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Communication

This chapter will explore how managers can help their care home communities tackle the matter of restraint by being good and willing communicators.

Care home communities include people with a diverse range of needs and wishes, and restraint is a difficult and emotive issue.

Residents, staff, relatives and other professionals (for example, a GP) may all have different views about what is risky behaviour or what restraint means.

In complex situations, good communication is vital.

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Communication

Below are some of the ways that managers can model good communication.

Click on each link to find out more information.

  • Be clear in your own views
    For managers, showing good leadership on the use of restraint will depend on you being able to speak plainly and clearly about your views on this emotive topic.
  • Develop a support network
    Before a challenging situation develops, it can help everyone if the manager is clear about sources of support should a problem arise - for you as an individual, and for your care team.
  • Work with relatives onr restraint
    Speaking with relatives about restraint may be some of the hardest discussions you have as a manager. However, ensuring that relatives have space to discuss any concerns could be vital and may help resolve the situation faster and more sensitively.
  • Involve all parties and talk together
    Facilitating a meeting of people with different views can be intimidating - and it can test the best communicator's skills. But tackling difference head-on is usually the best way forward.

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Communication

Be clear in your own views

Restraint approach

Spend time thinking about what is an appropriate use of restraint. What would your ideal approach be in your home? It may help to look at SCIE's other e-learning resources on this topic while you do this.

See the resources section for more information.

Policy

Look in detail at your organisation's policies on risk and restraint. If the policies do not exist or are unclear discuss your queries and concerns with senior management, and try to get some guidance and support (see RCN 2008).

Legal position

Research the legal position on restraint including professional guidance (in particular look at SCIE's website, which signposts an extensive range of resources that relate to the Mental Capacity Act).

For more on this, click on the visit the resources section

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Communication

Work with relatives onr restraint

"In Doncaster, care home managers meet together at quarterly networking forums to learn and share experiences. This forum is hosted by Rotherham, Doncaster and South Humber Mental Health NHS Foundation Trust's Care Homes Liaison Service based in Doncaster, which supports all care homes in the Doncaster area, often in situations that involve behaviour that is challenging. By meeting together, care home managers can learn from others' experiences and share lessons they have learned from difficult situations. Now some managers ring colleagues informally, even out of hours, for support and advice."

Networks

Try to find opportunities to discuss your situation with other managers in similar situations. Join a network - or establish one if there isn't one locally, and try to meet regularly. Some private care home firms have network meetings for managers. The Margaret Butterworth Care Home Forum is a London-based forum for those working in care homes, where people meet every few months. For more information, go to www.ucl.ac.uk/dementia . Online networks can be a practical solution for managers too, such as the one promoted by My Home Life, known as 'Shared Space' (go to www.myhomelife.org.uk ).

Joint working

Be clear about arrangements for joint working in difficult and crisis situations: this may involve liaising and even petitioning local acute and primary care trusts and the local authority if this help doesn't already exist.

Identify local contacts

Identify if there is a named individual professional who can assist and advise in difficult situations - preferably from local statutory services, and ideally from your care home firm's management also. Work to develop a positive relationship with this person. External professionals can sometimes see and say things that an 'insider' is unable to.

Identify specialists

Identify if there are any other local dementia specialists who could assist, for example a local Admiral Nursing service. The Admiral Nurses operate a national telephone advice line, staffed by specialist dementia nurses - this can help if there is no local service. The number for this service is 0845 257 9406.

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Communication

Work with relatives on restraint

Tips for working with relatives on restraint

Relative discussions

Be prepared - discuss risk and restraint with relatives before problems arise, for example at the start of the placement or at a regular review. Explain the home's approach to risk and restraint, and be positive about the ability of staff to respond to difficult situations.

Relative's views

Consider asking relatives some questions about their views on risk and restraint, such as: what are your fears for your relative here, and what helps your relative when they are distressed? These may be hard questions to ask and discuss. But this information could be invaluable and help make communication between all parties clearer and more positive.

Strategy

Be clear about what strategies are in place should problems arise and what support is available to the home and to families.

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Communication

Involve all parties and talk together

Tips for facilitating discussions about restraint

Sample invitees to planning meeting

  • Minnie (resident) for part of meeting, if Minnie wants to and is feeling up to it
  • Minnie's daughter
  • Beryl (home administrator, often involved in situations with trying to encourage Minnie not to leave the home)
  • Daphne (team leader)
  • Carolyn (manager)
  • Ron (local authority social worker who facilitated the start of placement two months ago)

Before a meeting

Before a formal meeting or discussion, first meet with staff to resolve issues within the team so that you can present a clear and united position. It may even be necessary to meet with an individual staff member if you feel there are particular concerns about their practice in this area. A relative too may feel better if they have been able to speak privately with the manager or another member of staff first.

Who to involve

Involve the resident if possible, staff, relatives or friends, and any professionals (perhaps a GP, or advocate) in a formal discussion. All parties can learn from each other and come up with an agreed plan of action that everyone can own.

At the meeting

At the meeting, start on a positive note. Make clear the team's approach, and be hopeful about the home's potential to respond positively to the situation. Some or all parties may have become quite negative about the situation and feel hopeless about a solution, but it's vital that managers set a positive tone.

Resident's wellbeing

Keep the resident's needs and the promotion of their wellbeing at the centre of all discussions. Be clear about what the resident's needs are. Participants may have different views on this, and what best supports the resident's wellbeing.

Good practice

Follow good practice for running meetings.

Give all invitees good notice of the meeting, ensure everyone has a chance to speak, and be clear about outcomes from the meeting, including who will do what and when.

Reporting problems

Use the care home's records to report on the problem. Some people may have an exaggerated idea of the scale of the problem. It can help if records make clear the nature and extent of the problem.

Solutions

Be prepared to consider a range of possible solutions. It may help to research options beforehand, or talk to other professionals about their ideas.

Facilitator

Ask an external facilitator to run the meeting if this would be helpful. You may feel you can participate better if someone else runs the meeting. Perhaps a regional care home manager could take this on?

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Communication

Finding other ways of communicating

The ideas in this chapter have been informed by a range of resources and publications, but in particular materials from the My Home Life project (see 2007 and 2008 publications).

The My Home Life project produces a range of valuable resources, including regular bulletins and posters that promote good practice and can be displayed in your care home.

For more information, go to www.myhomelife.org.uk

The Alzheimer's Society also produces colourful posters that can help display positive messages within a care home. For more information, go to www.alzheimers.org.uk