The restraint chair: A qualitative study of nurses' experience with the restraint chair versus four point restraint.

Restraint and seclusion continues to be a challenging topic in psychiatric nursing care. While there is a movement toward reduction and elimination of restraint, emergency situations still arise that require intervention for the safety of patients and staff. In addition to traditional methods of restraint (physical holds, four-point restraint, seclusion), the restraint chair has been introduced at some hospitals as an alternative to four-point restraint. The restraint chair allows the patient to be upright in a seated position during the restraint process. Little research on the restraint chair currently exists. The purpose of this study was to examine the nurses' experience with the restraint chair compared to four-point restraint. Results indicate nurses feel the restraint chair is easier to use, more humane, less traumatic, comforting, and enhances the therapeutic relationship compared to four-point restraint. Based on the reports of nurses in this study and prior quantitative work on the restraint chair (Castillo, Coyne, Chan, Hall, & Vilke, 2011; Visaggio et al., 2018), the restraint chair appears to be a safe and effective alternative to traditional four-point restraint. More research verifying these results at other hospitals in the United States and abroad is warranted.

Children admitted to hospital following unintentional injury: perspectives of health service providers in Aotearoa/New Zealand.

BACKGROUND: Unintentional injuries are the leading cause of death and hospitalisation among New Zealand children, with indigenous Maori and ethnic minority Pacific children significantly over represented in these statistics. International research has shown that many children hospitalised for injury, as well as their families experience high levels of stress, and ethnic disparities in the quality of trauma care are not uncommon. The research on which this paper is based sought to identify key issues and concerns for New Zealand's multi-ethnic community following hospitalisation for childhood injury in order to inform efforts to improve the quality of trauma services. This paper reports on service providers' perspectives complementing previously published research on the experiences of families of injured children. METHODS: A qualitative research design involving eleven in-depth individual interviews and three focus groups was used to elicit the views of 21 purposefully selected service provider key informants from a range of professional backgrounds involved in the care and support of injured children and their families in Auckland, New Zealand. Interviews were transcribed and data were analysed using thematic analysis. RESULTS: Key issues identified by service providers included limited ability to meet the needs of children with mild injuries, particularly their emotional needs; lack of psychological support for families; some issues related to Maori and Pacific family support services; lack of accessible and comprehensive information for children and families; poor staff continuity and coordination; and poor coordination of hospital and community services, including inadequacies in follow-up plans. There was considerable agreement between these issues and those identified by the participant families. CONCLUSIONS: The identified issues and barriers indicate the need for interventions for service improvement at systemic, provider and patient levels. Of particular relevance are strategies that enable families to have better access to information, including culturally appropriate oral and written sources; improve communication amongst staff and between staff and families; and carefully developed discharge plans that provide care continuity across boundaries between hospital and community settings. Maori and Pacific family support services are important and need better resourcing and support from an organisational culture responsive to the needs of these populations.

Experiences of whanau/families when injured children are admitted to hospital: a multi-ethnic qualitative study from Aotearoa/New Zealand.

OBJECTIVES: Several quantitative studies in the international literature have described disparities in the provision of and access to health services for a variety of health conditions among 'minority' populations. This New Zealand qualitative study aimed to explore and describe the experiences of indigenous Maori and Pacific families (both minority populations) and Pakeha (New Zealand European) families when their children were admitted to hospital for an unintended injury. DESIGN: Twenty-three children (eight Máori, eight Pacific and seven Pákeha) who were admitted to hospital following an injury were selected using maximum variation sampling from a trauma database and snowball sampling. In-depth individual and group interviews undertaken with the child's whanau/family explored the issues they encountered in the hospital setting. The data were analysed by key ideas and coded into main themes. Each strand was analysed separately by lead researchers of the same ethnic group prior to a comparative synthesis of the overall findings. RESULTS: While many families praised the dedication of the staff, the interviews revealed important concerns regarding their encounters with hospitals and related health and support services. These could be broadly characterised as (a) inadequate communication and information; (b) difficulties negotiating an environment perceived as foreign; (c) the stress of conflicting demands placed on families; and (d) issues relating to ethnicity and cultural miscommunication. Of note, many Maori and Pacific whanau/families felt particularly alienated within the hospital setting and did not appear to see themselves as being entitled to high-quality information or services. CONCLUSION: The findings have important implications for the structure, professional and institutional practices in the delivery of health services. The research also indicates the need for wider societal policies that increase Maori and Pacific whanau/families' sense of entitlement to the full range of available support services, and reduce alienation within public institutions such as hospitals.

What next? Sustaining a successful small-scale alcohol consumption harm minimization project.

Engaging communities in alcohol consumption-related action projects requires the application of a range of flexible and responsive evidence-based methods. These include: establishing collaborative relationships, implementing strategies to improve age verification practices, encouraging organizational change, and raising awareness of local alcohol issues. The focus of this article is the sustainability of an alcohol harm minimization project for young people in Hawera (a small New Zealand town) that has produced some encouraging results. The Hawera Alcohol and Young People project began in 2000 along with external formative and impact evaluation components. This article will draw on the evaluation findings to date and the experience of community action projects in New Zealand to explore what makes a sustainable community action project and to examine the extent to which this has been achieved by the Hawera Alcohol and Young People project. The limitations of the study are noted.