SCIE's Social Care TV film 'Restraint: a human rights issue'
examines how good practice in care needs to take account of an individual's human rights.
How the Mental Capacity Act provides guidance on the use of restraint.
And how accessing public services often involves an imbalance of power between
those providing services, such as medical professionals, and those using them,
such as patients and families.
It notes how these imbalances of power can be keenly felt in situations when we are often
at our most vulnerable - and ensuring that people's human rights are respected and put
at the centre of decisions about their health and care is key to good outcomes and experience.
This film includes two very different examples, fictionalised - and yet drawn from the practice
of health and care professionals with an extensive background working
in the care of older people.
Peter was living in a care home and had developed a urinary tract infection
for which he was taking antibiotics.
A common side effect of such infections is confusion,
made worse by Peter's Alzheimer's disease.
So he was very disorientated. He wasn't sure where he was.
And when a young member of staff tried to explain to him that he was incontinent,
that he'd wet himself, he didn't believe her.
He felt confused and angry.
The team assessed him as lacking capacity at that time as he was unable to understand
or retain information about the decision to get changed.
The first approach was just to wait for a while and revisit Peter.
Different colleagues would try to speak to him and gently try to encourage him
to let them change him.
That approach didn't work.
So they waited for a little while until his family came in.
They took the family to one side and asked if they would mind trying to explain to Peter
that he needed to be changed.
This too was unsuccessful.
Peter became very resistant to the idea of being changed at all and although by nature
he was a very gentle person, his confusion led to signs of aggression.
The staff then met once more with the family and explained that it wasn't in
his best interests to be left as he was.
A decision was made by the team that Peter would have to be held and in the
least restrictive way, changed and cleaned.
It was noted that his dignity should be maintained as far as possible.
Although it was by no means an easy decision
one made after careful consideration and the exploration of all options in this instance
the intervention was agreed to be the best course of action for Peter, his rights,
dignity and wellbeing being central to the decision.
Importantly, the process and options were discussed with his family.
It was also documented in the care plan that if the same situation arose in the future
they may have to consider carrying out the same intervention - but noting that
this need not always be necessary as his condition could well improve.
The situation was also communicated verbally with other carers so as not be
overreliant on the care plan.
Peter continued with his course of antibiotics, became less confused
and less incontinent as a result.
He became more trusting of staff and he no longer needed to be restricted in this way.
Sometimes it is necessary to apply restraint in the interests of an individual's well-being.
However, just because the intervention was necessary once, it doesn't mean that same
intervention needs to be continued into the future.
When people lack the capacity to comply with a request to do something which is in their
best interests, the need for restraint always has to be reassessed on each and
every occasion, as needs and possible solutions change and evolve over time.
Florence, a lady in her late 80s, who had been living alone in her own home, had developed
a chest infection, was suffering from delirium and had been admitted to hospital.
She was becoming increasingly agitated and had taken to wandering the corridors
of the hospital, upset and distressed, crying out for help.
Florence wanted to go and find her Mum and, concerned for her safety, the nursing staff
had raised the rails on the side of her bed as a form of restraint.
As she was not at risk of falling out of bed, the use of side rails was inappropriate
and this was picked up on by a Senior Nurse.
The Senior Nurse explained that there were alternative means of protecting
Florence at this time.
She put the side rails down, helped her put her slippers on and walked around the ward,
talking to Florence about her Mum.
The Senior Nurse, through experience, had understood that many of us when in pain or
afraid have a deep seated need for our mother.
She recognised that what Florence actually needed was comfort and reassurance that
she was safe and that everything was going to be fine.
Luckily Florence had a Life Story Book on the ward, which gave information about
her family background, including her mother,
where she used to live as a child, what her familiy's names were.
She was able to discuss something that was meaningful to her, rather than
simply being presented with the facts:
that she was in hospital, that her mother was not there, that she had a chest infection
and that she couldn't go home.
The action of walking around, taking 10 minutes out to talk to her, holding her hand,
had alleviated her immediate fears and anxieties.
The Senior Nurse was able to explain to Florence that her family would be coming
to see her the next day - and she calmed down, returned to her bed and rested,
without the need for the raising of the side rails.
For Florence's safety, it had to be documented that she had
the urge to leave the ward.
It was communicated verbally with other members of staff, as well as her family
and documented in the care plan, as was the solution.
Safely supporting people is complex.
It is not always possible to spend extended periods of time with one person.
However, in this instance, the time taken to support Florence negated any possible need
for restraint and, on balance, saved time.
The story of Florence is an example of where restraint had been used inappropriately.
Using a person-centred approach and understanding a person's life story
their feelings and emotions has to be central to their care.
Crucially, applying physical restrictions should always be the last resort.