How ward rules and limit setting contribute towards restrictive practices and presentations of challenging behaviour in patients on mental health wards [2020]

Background/Aims
Admission to mental health facilities is often confusing and distressing for patients. Ward rules can help to set out expectations and boundaries but can become restrictive practice when they unnecessarily limit patients. The aim of this study is to understand how ward rules and limit setting can impact on restrictive practice and subsequent challenging behaviour in patients.

Methods
Three electronic databases were searched (CINAHL, MEDLINE, PsychINFO) using a systematic approach. Seven articles were identified using inclusion/exclusion criteria and findings were synthesised using thematic analysis.

Results
Six themes were generated finding that ward rules and limit setting could contribute towards challenging behaviour. Passive acceptance could also occur with negative patient outcomes.

Conclusions
Negative outcomes occurred when patients did not understand or agree with the rule rationale. It also occurred when patients felt a nurse was being emotionally distant or when rule enforcement was one of the only forms of contact.

Anna Doyle, Louise L Clark
British Journal of Mental Health Nursing, 23 Mar 2020
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