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Making a start on minimising restraint
First, read the transcript below about Des to see how taking a positive approach can help avoid the need for restraint to be used.
Transcript
Narrator:
Des came to the home on a high dose of anti psychotics because of challenging behaviour.
Care Home Manager
He was very unsettled, very angry with life. And he used to pick up the furniture, pile it in the middle of the dinning room and talk about fire. He was just so angry and upset and the first instance from the staff was "Oh my goodness, we can't keep him here."
Narrator:
In Des's case the care workers made a remarkable discovery about his habit of piling furniture high.
Care Home Manager
We looked at his life history and we found that he was a painter and decorator. And, in fact, what he was doing was getting everything, preparing to decorate. He would cover up televisions with sheets, strip off his bed and. So when we looked at that, just understanding what he was doing helped the staff. And we’d have a meeting and sit down and say "Ok how can we help this gentleman?"
We had paint brushes and a roller and just some water in a tin and he was just so pleased to be able to have some sort of meaningful occupation and it’s an important part now of his life.
Des's daughter:
It is obviously working because he is so, he is calmer. But when he is on a mission, he’s on a mission. You could say he thinks he is back in the navy.
Narrator:
As a result, the staff were able to take Des off his anti psychotics.
Page 2 of 7
Making a start on minimising restraint
Can you see what a difference it made to Des, once the staff understood his situation?
Margaret and her team of staff took a person-centred approach to find the right support for Des. This clip shows us that:
- Discussing the problem together
- Finding out about the person and their life history, and
- Being prepared to try unusual ideas
can help to improve situations that seem impossible, and reduce or avoid the need for any restraint.
Page 3 of 7
Making a start on minimising restraint
Now we're going to think about three different residents, and how our work with them could make a difference in reducing the need for restraint.
Click on each of the people below to hear their stories.
When you have read their story, think about the questions at the bottom and click the study notes read some of our ideas.
Making a start on minimising restraint
Nell
Before coming to live in the care home, Nell always enjoyed her daily morning walk up to the local shops. She never missed a day. Chatting to a few of the shopkeepers, seeing the buses come and go, Nell had her routine. She knew her route and seemed to keep to it reliably, despite increasing memory problems.
Nell has now been at the home for a month. She is desperate to leave and constantly pulls at the front door. She is a very energetic person, and seems bored. The fact is, she never leaves the home.
How would you feel if you were Nell?
What do you think might help in this situation?
How do you think your care home would handle this situation?
Making a start on minimising restraint
Nell - Study Notes
The important thing here is to try to find out as much as possible about Nell, and why it is that she is wanting to go for a walk. Is it talking to people that is important to her, or the fresh air?
Rather than restrain Nell as she tries to leave the home, it would be better to support her to continue this routine as much as possible, perhaps in a modified way if necessary.
- Could Nell go out on her own? With careful planning, risk assessment and monitoring this might be a possibility and should be considered.
- Could a staff member go with her for a short walk outside?
- Could several residents go out together with staff?
- Could a relative go out with Nell, perhaps once a week?
- Is there a safe place in the garden where Nell could sit and watch the outside world go by?
The lesson from this example is that good practice involves valuing the person's needs, preferences and view of the world.
Making a start on minimising restraint
Bill
Bill becomes distressed every time after his wife has visited, usually lashing out at staff verbally and sometimes physically. Care staff know it will happen, and it almost always does. Each staff member responds as best as they can in the situation - but each person's approach varies, and the team are not sure what to do next.
What could help Bill in his situation?
Making a start on minimising restraint
Bill - Study Notes
The team need to come up with a care plan that they can all work to together, based on their knowledge of Bill. And don't forget - the team involves family too.
Does Bill's wife know about his reaction to her departure? Does she have ideas for what might help?
Would it help to delegate one staff member to spend time with Bill when his wife leaves?
Would it help if Bill was encouraged to do something such as play cards with another resident when his wife leaves?
By being consistent and offering extra support at times when residents have higher needs, we are more likely to prevent problems arising - such as the need for urgent restraint. Good care planning and teamwork can make a real difference.
Making a start on minimising restraint
Lillian
Lillian has found it difficult to make friends since coming here a year ago, despite being a sociable woman. She is the only black woman living at the care home. Previously she was a cook at her local Caribbean lunch club and well-known to many. Other residents don't seem to talk much, and some of the staff have difficulties understanding Lillian's accent. She finds the food unappetising, especially since the Caribbean chef left recently. Lillian has become quite withdrawn and doesn't participate in any activities at the home. Lillian's daughter is becoming distressed about the situation. She feels the staff are not concerned enough about the change in her mother's situation and that they are not doing anything active to assist - they just seem to say 'That's how Lillian is now'.
If you were Lillian's daughter, what would you try to do in this situation?
What should staff be trying to do now?
Making a start on minimising restraint
Lillian - Study Notes
Lillian is not being physically restrained here - but she is being unintentionally, or passively, restrained as she is needs active support to keep up vital connections with her community and her past, and to feel at home here.
Staff need to find out as much as possible about Lillian's background, cultural needs and interests to link her with culturally appropriate networks and support.
Developing a good relationship with Lillian's daughter and taking her concerns seriously could be key to this.
Perhaps Lillian's daughter has a solution?
Could Lillian's daughter work with the home to establish a link with the lunch club where Lillian worked? Perhaps a volunteer from there could visit Lillian?
Does the new chef need to be involved in finding out Lillian's preferences for food?
This example shows that valuing the views and involvement of relatives can also make a difference on issues to do with restraint.
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Making a start on minimising restraint
None of these situations were everyday experiences for us but, unfortunately, they can be for many people with dementia. The way we interact with people has a major impact and we need to be careful not to cause distress or anger because we haven't understood how things seem from the person's perspective.
If we pay close attention to the person's responses, we can gain insight into their reality and find ways of communicating that address this.
This may involve, for instance, providing explanations; ensuring that people feel in control; focusing on abilities rather than difficulties, and always taking feelings seriously.
Page 5 of 7
Making a start on minimising restraint
Now read through these two video extracts, and notice how the communication of staff in these care settings takes into account the feelings and needs of each person.
Transcript 1
Care home staff worker
Yes, it's really important that we do get the hearing right on a resident because obviously if we can't communicate with them they can't communicate back. Then you get frustration will build up where their trying to express what the problem is.Cut away to staff member looking at a patients hearing aid.
Right how’s that... ?
If you haven't got the hearing right, you know, the communication just isn't good. So it is quite important to get it checked regular.
Second Care home staff worker
Sometimes residents get upset and when we come along we don’t know what the reason is. The best thing to do is find out what it is that their upset about and have a word with them to comfort them and make them feel comfortable, instead of going against what they believe. When they get upset to them it is always for a good enough reason, to them it is real.
Transcript 2
Older lady in white shirt, pink cardigan
Di di di di do do do di di di do do do. It's wonderful, he, he he , ha ha ha ha. Can we sit down minute please?
Carer
Yes come on then, you want to go in doors?
Older lady in white shirt, pink cardigan
It's cold
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