Practice question

Care home residents can benefit from carrying out everyday activities

A risk-averse culture has eroded the right of care home residents to carry out activities that benefit them, says Lynne Phair

A risk-averse culture has eroded the right of care home residents to carry out activities that benefit them, says Lynne Phair

Picture of push-on mower. Older people in care homes can benefit from doing everyday tasks such as mowing the lawn
Picture: iStock

Nursing has become dominated by health and safety and the fear of something going wrong.

Care has improved and harm to residents and staff has been reduced because appropriate risk assessments have been carried out and suitable equipment and control measures put in place. However, the resident’s right to take normal, everyday risks has been eroded.

Risk assessments are vital when nurses are caring for vulnerable people who may be unable to assess risk for themselves, but that does not mean they can no longer carry out risky activity. Residents with dementia may demonstrate responsive behaviours, not only because of emotional distress or physical ill health, but because they are bored.

Meaningful activities might include helping maintenance staff or preparing vegetables for lunch

The National Institute for Health and Care Excellence defines meaningful activity as including ‘physical, social and leisure activities that are tailored to the person’s needs and preferences’. For some this might mean being involved in the gardening, helping the maintenance staff or preparing vegetables for lunch.

A positive risk-enabled approach is supported by guidance from the Health and Safety Executive on health and safety in care homes. It states that all risk assessment decisions should be sensible.

‘When considering the care needs of an individual, everyday activities are often identified that will benefit their lives, but also put them at some level of risk. This requires a balanced decision to be made between the needs, freedom and dignity of the individual and their safety – with the aim of enabling residents to live fulfilled lives safely, rather than providing reasons for restricting them,’ the guidance says.

Guidance issued by the Department of Health in 2010 contains a risk enablement framework. It fits perfectly with person-centred care and a biographical approach to identifying a person’s needs and wishes.

RCN identifies the components of a rights-based approach

Royal College of Nursing guidance provides advice and information on reducing the use of restrictive practice, using the mnemonic FREDA to identify the components of a rights-based approach to risk assessment:

  • Fairness People have access to fair processes for getting their views heard.
  • Respect People are valued as individuals, listened to and what is important to them is considered by health and social care staff.
  • Equality There is no discrimination.
  • Dignity People are treated with compassion in a way that values them as fellow human beings.
  • Autonomy People can exercise the maximum amount of choice and control possible.

Enabling a person to participate in activities that were previously felt to be too risky requires a whole-team change in culture moving from the starting point of ‘They can’t do that because…’ to ‘They can, I’m sure. We must find a way.’

The man who loved mowing the lawn

For example, Bert has dementia and lives in a care home, but had been a keen gardener. He was always pacing around and trying to go outside. The staff spoke to Bert and his family and discovered that he loved mowing the lawn.

A risk-enabled assessment was carried out, with the starting point that Bert could help mow the lawn.

His strengths were that he walked well independently, loved being outside and could use both arms. He was unable to recognise an electric cable and the petrol mower was too heavy. These were identified as risks.

The maintenance team purchased a lightweight, push-along mower and asked Bert to help them when they were mowing the lawn. Bert mowed the lawn regularly, whenever he wanted to do it, and if it was being mowed too much the maintenance staff adjusted the blade length so the purposeful activity was also free of failure.

Lynne Phair is an independent nurse consultant


This article is for subscribers only