Identify barriers to best practice

The statewide review of seclusion, observation and restraint is a response to serious public and professional concerns about standards and practices in NSW mental health facilities, says nursing academic Bethne Hart.

Bethne Hart, Associate Professor in the School of Nursing at the University of Notre Dame, Sydney, says NSW Health policy is very specific about seclusion, restraint and observation standards and practices.

Bethne, a mental health nurse and sociologist, says, “We have to ask, what gets in the way of policies being upheld and best nursing practice being followed?

“It is important that we engage fully with the review and systematically identify the factors that support best practice mental health care, and the factors that contribute to weaknesses and failures in care provision.

“Are staffing and other resources sufficient? Are staff properly educated, skilled and up to date with policy developments?

“Mental health nurses are providing care to people who are often seriously ill, with both physical and mental health needs. Standards of care and policies governing this care must be embedded into the everyday practices of nurses.

“This requires continuing professional development and strong clinical leadership.

“Clinical supervision and staff mentoring are very important to nurture and sustain best practice mental health nursing.

“There is also a question of leadership and workplace culture. Are managers strongly leading the practices of nurses?

“Is the culture of workplaces getting in the way of policies being observed and implemented and standards being upheld?

“Safe workplace cultures have effective communication, teamwork, and core values of therapeutic care.

“Nurses need to be able to speak up about their concerns regarding patient safety and the upholding of standards and policies, and their own well-being.”

Trust needed in mental health services

Bethne says it is important to examine not only deficiencies but also those mental health services that “work hard to reduce seclusion and are very aware of upholding policy.”

“Many mental health services and nurses are engaged in models of care and standards of practice that uphold safety, expertise and core therapeutic values. These must be recognised, and their knowledge and practices shared across the health professions and services.”

She says mental health services and nurses are challenged in caring for people who may be acutely intoxicated, aggressive, distressed, and a threat to the safety of themselves, nursing staff and patients.

“We must be certain that the environments in which we give care actually support safe care.

“Close observation of people who are very unwell can be limited by environmental conditions, and distress and disturbed behaviours will increase in environments where people feel unsafe or unable to recover within their surroundings.”

Bethne says the Australian College of Mental Health Nursing is providing leadership via a project that supports the reduced use of seclusion.

“The college is promoting mental health nursing and workplace cultures that reduce the risks of physical and emotional harm for people with mental illness.

“Fundamentally, we want people with mental illness and their carers, and broader communities to have confidence and trust in mental health services.

“What we do as mental health nurses, and how we are educated and supported to do this, is central to this goal.

“We must take every opportunity within the review to speak up about what we do well, and also about the factors that diminish care and what we need to do better.”