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Service users' views of physical restraint procedures in secure settings for people with learning disabilities
- Authors:
- JONES Peter, KROESE Biza Stenfert
- Journal article citation:
- British Journal of Learning Disabilities, 35(1), March 2007, pp.50-54.
- Publisher:
- Wiley
The appropriateness and justification of physical restraint procedures in secure learning disability settings is an emotive issue. This paper examines the views of 10 service users from secure residential facilities who are restrained frequently. Using a semi-structured interview schedule, Service users were interviewed about their restraint experiences. They reported that restraint can lead to potentially abusive situations and that staff should try other approaches before restraining someone. They were divided on whether it calmed them down and whether staff enjoyed performing restraint. Other comments included that restraint may or may not serve a purposeful goal and that there is a definite need for staff training for those involved in performing restraint.
Lived experience of restraint, seclusion and segregation (RSS): stories and recommendations for safer care
- Authors:
- ADVONET, CHANGE
- Publishers:
- Advonet, Change
- Publication year:
- 2020
- Pagination:
- 23
- Place of publication:
- Leeds
This report aims to put the authentic voices of people with lived experience of restraint, seclusion and segregation (RSS) in care settings at the heart of the conversation about safe and effective care. Participant spoke of being afraid, scared, angry, upset when experiencing RSS; they felt that staff in healthcare settings lacked empathy and were not person-centred; and that there was a lack of adequate staffing in care settings. They saw the impact that poor resourcing, lack of training, and unsupportive cultures had on the staff who were at the frontline of their care. Some participants had positive experiences of RSS. They were clear that this was when it was used as part of a person-centred de-escalation strategy, with compassion, and as a last resort where safety was a concern. However, participants also provided very many examples of bad practice in implementing restraint, seclusion and segregation. People spoke of many experiences where they were physically, psychologically and emotionally harmed. People with lived experience expect: robust, personalised and appropriate training for care staff; accountability and action, at all levels, including funding commitments from the government for better, community-led care models; a stronger role for advocacy, including peer and family advocacy, and a more co-operative and involving culture within care providers. Most of our participants voiced the view that restraint, seclusion and segregation should be stopped, and people should be cared for in their own communities with appropriate support. (Edited publisher abstract)
Restraint and seclusion: the perspective of service users and staff members
- Authors:
- MERINEAU-COTE Julie, MORIN Diane
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 27(5), 2014, pp.447-457.
- Publisher:
- Wiley
Background: The current study examined how restrictive measures are perceived by persons with intellectual disabilities and staff. Materials and Methods: Interviews were conducted with eight persons with intellectual disabilities who experienced a restrictive measure and their care providers. They were queried on their understanding of the restrictive measure, its impact on the relationship, their emotions and alternative interventions. Results: Restrictive measures were experienced negatively by persons with intellectual disabilities and their care providers. Service users reported feeling sad and angry, whereas staff mentioned feeling anxious. Moreover, persons with intellectual disabilities appeared to understand the goal of restrictive measures (e.g. ensuring their own and others' safety) and identified alternative interventions (e.g. speaking with a staff member or taking a walk). Conclusion: Debriefing sessions with service users and staff may help minimize negative consequences. (Edited publisher abstract)
Service users and staff from secure intellectual disability settings: views on three physical restraint procedures
- Authors:
- JONES Peter, KROESE Biza Stenfert
- Journal article citation:
- Journal of Intellectual Disabilities, 12(3), September 2008, pp.229-237.
- Publisher:
- Sage
- Place of publication:
- London
The appropriateness of and justification for physical restraint procedures in intellectual disabilities settings is an emotive issue. It creates a number of ethical dilemmas for nursing staff. This article examines the views of service users and nursing staff from secure residential facilities where restraint is used frequently. Both groups were asked to rate three videotaped restraint procedures for their acceptability. There were no significant differences between the two groups in the acceptability ratings of the methods of restraint. Service users were then interviewed about their restraint experiences. They reported feeling very angry, sad, stressed and confused and not at all happy or relaxed when being restrained. Scores indicated that participants were significantly happier and less stressed after restraint than during restraint.
Parents' use of physical interventions in the management of their children's severe challenging behaviour
- Authors:
- ALLEN David, COOPER Viv
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 19(4), December 2006, pp.356-363.
- Publisher:
- Wiley
Although training staff supporting people with challenging behaviour in physical interventions has become accepted practice, parents are often left to fend for themselves while managing equivalent behaviours. The study explores parents' experience of managing severe challenging behaviours, their use of physical interventions and access to training in reactive strategies. A postal survey methodology was employed that utilized a novel 20-item questionnaire. The questionnaire yielded both quantitative and qualitative data concerning the types of challenging behaviour displayed by the children, frequency of use and nature of physical interventions, types of training received and any difficulties experienced in obtaining training. The sample was drawn from the membership of the Challenging Behaviour Foundation, a UK charitable organization, and comprised of 72 respondents. The majority of respondents had experienced major episodes of challenging behaviour. The emotional impact of living with such behaviours was apparent. Although the vast majority of respondents had employed restrictive physical interventions, few had received any formal training in such strategies. There was evidence that a number of high-risk physical interventions were sometimes being employed. Accessing training appeared more problematic for parents when compared with paid care staff. In this specific sample, parental use of physical intervention was high while parent training in physical intervention was uncommon. Impediments to parent training in physical intervention are discussed, as are wider issues concerning parental support.
The last resort? Staff and client perspectives on physical intervention
- Authors:
- FISH Rebecca, CULSHAW Eloise
- Journal article citation:
- Journal of Intellectual Disabilities, 9(2), June 2005, pp.93-107.
- Publisher:
- Sage
- Place of publication:
- London
This study provides feedback from research with staff and clients of a medium secure learning disability service in north-west England. Participants were asked about incidents which required the use of physical intervention, using unstructured interviews within a participatory research framework. The article explores clients’ and staff accounts of aggressive incidents and the consequences of physical intervention. Clients cited other clients and the ward atmosphere as the main reasons for aggressive behaviour. Some clients said that the use of physical intervention made them more frustrated and brought back memories of frightening experiences. Staff reported that incidents of aggression and the use of physical intervention were upsetting and traumatic, causing feelings of guilt and self-reproach. Staff said that they always used physical intervention as a last resort, although clients often reported otherwise. Time out and post-incident discussions were valued by both groups, as were strong staff/client relationships.
The use of physical interventions with people with intellectual disabilities and challenging behaviour: the experiences of service users and staff members
- Authors:
- HAWKINS Sarah, ALLEN David, jENKINS Rosemary
- Journal article citation:
- Journal of Applied Research in Intellectual Disabilities, 18(1), March 2005, pp.19-34.
- Publisher:
- Wiley
The views of both service users with intellectual disability and their support staff on the use of physical interventions are largely unknown. The research that does exist describes a largely negative pattern of responses. The present study aimed to explore the personal impact of receiving and implementing physical interventions, and also how service users and staff felt the use of such procedures impacted on each other. Eight service user/staff pairs were interviewed about their experiences of physical intervention within 1 week of their mutual involvement in a behavioural incident requiring restraint use. A qualitative methodology was employed to obtain views on a non-pain compliance approach to physical intervention. Service user and staff experiences were intrinsically linked, highlighting the interactional nature of physical interventions. It was apparent that experiences of physical intervention were dependent on far more than the application of techniques alone. Participants’ accounts were primarily negative. Service user and staff experiences were clearly affected by their appraisals of each other's behaviour throughout the physical intervention process.
The reported experience of four women with intellectual disabilities receiving emergency psychiatric services in Canada
- Authors:
- LUNSKY Yona, GRACEY Carolyn
- Journal article citation:
- Journal of Intellectual Disabilities, 13(2), June 2009, pp.87-98.
- Publisher:
- Sage
- Place of publication:
- London
A focus group study was conducted in 2005 in Toronto, Canada with four women with intellectual disabilities who had paid repeated visits to their local emergency department due to a psychiatric or behavioural crisis. These women spoke about not feeling respected, the trauma of being restrained physically or chemically, and about hospital staff not being comfortable working with women with intellectual disabilities. Clinical implications are discussed and recommendations are presented to improve the experience of women who require emergency services in the future.
Restraint and seclusion: service user views
- Authors:
- SEQUEIRA Heather, HALSTEAD Simon
- Journal article citation:
- Journal of Adult Protection, 4(1), February 2002, pp.15-24.
- Publisher:
- Emerald
Reviews the literature documenting the personal views and experience of people with learning disabilities and severe mental health problems following physical restraint or seclusion.
Checking how the Mental Health Act is used: easy read
- Author:
- CARE QUALITY COMMISSION
- Publisher:
- Care Quality Commission
- Publication year:
- 2010
- Pagination:
- 30p.
- Place of publication:
- London
This document is the easy read version of the first report into the work of the Care Quality Commission on monitoring the use of the Mental Health Act. It covers the period from April 2009 until March 2010. It describes the findings of these visits, listing aspects that need to be improved. It considers the following: taking people into hospital and keeping them there; children or young people; safe places; general hospitals; what things are like for people who are kept in hospital under the Mental Health Act; locked wards; low secure services; involving patients and looking after their rights; Independent Mental Health Advocates; Mental Health Tribunals; people being stopped, held or kept away from others; patients agreeing to treatment; Second Doctors; electro-convulsive therapy; and supervised community treatment. It concludes that services need to get better at involving patients who are kept in hospital in their care and treatment, checking whether patients understand and can agree to treatment, and treating people as individuals and making sure rules to keep people safe do not take away everyone’s rights.