Clinical decision-making in cases of rapid tranquillisation in mental health inpatient settings: an integrative review

Martin Locht Pedersen, Ellen Tingleff, Ronni Laulund, Frederik Gildberg, Kim Jørgensen

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Abstract

Background: Rapid tranquillisation remains widely used in mental health inpatient settings worldwide although reducing and/or eliminating restrictive practices in mental health practices has been an international priority. Nurses are the health professionals most likely to perform rapid tranquillisation in mental health inpatient settings.

Aims: To advance our understanding of nurses’ clinical decision-making concerning use of rapid tranquillisation in adult mental health inpatient settings. Specifically, literature concerning the decision-making process and factors influencing and/or associated with nurses’ clinical decision-making were reviewed.

Methods: An integrative review was conducted using the methodological framework described by Whittemore and Knafl (2005). The Reporting Checklist for Systematic Reviews (PRISMA) and qualitative-research-specific guidelines (ENTREQ and eMERGe) were used for reporting the findings. A systematic search was conducted in APA PsycINFO, CINAHL Complete, Embase, PubMed and Scopus. Additional searches for grey literature were conducted in Google, OpenGrey and selected websites, and in the reference lists of included studies. The study selection process was guided by the following inclusion criteria: primary studies describing situations and/or clinical decision-making concerning use of rapid tranquillisation; addressing causes and/or reasons for such use; or presenting perceptions, attitudes and/or experiences about clinical decision-making related to the use of rapid tranquillisation. Studies from a nurse perspective and with rapid tranquillisation used in adult mental health inpatient settings were included. The Mixed Methods Appraisal Tool was used for critical study appraisal.

Results (preliminary): A process of manifest content analysis inspired by Graneheim and Lundman (2004) was conducted. Altogether 151 meaning units were abstracted from 10 included studies; 11 categories were generated. Of these categories, five concerned the clinical decision-making process: 1a) to become aware of and consider alternatives, 2a) to negotiate voluntary medication, 3a) to end in an impasse, 4a) to implement the use of rapid tranquillisation and 5a) to be out on the other side. The remaining six categories concerned factors that influence and/or are associated with nurses’ clinical decision-making: 1b) to see rapid tranquillisation as part of the job, 2b) to experience the clinical decision-making process differently, 3b) to take on the dual role, 4b) to divide restrictive practices into a hierarchical order, 5b) to be affected by local conditions and 6b) to be the good nurse.
Original languageEnglish
Title of host publicationViolence in Clinical Psychiatry : Proceedings of the 12th European Congress on Violence in Clinical Psychiatry
EditorsPatrick Callaghan, Roger Almvik, Frans Fluttert, Sabine Hahn, Trond Hatling, Kevin McKenna, Nico Oud
Volume12
Place of PublicationRotterdam
PublisherSympopna | Leids Congres Bureau
Publication dateOct 2022
Pages84-86
Chapter3
ISBN (Print)978-90-90-36523-7
Publication statusPublished - Oct 2022
Event12th European Congress on VIolence in Clinical Psychiatry - De Doelen International Conference Center, Rotterdam, Netherlands
Duration: 6. Oct 20228. Oct 2022
Conference number: 12
https://ecvcp.eu/

Conference

Conference12th European Congress on VIolence in Clinical Psychiatry
Number12
LocationDe Doelen International Conference Center
Country/TerritoryNetherlands
CityRotterdam
Period06/10/202208/10/2022
Internet address

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