nursing Education, UCL University College, Vestre Engvej 51C, 7100 Vejle, Denmark. E-mail:

Received September 12, 2019; accepted for publication January 29, 2019

© 2019 by the International Association of Forensic Nurses. All rights reserved.
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