This guide will help you answer The RQF Level 2 Diploma in Care Unit 1.5 Describe restrictive practices.
Restrictive practices are measures or interventions that limit an individual’s freedom and autonomy. In health and social care settings, they are used to manage challenging behaviours and ensure the safety of the individual and others. However, their use must be justified, proportionate, and in the best interest of the person receiving care.
Types of Restrictive Practices
Physical Restraint
Physical restraint involves using force to hold someone and restrict their movement. This includes holding a person’s arms down to stop them from hitting someone or using a lap belt on a wheelchair to prevent falls. Physical restraint should be a last resort and used only when absolutely necessary to prevent harm.
Examples:
- Holding arms to prevent self-harm or harm to others.
- Using bed rails to prevent falls during sleep.
Mechanical Restraint
Mechanical restraint means using equipment to restrict a person’s movement. This method includes things like specialised chairs with belts or cuffs. It’s typically used when there is a significant risk of injury, and other methods have failed.
Examples:
- Wrist straps to prevent someone from removing vital medical equipment.
- Chairs with safety belts to maintain the position of individuals who can’t sit unaided.
Chemical Restraint
Chemical restraint involves using medication to control or subdue behaviour. This should only be done under medical supervision and as part of a care plan. Continuous assessment is vital to ensure the dosage and its necessity remain appropriate.
Examples:
- Sedatives to calm someone during a severe agitation episode.
- Antipsychotic medications for managing severe psychiatric symptoms.
Environmental Restraint
Environmental restraint is about controlling a person’s access to certain areas or items. It involves changing the environment to reduce risks and harm. This method must balance the individual’s freedom and safety, always respecting their rights.
Examples:
- Locked doors to prevent access to hazardous areas.
- Removing sharp objects to prevent self-harm.
Seclusion
Seclusion involves keeping someone in a room or area where they can’t leave. This practice is typically used when a person poses an immediate threat to themselves or others. Seclusion should follow strict guidelines and be monitored continuously.
Examples:
- Isolating someone in a safe room during a violent outburst.
- Using a secure room in a psychiatric hospital for acute management of dangerous behaviour.
Ethical Considerations
Person-Centred Approach
Every restrictive practice must follow a person-centred approach. This means understanding the individual’s needs, preferences, and rights before implementing any restriction. Care plans should be reviewed regularly to avoid unnecessary or prolonged use.
Least Restrictive Option
Always use the least restrictive option. This principle ensures that the person’s freedom is limited as little as possible to achieve the intended safety outcome. Any action taken must be proportional to the risk presented.
Consent and Capacity
Assessing consent and capacity is critical. If a person has the capacity, they should be involved in making decisions about their care. When they lack capacity, decisions should be made in their best interest, considering past preferences and involving their family or advocates.
Legal Framework
In the UK, the use of restrictive practices is governed by several laws and guidelines. These include the Mental Capacity Act 2005, the Care Act 2014, and the Human Rights Act 1998. Adhering to these regulations ensures practices are ethical, legal, and in the best interest of the individual.
Minimising the Use of Restrictive Practices
Positive Behaviour Support
Positive Behaviour Support (PBS) focuses on understanding the reasons behind challenging behaviours. By addressing the root causes, PBS reduces the need for restrictive practices. It involves creating supportive environments and teaching new skills to replace challenging behaviours.
Training and Supervision
Staff training is crucial. Workers must understand the types, ethical considerations, and legalities of restrictive practices. Regular supervision ensures that practices are used appropriately and that staff are supported in managing challenging situations.
Monitoring and Review
Regular monitoring and review are essential to ensure restrictive practices are necessary and effective. This includes maintaining detailed records and conducting regular audits. Reviews should involve multidisciplinary teams and, where possible, the individual and their family.
Involvement of Families and Advocates
Families and advocates should be involved in decisions about restrictive practices. They provide valuable insights into the individual’s history, preferences, and behaviours. Their involvement ensures that decisions are person-centred and respect the individual’s rights.
Example answers for 1.5 Describe restrictive practices
Here are example answers a care worker might write when completing this unit:
Example Answer 1: Physical Restraint
Physical restraint is when I use force to hold a person and stop them from moving freely. I’ve seen this used in our care home to prevent someone from harming themselves or others. For example, we had a resident who kept trying to hit other residents when they were upset. We used a gentle but firm hold on their arms to stop them from hitting out. We only used this when absolutely necessary and always recorded it, ensuring the restraint was the minimum needed to keep everyone safe.
Example Answer 2: Mechanical Restraint
Mechanical restraint involves using equipment to restrict movement. One instance I remembered is when we used a specialised chair with a belt for a resident who couldn’t sit upright by themselves and kept slipping, risking injury. The belt helped to keep them in a safe position. It’s important that we check the belt regularly to ensure it’s not causing discomfort and only use it as part of their care plan agreed with their family and healthcare professionals.
Example Answer 3: Chemical Restraint
Chemical restraint refers to using medication to manage behaviour. I recall a situation where a resident with severe dementia often became extremely agitated and posed a risk to themselves and others. After consulting with the GP and the resident’s family, they were prescribed a mild sedative to be used during these episodes. We always monitored the resident closely after administering the medication to ensure they were safe and comfortable and reviewed the medication regularly with the healthcare team.
Example Answer 4: Environmental Restraint
Environmental restraint is about controlling access to certain areas or objects to ensure safety. For example, our care home has a kitchen with sharp utensils. To prevent residents with cognitive impairments from accessing dangerous items, the kitchen is always locked when not supervised by staff. This helps prevent accidents and injuries while also ensuring the residents’ safety. We also explain to residents why certain areas are restricted to maintain trust and understanding.
Example Answer 5: Seclusion
Seclusion is when a person is put in a room or area they can’t leave. I have seen this used once when a patient became extremely violent, posing an immediate threat. They were moved to a seclusion room designed to be safe and watched closely by staff through a window. This was to calm down safely. Seclusion is always a last resort, used only when necessary and for the shortest time possible, and recorded with detailed notes about the incident and the reasons for using seclusion.
Example Answer 6: Positive Behaviour Support
To minimise the use of restrictive practices, we use Positive Behaviour Support (PBS) approaches in our care setting. For instance, we had a resident who would often get very distressed during meal times. By observing and understanding their behaviour, we realised that the noise in the dining area overwhelmed them. We implemented a quieter mealtime setting for them, which significantly reduced their distress and eliminated the need for any restrictive practice. Positive Behaviour Support helps by addressing the root causes of challenging behaviours through personalised and supportive interventions.
These responses show a comprehensive understanding of different restrictive practices and highlight the importance of ethical, person-centred care.
Conclusion
Restrictive practices are sometimes necessary to ensure safety in health and social care settings. However, they should always be the last resort and follow ethical and legal guidelines. By adopting a person-centred approach, using the least restrictive options, involving the individual and their advocates, and regularly reviewing practices, we can ensure that the use of restrictive measures respects the dignity, rights, and well-being of individuals in care.
Understanding restrictive practices enables care workers to balance safety and autonomy effectively. With proper training, supervision, and adherence to laws and ethical guidelines, restrictive practices can be implemented responsibly, ensuring the best outcomes for individuals in care.