Minimising the use of restraint in care homes

Title of guidance:

Minimising the use of restraint in care homes for older people: exploring restraint

Author: Nursing Times video produced by Social Care Institute for Excellence

Minimising restraint stillYear published: 2010
Length: 11 min 53
Format: on-line video resource; videos available for download (MOV and WMV files); PDF transcript(458Kb)
Other formats: Contact http://www.scie.org.uk/socialcaretv/index.asp
Producer/ Publisher: Social Care Institute for Excellence (Social Care TV)
Type or organisation: NGO/voluntary organisation

 Download guidance:

  • Download this report from the Social Care TV website
  • Link in full: http://www.scie.org.uk/socialcaretv/video-player.asp?guid=5d129afa-6dfb-41e0-9955-c91116eb3629 or http://www.nursingtimes.net/5018391.article?referrer=e26

Categories:

Adult Social Care | Health | Generic | Evaluation of practice | External Service Guidance | GB wide| Case studies

Audience: Service management | Front-line service personnel | Policy managers and directors | Human resources

Topics: Human rights | restraint | assessing risk | dignity | autonomy | mental capacity | mental health | manual handling | residential care | safeguarding | best interests | disability | age | abuse | independent living

Summary

This video provides expert commentary in exploring the (sometimes subtle) uses of restraint in residential care homes and gives an assessment of good and bad practice of front-line staff. The use of restraint and the appropriate responses of care providers to residents are addressed in the video.

Four scenarios are enacted and commented on. In scenario 1, a resident is interested in going outside; in scenario 2, a woman is prevented from getting up from her chair; in scenario 3, a man is chemically restrained when seeking care assistance in the middle of the night; and in scenario 4, a woman is dressed in preparation for a meal. Two experts discuss each situation and assess whether appropriate restraint and behaviour was applied. They provide commentary as to how the situations could be handled to minimise restraint and to ensure the dignity of the care home residents.

Key human rights messages in this guidance

  • Use of restraint is linked to a number of quality of life issues that must be assessed when providing care to the elderly.
  • Person-centred care means listening and gathering information about the individual and their preferences and needs, with conscious thought to preserving the individual’s dignity and being open to ways of minimising unnecessary restraint.
  • Minimising restraint can be accomplished by striking a balance between empowerment, independence, safety and risk. Restraint should only be used as a last resort.
  • All of the scenarios examined highlight important issues around treating people with dignity and respect. They are also particularly relevant to the issue of protecting people’s right to private and family life.
     

 

Full review of this guidance

Key practice issues

Two experts, Tracey Paine, Author of RCN Let’s Talk About Restraint and Ann McFarlane, a disability rights and equalities consultant, view four video enactments (fictional case scenarios) of residential care home staff working with care home residents. They comment on whether each example constitutes restraint and what can be learned from the scenarios depicted.

The video addresses the following issues around restraint:

  • different forms of restraint
  • prevention
  • not listening
  • restriction/isolation
  • controlling
  • risks
  • safety
  • abuse and neglect
  • inappropriate medication
  • human dignity
  • respect for privacy
  • attention to individual needs
  • mental health
  • enablement
  • equality
  • freedom
  • independence
  • empowerment

Scenario 1

In this scenario, Bob is physically restrained (stopped) from opening a door to the outdoors, which appears to be locked. The care provider scolds Bob for attempting to go outside, noting the dangers of the busy street outside, and moves Bob out of sight of the door quickly. She tells Bob to sit in his favourite chair and that his actions are pulling her away from her other tasks.

Expert comments: The experts find that physical restraint is used in keeping Bob indoors. The emotional response of the care provider is inappropriate, and there is no concern shown for Bob’s interests or who Bob is as an individual. The care provider is concerned with safety regulations, and getting on with her day, rather than focusing on the needs of the resident. The experts comment that residents should be supported to have access to things they enjoy or are used to in their lives, such as enjoying the outdoors. The management of the care facility should consider making a door available to the outdoors where residents can come and go independently, or have staff available to escort them as needed.

Scenario 2

A woman is constrained to a chair with a plate of food in front of her and she is moving the chair in frustration. The care provider responds to the woman by describing her actions as ‘like a monkey’ and placating her frustrations by trying to calm her into being a ‘good girl,’ telling her it is a lovely day and it is almost time for her nap, whilst not addressing the source of her frustration.

Expert comments: The experts find that physical restraint is used to prevent the woman moving from her chair. Issues of dignity, independence, and social isolation are raised here, as well as the need for care workers to consider promoting social interaction and alternatives to such forms of isolation and restraint. The experts offer ways to think creatively about minimising restraint and creating an environment that encourages social interaction, particularly during mealtimes.

Scenario 3

A man appears distressed and confined to a bed. He rings his bell for assistance. The care provider first stops at a locked cupboard and retrieves medication, and then goes to him and tries to quieten the man by asking him to calm down, stating his waking at night is a continual pattern and a problem for her. She does not listen to or communicate with him. She gives him medication and leaves him while he is still showing signs of distress.

Expert comments: The experts find that chemical restraint was applied with no apparent reason. No assessment was made of the reason for his waking, or what his needs for assistance were. The experts stress the importance of assessing the needs of the individual. Managing the man’s care plan is also an issue here. If he is distressed every night, this information should be logged by the care providers and an assessment should be made as to what might be causing this disturbance. Could it be linked to his sleep pattern? Perhaps a lamp for reading could be provided for people who do not sleep at ‘scheduled’ times. Are care providers taking time appropriately to respond to residents’ needs? The experts point out the problems in making assumptions without asking residents what their needs are first.

Scenario 4

A woman is in her chair and closes her eyes when a care provider enters the room. The care provider wakes her, moves her and handles her to get dressed quickly, in a rush for lunch. The care provider moves her arms and head to fit her into the clothes, outpacing her and saying ‘good girl’ at every move.

Expert comments: The woman is spoken to like a child, treated in a humiliating way. One expert identifies this as ‘very subtle restraint’, which, she comments, goes on every day in residential care facilities. Lack of attention to the woman’s own daily routines (e.g. combing her hair) is a subtle form of restraint. Care providers should not expect residents to conform to someone else’s time frame, but should facilitate an environment that respects the resident’s time frame and their individual needs.

In conclusion, the experts discuss the need for care home resident committees or groups to involve residents in all aspects of creating a care home, such as choosing a garden area or having a voice in shaping the space that they can feel at home in. Nurses and care staff need to take up the challenge of finding the right balance between independence, safety and risk for each individual. The experts stress that a care home should support the needs of individuals, and not be an institution that puts staff duties before understanding residents’ needs and wishes. Tracey Paine states that for her restraint is a last resort option.

Date of review

March 2012

This video is the second in a three-part series: Minimising the use of restraint in care homes for older people videos on Social Care TV: http://www.scie.org.uk/socialcaretv/topic.asp?t=minimisingtheuseofrestraintincarehomesforolderpeople

The other two videos are:

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