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Introduction to restraint
This module will help you to think about restraint: what it means for you and what it might mean to others, and some ideas that could help your practice.
This introductory chapter explores some basic points about restraint: what is it, and is it ever acceptable?
The ideas presented in this module are based on best practice approaches to care, specifically person-centred care and relationship-centred care. To find out more about these, click here.
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Introduction to restraint
Restraint can be a difficult issue, particularly in care homes.
For care home staff, restraining a resident can be a hard thing to do, but at times not restraining a resident (for example, someone who gets lost outdoors) can also lead to problems.
For many, it is not clear:
- what restraint means
- if restraint is acceptable and in what circumstances
- what is good practice on restraint.
"Care homes criticised for restraints on residents"
The Guardian, 18 December 2007
"Pensioner missing from care home"
BBC news online, 31 January 2007
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Introduction to restraint
Over to you
Let's spend some time thinking about these big questions. Write your first thoughts to the question below.
- What does the word 'restraint' mean to you?
When you have finished, click 'next' to read our thoughts.
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Introduction to restraint
What does restraint mean to you?
For many people, the word 'restraint' makes people think of residents being tied in chairs or held down with force. These are examples of physical restraint, but there are many other types of restraint.
Read the options below to learn more about some other types of restraint.
A helpful general definition of restraint is: "anything which interferes with, or stops, a resident doing what they appear to want to do" (Clarke and Bright, 2002).
Chemical restraint
This includes residents being given sedative or antipsychotic medication inappropriately, without regular review.
Environmental restraint
Some examples of this could be a care home having a complicated layout, hard-to-use door handles or poor lighting, all of which make it difficult for residents to find their way independently around a care home.
Technological restraint
A keypad system or electronic tagging system are examples of this. For some residents, this may increase their safety, while limiting the movement of others.
Passive restraint
An example of this could be when staff routinely tell a resident they should stay sitting down rather than helping them be as independent as possible.
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Introduction to restraint
Over to you
Now, write your first thoughts to the question below.
- Do you think restraint is ever acceptable?
When you have finished, click 'next' to read our thoughts.
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Introduction to restraint
Is restraint acceptable?
Yes, the law tells us that in some situations restraint can be acceptable, but it should be used only as a last resort, and in the least restrictive way possible.
If the resident can't give consent, it is still acceptable for restraint to be used if:
- it is very likely that they will harm themselves or others, and
- the restraint is as least restrictive as possible and used for the shortest amount of time
Care homes should be trying to use restraint as little as possible, if at all.
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Introduction to restraint
Is restraint acceptable?
Continued...
Although a number of laws are relevant to this issue, the most important law on restraint is the Mental Capacity Act 2005. This Act says restraint can be used, but it should only be when it is necessary to protect the person from harm and is proportionate to the risk of harm (see section 6(4)).
A number of organisations have also produced guidance on how to use restraint appropriately.
Dementia:
Supporting people with dementia and their carers in helath and social care, by the National Insitute for Health and Clinical Excellence and the Social Care Institute for Excellence (2006)
Guidance for inspectors:
How to move towards restraint free care, by the Commission for Social Care Inspection (2007) (now the Care Quality Commission)
Lets talk about restraint:
Rights, risks and responsibility, by the Royal College of Nursing (2008)
Physical interventions:
A policy framework, by the British Institute of Learning Disabilities (2008)
Residents taking risks:
Minimising the use of restraints. A guide for care homes, by Counsel and Care (2001)
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Introduction to restraint
Over to you
Write your first thoughts to the question below.
- When is restraint acceptable?
When you have finished, click 'next' to read our thoughts.
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Introduction to restraint
When is restraint acceptable?
Restraint is acceptable in some circumstances.
Read the information below to find out more.
If you want to know more about the conditions under which the law says it is reasonable to use restraint, look at sections 6.40 to 6.48 of the Act's Code of Practice.
A resident may ask for restraint.
Sometimes residents ask for restraint because it makes them feel safer. For example, a resident may ask for bedrails if they are afraid of falling out of bed.
It is part of the care plan agreed by all parties.
It may be that the resident, relatives and the staff team include a form of restraint into a person's care plan (for example, taking a tagging device out when walking in the neighbourhood) as a way of responding to concerns about the resident's safety.
The resident is at clear risk of harming themselves or others.
On other occasions, a situation may develop that presents clear and immediate risks either to the resident themselves or to others. Care staff need to make quick decisions - often under difficult circumstances - as to how best to resolve the situation, which may, for example, involve restraining the person physically.
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Introduction to restraint
Over to you
Lastly, write your first thoughts to the question below.
- When is restraint wrong?
When you have finished, click 'next' to read our thoughts.
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Introduction to restraint
When is restraint wrong?
In some circumstances, restraint is wrong.
In 2007, the Commission for Social Care Inspection (CSCI, now part of the Care Quality Commission) did a survey on restraint in the care of older people in England and reported examples of improper use of restraint.See below for some examples
Some restraint - such as the examples opposite - is abusive and clearly wrong. If you do witness abusive restraint, you must report this to your line manager or a senior manager within the home as soon as possible.
"A staff member dragged a resident by the hair and tied her to a chair."
"A resident sustained bruising to his arms following restraint."
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