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1 – 10 of over 1000Helen Macilwaine, Carole Watson and Ian McKenzie
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…
Abstract
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.
Krishna Menon, Raghavendra Baburaj and Sarah Bernard
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…
Abstract
Purpose
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.
Design/methodology/approach
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.
Findings
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.
Originality/value
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.
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Heather Sequeira and Simon Halstead
Despite the controversy surrounding physical restraint and seclusion in the care of vulnerable adults, the views of service users have had little impact on current practice. This…
Abstract
Despite the controversy surrounding physical restraint and seclusion in the care of vulnerable adults, the views of service users have had little impact on current practice. This paper reviews the literature documenting the personal views and experience of people with learning disabilities and severe mental health problems following these procedures.
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The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the…
Abstract
Purpose
The purpose of this paper is to describe the nature and impact of a restraint reduction strategy implemented within a secure learning disability service in response to the national Positive and Safe programme.
Design/methodology/approach
The strategy was comprised of three primary interventions – Safewards, positive behavioural support and data-informed practice – and utilised a programme management approach to ensure effective delivery. Baseline measures were collected from 12 months of data prior to implementation of the programme and the frequency of each category of restrictive intervention was then measured prospectively on a monthly basis throughout the duration of the programme.
Findings
Upon completion of the programme the following results were achieved: elimination of prone restraint – elimination of mechanical restraint – 42 per cent reduction in general use of restraint – 42 per cent reduction in use of seclusion – 52 per cent reduction in rapid tranquilisation.
Originality/value
The paper adds to the growing body of evidence that carefully designed interventions can reduce the frequency of seclusion and restraint. In this case, Safewards and PBS have combined to exert their effect. Data-led practice and senior leadership were also found to be of critical importance. Finally, the need for a stable workforce is considered.
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Joy Duxbury, Frances Aiken and Colin Dale
The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and…
Abstract
Purpose
The practice of restraint is controversial as deaths in care or custody have been a consequence of restraint. The purpose of this paper is to clarify research from national and international literature to ascertain any common findings in order to provide guidance for staff on safe and effective restraint techniques where there is no other resort in the management of violent and aggressive individuals.
Design/methodology/approach
The researchers undertook a review of the literature on the medical theories relating to restraint‐related deaths and an analysis of deaths in custody in the UK for the time period 1 Jan 1999 to 1 Jan 2010.
Findings
Findings showed that certain groups are particularly vulnerable to risks while being restrained. There are also biophysiological mechanisms which staff need to be aware of when restraining an aggressive or violent individual.
Originality/value
It is evident that those in vulnerable groups when restrained in a prone position, or in a basket hold, for a prolonged period and who are agitated and resistive, are most at risk of death in custody. Consistency in reporting relevant deaths locally and nationally is necessary to facilitate analysis of key information and prevent deaths in custody in the future. Staff training and awareness are also key factors.
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Concerns about the overuse, misuse and potential abuse of restrictive interventions used to manage people who may exhibit behaviour described as challenging led to revised…
Abstract
Purpose
Concerns about the overuse, misuse and potential abuse of restrictive interventions used to manage people who may exhibit behaviour described as challenging led to revised guidance in England. The purpose of this paper is to examine the implementation of this guidance in organisations providing services for people with learning disabilities.
Design/methodology/approach
A survey collected data from professionals, on leadership, data use, staff issues and post-incident review.
Findings
Most senior leaders were seen as acting on the guidance. Data collected were regarded as generally accurate, but less than half of the managers were seen as likely to respond to consistently high or increasing use of restrictive practices. Frontline staff and managers were seen as very significant for reducing restrictive practices. Uncertainty was shown regarding the goals and activities needed to provide post-incident review.
Research limitations/implications
This exploratory survey may be useful for organisations wanting to audit their implementation of government policy and/or for research on a wider scale to indicate how well societies are implementing policy to reduce restrictive practices. Further research on the survey’s validity and reliability is required.
Practical implications
Further action is needed to encourage all organisations to implement best practice and government policy. This survey showed that some organisations appear to be committed to and potentially achieving reductions in restrictive practices.
Originality/value
This paper describes the first survey designed to evaluate organisational efforts to implement an important policy initiative.
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There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The…
Abstract
Purpose
There continues to be a small group of people who have intellectual disabilities who need some form of restraint in their support plan due to their self-injurious behaviour. The mechanical restraint restricts their freedom of movement to help prevent injury. Despite the growing literature on the use of such devices, there is very limited literature looking at the impact the use of mechanical restraints has upon service users and support staff using them. The aim of this study was to ascertain the experiences of support staff who apply the restraints to the people they support.
Design/methodology/approach
Qualitative methodology was utilised. A semi-structured interview was conducted with nine support workers who: directly worked with a client with intellectual disabilities who engage in self-injurious behaviours; followed positive behavioural support plans developed with a multi-disciplinary team; applied restraints as a response to severe self-injurious behaviours to prevent harm; and they had to have been directly involved in the application and removal of the mechanical restraints in the last week. Content analysis utilising emergent coding was used to analyse the data.
Findings
All participants described using mechanical restraints as having a negative impact upon them. Participants said they manage the negative impact by reframing, inhibiting their emotions, following support plans closely and gaining support from other staff. Participants described concerns and unmet needs regarding whether they were applying the restraints correctly, the responsibility of teaching others to use restraints, not feeling prepared on starting their current job and that the impact/concerns of using restraints is not talked about. Recommendations for practice are made.
Originality/value
This is the first study to explore the views of care staff who are required to use mechanical restraint. It provides insight on the impact of this on them.
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