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There are considerable differences between the USA and the UK in terms of the practice of in‐patient care, particularly in the use of restraint. The American legal system defines restraint in terms of physical, mechanical, and chemical restraints, of which only physical and chemical restraints are routinely used in the UK. There is a need to agree a standard definition of restraint as it is used in the UK, which may be valuable as one proxy for quality. Such information would enable nurses to make appropriate use of the published literature, make valid comparisons within and between institutions, and provide evidence about the kind of nursing education and nursing practice development needed to produce quality patient care.

This review seeks to provide an overview of the current research evidence on the use of restraint as an intervention in managing challenging behaviours in relation to children with intellectual disabilities. It also aims to discuss legal frameworks and ethical considerations that underpin the use of restraint in intellectually disabled children who present with challenging behaviours.

The authors conducted a search of existing literature primarily pertaining to the management of challenging behaviours in intellectual disability on PubMed, PsycInfo and Google Scholar using combinations of the following key words – children, intellectual disabilities, learning disability, mental retardation, challenging behaviour, restraint, seclusion, physical restraint, mechanical restraint, personal restraint, and chemical restraint. Since research on the use of such interventions in children has been hitherto scant, literature relating to their use in intellectually disabled adult populations as well as cognitively able children was also examined to ascertain whether the broad principles informing the use of restraint interventions could be generalised to their use in intellectually disabled children.

The review finds evidence to suggest that restraint interventions in their myriad forms are widely used to manage challenging behaviours in children with intellectual disabilities and outlines the evidence base, clinical scope, and the risks associated with the use of such interventions in children. It also helps highlight the current absence of comprehensive evidence based guidance that incorporates clinical, ethical, and legal aspects of the use of restraint interventions in children with intellectual disabilities and raises relevant questions in relation to their judicious use in this patient group.

The authors believe that the review completes the first in depth evaluation of the use of restraint interventions in children with intellectual disabilities and are confident that this would serve as useful guidance for professionals working with this patient group who may be considering using restraint interventions in their everyday clinical practice.

The purpose of this paper is to critically review the context of adult protection in Ireland with a focus on older people. The paper traces advances and current limitations in policy, regulation, practice and legislation.

A review of historical and current contexts in adult safeguarding in Ireland is presented with consideration of key public reviews and commentaries related to care provision, governance and the legislative status of adults at risk.

While Ireland’s journey to provide adult safeguarding responses for older people has progressed since 2002, there remain many gaps. Further work needs to be addressed urgently to enable a comprehensive alignment of fit-for-purpose, responsive legislation, practice and policy to meet the complex and diverse needs of an increasing ageing population who may require safeguarding support. This includes fostering robust inter-sectorial collaboration, safeguarding legislation and cultural change related to human rights approaches.

The paper is a discussion on the context of adults safeguarding in relation to practice, policy and legislation.

Identifies the need for significant reform in the Irish system of health service. Argues for an overarching, inter-sectorial approach to addressing adult safeguarding, which focuses on prevention as well as early intervention.

The paper offers a review of the current diverse elements comprising current adult safeguarding and older people in Ireland and integrates legislative, regulatory, policy and practice realities. Challenges are illustrated within the context of reactive rather than proactive safeguarding agendas which are linked to public scandals and debates. The paper argues for a more integrated and robust inter-sectorial approach to safeguarding underpinned by adult safeguarding legislation and an overarching governance structure.

The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like.

This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance.

People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital.

Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld.

The purpose of this paper is to outline the historical background and policy context of mental health services for people with intellectual disability (ID) in Ireland. It then considers recent implementation and lessons from the Irish experience.

The policy background and research literature relevant to the development of mental health services for people with ID in Ireland was reviewed and discussed.

Mental health services in Ireland remain in a state of change, moving towards the implementation of specialist multi-disciplinary teams in the community, alongside previous models of care and service.

This paper summarises recent advances and research regarding mental health services for people with ID in Ireland.

The paper illustrates the process of delivering changes to mental health services with practical implications for mental health services internationally.

This is the first paper in many years to summarise the development of mental health services for people with ID in Ireland. There has been considerable recent change and it is therefore important to provide a useful reference for the current status of services.

Past research has shown individuals with autism spectrum disorder (ASD) visit hospital emergency departments (ED) at high rates. In order to assist individuals with ASD, their families and health care providers to improve ED care, it is important to understand these encounters in greater detail. The purpose of this paper is to provide a descriptive summary of the ED experiences of adolescents and adults with ASD, from the perspective of their families.

A subset of data from a larger prospective cohort study was used. Specifically, 46 parents of adolescents and adults with ASD provided details concerning 49 ED visits over a 12-month period.

Results suggest a range of presentations requiring ED use, and also diverse profiles of those with ASD who visited the ED, in terms of age, gender, and ASD severity. While overall degree of satisfaction with care received in the ED was high, parents provided recommendations to improve the ED experiences for their family members with ASD.

This is the first study to provide detailed accounts of ED visits from the perspective of parents of adolescents and adults with ASD. Families play an important role in the lives of individuals with ASD across the lifespan and it is important to include their perspective to improve hospital-based care for those with ASD.

This study provides data on elder abuse and neglect in German nursing homes. It uses a multimethod approach to analyse conditions leading to abusive and neglectful behaviour.

Abuse and misuse of Substitute Decision-Making (SDMg) authority impacts the lives of children and adults with decision-making disabilities. The concerns raised in this paper amplify previous attention addressed by advocacy agencies and law reformists such as the Law Commission of Ontario. I analyse problems associated with Plenary Guardianship from both the lived experience of the non-guardian perspective and from the authority bestowed to the Guardian pursuant to the Guardianship and Administration Act 1990 of Western Australia legitimating the unintended capacity to abuse one’s substitute decision-making authority. Substitute decision-making arrangements enable decisions to be made on behalf of a person with a decision-making disability; usually made when such arrangements are necessary and subject to safeguards. Detrimentally, the substitute decision-maker (SDM) can assert broader powers beyond sensible measures that include thwarting investigations undertaken by family members; removing family members from the life of the person for whom an order is made; inappropriately applying a paternalistic or ‘best interest’ approach to decision-making where other approaches are required; failing to consider the individual’s wishes or making decisions contrary to those wishes; having insufficient contact with the individual; and, sharing insufficient or incorrect information. Moreover, they may subject the individual for whom an SDM order is made to experimental medical treatment in tandem with imposing or condoning severe and harmful restrictive-practices. Consequently, the second issue addressed in this paper concerns normalising both chemical and physical restrictive-practices that are both morally abhorrent and clinically highly questionable. Furthermore, often undertaken by service providers and their contracted psychiatrists and treating teams, endorsed under authority of a collaborating Guardian or SDM.