Active Independence has been working with Disability Sheffield on a project about Safe Restraint. The purpose of the project was to talk with individual employers and PAs around their understanding of restraint, alternatives to restraint and safe restraint practice.
PAs and individual employers in Doncaster and Sheffield have attended workshops and filled in questionnaires describing their understanding and experiences of restraint. All this information is being used to produce a leaflet which can be used to help you have a conversation with your employer about restraint.
Restraint can be difficult subject, and many don’t wish to talk about it. It is however a very important subject and one that every PA should be familiar with. Let’s take a look…
What is restraint?
“anything that prevents someone from doing something.”
It can take the form of physical restraint, locked doors, use of medication, restricting someone’s choices or withholding information. As PAs we have a duty of care towards the people we are supporting. We need to respect our employer’s right to dignity, freedom and respect.
Our boss may need support in managing their care and making decisions, but they have the right to make choices about their lives and to take risks. They are free to do what they want unless limited by law.
If a person has capacity, does not consent to restraint and there is no risk of harm to other people then restraint is not justified. Restraint is illegal unless it can be demonstrated that for an individual in particular circumstances not being restrained would conflict with the duty of care we provide, and they would either cause harm to themselves or others if we did not restrain, and that the outcome for the individual would be harm to themselves or for others.
The consequences of restraint
The misuse of physical restraint can result in injuries and death. Things to consider before we restrain.
- We need to avoid harm this can be physical or psychological.
- We need to assess the consequences of the restraint we use, we need to weigh up the benefits of what we do versus the harm that could be caused. To me this is more important than it may seem.
- We need to respect for individual’s rights to make their own decisions, and respect these.
- Our actions need to be in the person’s best interests. This is a commonly applied way of ethically justifying an action or decision.
- Our values and beliefs need to be thought about.
There is no one piece of legislation that specifically looks at the use of restraint, but there are a number of laws that have a direct relevance and include reference to restraint within them.
The Care Standards Act 2000 states:
“ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances.”
Restraint may only be used where it is necessary to protect the person from harm and is proportionate to the risk of harm.
Types of restraint
- Physical restraint
The most obvious form of restraint that people think of is physical restraint.. This involves one or more people holding the person, moving the person, or blocking their movement to stop them leaving. A physical intervention is a direct action by one or more people holding or moving the person, by blocking their movement to stop them going where they wish. This should not be confused with guiding and prompts intended to support the person. Physical restraint can also be done by the use of equipment that is not specifically designed for that purpose ie bed rails, belts, tables or chairs etc. The use of this can be subjective and wide ranging.
- Mechanical restraint
Mechanical restraint can involve the use of equipment, such as using a heavy table or belt to stop the person getting out of their chair; or using bedrails to stop an older person from getting out of bed, arm cuffs, splints, or helmets, to prevent self injurious behaviour (SIB) or harm to others. Controls on freedom of movement – such as locked doors, baffle locks and keypads, complicated door handles, narrow doorways, not providing corridor rails, steps or stairs, poor lighting, moving walking aids such as zimmers and sticks, can also be a form of mechanical restraint as it restrains a persons environment preventing them moving as they wish.
- Chemical restraint
This is the use of drug to change or moderate peoples behaviour. This is also known as covert medication. This could be regularly prescribed medication – including that to be used as required – over-the-counter medication, or illegal drugs. There have been many scandals about this in care homes and is quite common in the community.
- Forced Care
Forced care is the act of ‘forcing’ someone to receive care. This could be food, medication, clothing etc.
- Threatening or verbal intimidation
This could be used to make a person subservient or scared of doing what they want to do. It may be calculated to lead people to believe they have no option but to remain in a particular care setting, or make them fear repercussions should they choose to resist.
- Electronic surveillance
Examples include the use of electronic tags, exit alarms, CCTV and pressure pads to monitor or restrict movement. These are often used to alert staff that the person is trying to leave or to monitor their movement. Whilst not restraint, they could be used to trigger restraint, eg physically restraining a person who is trying to get out of bed.
- Cultural or psychological restraint
This could be constantly telling people not to do something, or telling them that what they want to do is not allowed, illegal, or too dangerous. It could be depriving a person of lifestyle choices eg. telling them what time to go to bed or get up, having meals at a time to suit the PA, or even deprivation of activities and other stimulation, such as having the radio on at work when your employer would rather watch the TV. It might also include depriving people of equipment or possessions they need, for example taking away walking aids, glasses, outdoor clothing or keeping the person in nightwear with the intention of stopping them from leaving.
- Medical restraint
This is the fixing of medical interventions such as catheters to deliberately restrict movement or being positioned to prevent their removal.
Restraint should be about helping everyone to stay safe, it should only be used if other ways of helping do not work and it should always be talked about in someone’s support plan.
Please note since this article was written the Restraints project developed into a stand alone website, which can be found by clicking the link below.