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Getting started on making difficult decisions
In this chapter we look at some important general ideas to remember when it comes to making difficult decisions about restraint:
- Keep the resident's needs at the centre of the decision making process.
- Be open and positive.
- You are not alone!
- Good record-keeping helps.
- Be aware that there are many alternatives to restraint.
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Getting started on making difficult decisions
Click on the points below to find out more.
Page 2 of 2
Getting started on making difficult decisions
The resident's needs should always be at the centre of the decision making process.
Unintended or passive restraint - where staff fail to provide necessary care - is far more likely when staff are overloaded and not readily available for residents. In these situations, it is the needs of staff that are guiding actions.
In other situations, relatives may have strong views that influence the decision making process. They must be heard and involved, but remember, the prime responsibility of the home staff is to the resident. It is the resident's needs which should guide actions.
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Getting started on making difficult decisions
Be open and positive.
When difficult situations develop - perhaps a resident is doing something that is hard to respond to, such as repeatedly striking staff - it can be tempting for staff to think 'this resident can't stay here'.
The most important thing is to try to be open and positive about the potential you and your staff team have to improve the situation.
So often, with reflection and teamwork, staff can work together to develop an action plan to respond differently and ensure the placement continues smoothly. Staff benefit from this approach too in many ways.
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Getting started on making difficult decisions
You are not alone
You may find yourself alone with a resident when a difficult situation arises, but generally another staff member should be nearby and able to help. Always call on team support in these urgent situations. Having another person witness the event could be vital too.
To make plans about using restraint in the longer-term, remember that good decision making involves consulting with all relevant parties, including the resident, family members, friends, the manager, other involved professionals (say a GP), and, in some particularly difficult cases, the inspection services.
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Getting started on making difficult decisions
Good record-keeping helps.
Reviewing a resident's current situation is difficult without access to good records. No one worker can know everything that has gone on recently.
Although care staff often find time for paperwork is limited, keeping good records is essential. It can form an objective basis to deciding whether something really is a problem after all, and to seeing if there are any patterns to difficult situations.
It is also where you explain your reasons for taking any restraining action - an important legal record. If you are unsure about what to write when recording difficult situations, discuss this with your manager.
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Getting started on making difficult decisions
Be aware that there are many alternatives to restraint.
Finding out about a resident's past and interests, if possible with the help of family, could be the key to knowing what to do in a difficult situation involving restraint.
Playing favourite music might work well to help calm a resident who is distressed by another resident's behaviour. Doing a long, tiring session in the garden could be very satisfying for another resident, making them less likely to be frustrated and lash out at others.
Most likely, the solution will be different for each resident.
If you would like to read more about alternatives to restraint, read SCIE's review of research on restraint, pages 12-14.
Look at the brief list of activity ideas below:
- Music
- drama
- arts activities
- exercise and games
- reminiscence and life histroy projects
- spending time with a volunteer
- aromatherapy
- looking after a pet
- massage
- gardening and access to green spaces
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- Getting started on making difficult decisions