This novel nurse-led education and research project, which is funded by The Burdett Trust for Nursing, empowers the mental health nursing workforce to lead multi-disciplinary clinical teams to develop their skills and practice, to reduce restrictive interventions. Our vision is of compassionate nurse-led clinical teams who feel skilled, empowered and connected to reduce the use of restrictive practices and improve the experience and outcomes of service users.

Over the next 12 months we aim to develop, pilot, and evaluate an Augmented Reality (AR) de-escalation training package that delivers sustainable, scalable, and empathy-building learning to frontline clinical staff. AR is a three-dimensional digital environment with the user can interact with as they would a real environment. This learning package will use 360-Degree Augmented Reality (AR) approach, and will be co-produced with service users, front line expert nursing staff, and experts in developing Augmented Reality who will inform development, evaluation, and sharing outcomes. Reducing restrictive practices, with a focus on restraint, will be achieved through using AR to improve de-escalation skills and enhanced empathy for frontline nurses. Implementation will be supported by Nursing Champions within clinical teams.

Through building their own digital environment and using AR, service users and mental health nurses working in SLaM will be placed at the forefront of the current digital revolution within healthcare (Topol review (2019) whilst continuing to adhere to core nursing skills of partnership working, compassion and empathy.

Background to the project

Mental health nurses have a primary role the implementation of restrictive practices including restraint and seclusion. This aspect of mental health nursing is at seemingly odds with the therapeutic role of the mental health nurse and core nursing values of compassion, respect and kindness (NMC, 2018). However, nurses may struggle to maintain their compassion and empathy when working in challenging settings, where there is high empathic demand (Santamaría-García et al, 2017). Nurses may also fear censure from their colleagues due to being seen to actively engage with or conversely avoid restraint and seclusion. Fear and the erosion of empathy have been starkly highlighted by inquiries where restraint has been applied unskilfully and without compassion such as that into the death of David Rocky Bennett in 2004. Greater empathy in nursing has been linked with the reduced use of restrictive practices (Gerace and Muir-Cochrane, 2019).

It has been challenging to promote empathy in traditional training programmes for nurses. Simulation in the classroom has been shown to be effective in enhancing empathy for mental health nurses but can be resource intensive and not available for all nurses (Outlaw, 2019). In 2015, MIND called for training by service users which promotes empathy and compassion, to enable staff to imagine how it feels to be restrained. Face-to-face training has been delivered in partnership with service users but, despite the value that service users bring to these sessions, it remains difficult to place oneself in the shoes of a service user who is being restrained and gain an understanding of what this experience is like. AR provides a realistic and immersive virtual environment, which is adaptable and portable, and can enable nursing staff to engage in simulation and gain a subjective experience of restrictive practices from a service user perspective, whist reinforcing existing skills which have been shown to reduce the incidences of restraint (CQC 2018). Similar studies that use simulation technology as a form of training indicate increased empathy from staff, which service users report to be key in developing positive therapeutic relationships (Riches et al, 2019).

Expected outcomes

It is expected that nurses will be empowered by the AR package by developing greater confidence to make person-centred decisions that reduce the use of restrictive practices through rehearsal, skill reinforcement and the regular provision of up-to-date and service user-focussed evidence for care. Increased confidence in skills, ability and a strong evidence base is also expected to reduce nurses’ fear of the consequences of their action or inaction and empower them to make positive decisions. Empathy will be enhanced by this package, which in turn will support the development of compassionate leadership, to promote the development, growth and empowerment of nurses.

CQC (2018) Brief guide: restraint (physical and mechanical)

Gerace, A, And Muir-Cochrane, E. (2019) Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey International journal of mental health nursing 28(1):209-225 · DOI: 10.1111/inm.12522

MIND (2015) Restraint in Mental Health Services, What the Guidance Says [accessed 22 July 2020]

Riches, S., Khan, F., Kwieder, S., & Fisher, H. L. (2019). Impact of an auditory hallucinations simulation on trainee and newly qualified clinical psychologists: A mixedmethods crosssectional study. Clinical psychology & psychotherapy, 26(3), 277-290.

Santamaría-García, H., Baez, S., García, A.M. et al. Empathy for others’ suffering and its mediators in mental health professionals. Sci Rep 7, 6391 (2017).

Topol, E. (2019). The Topol Review. Preparing the Healthcare Workforce to Deliver the Digital Future, 1-48.