Factors involved in healthcare professional’s decision-making in the use of restrictive care practices in adult mental health inpatient settings
An umbrella review of qualitative reviews
Bibliographic Data
The use of restrictive care practices, such as physical restraint, seclusion and chemical restraint, is complex and controversial, posing ethical and legal dilemmas for healthcare professionals. These challenges often lead to reliance on subjective judgments, resulting in inconsistent clinical practices. This umbrella review synthesized findings from systematic reviews to identify and summarize key factors influencing healthcare practitioners’ decision-making regarding restrictive care practices in adult mental health inpatient settings. A comprehensive search of electronic databases and manual reference list reviews was conducted. Studies were screened using Covidence software, and eligible reviews underwent quality assessment with the JBI Critical Appraisal Checklist for Systematic Reviews. Only reviews reporting qualitative data on factors and contexts influencing clinician’s decision-making to implement restrictive care practices were included. The data were synthesized using inductive content analysis. The findings, presented in accordance with the PRIOR checklist, are based on 21 qualitative reviews. This review identified a wide range of contexts and actors influencing decision-making. Factors were grouped into five themes: healthcare professionals’ characteristics, service user-related factors, organizational and contextual factors, the involvement of other people and external elements such as international conventions, policies and cultural norms. Decision-making is shaped by the interplay of these factors, leading to variability in the application of restrictive care practices across healthcare settings. The findings emphasize the need for standardized frameworks to promote consistency in clinical practice. Addressing external pressures, such as organizational policies, staffing shortages, limited resources, time constraints and safety concerns, while providing healthcare professionals with appropriate tools and evidence-based guidelines, will support ethical, consistent and informed decision-making that aligns with best practices.
Electroconvulsive Therapy Studies · Healthcare Decision-Making and Restraints · Psychiatric care and mental health services
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Inductive Content Analysis
Inductive content analysis
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Reading Qualitative Studies
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