News

Policy briefing: restrictive practice

Your essential guide to restrictive practice policy including strategies to reduce its use and expert comment
Good restraint

Your essential guide to restrictive practice policy including strategies to reduce its use and expert comment

Essential facts

Concerns were raised about restrictive practices after the abuse of patients was uncovered at the Winterbourne View residential care home near Bristol. This led, in 2014, to the development by the Department of Health (DH) of a comprehensive strategy to reduce restrictive practice, called Positive and Proactive Care.

Good restraint
Picture: Mike Wilkinson

Restrictive interventions have not always been used only as a last resort in health and care, they have even been used to inflict pain, humiliate or punish, the strategy said.

What’s new?

The RCN organised a series of roadshows the UK in 2015 to discuss Positive and Proactive Care, provide education on the document and discuss how staff are reacting to its implementation. These events discussed the importance of the cultural change needed to reduce the use of restraint, and understanding and preventing the causes of violence and aggression. Nurses face ethical and moral dilemmas and have been struggling in difficult situations, says the RCN.

Positive and Proactive Care

The guidance from the DH says that staff must not deliberately restrain people in a way that impacts on their airway, breathing or circulation, such as face down restraint on any surface. It also states that if restrictive intervention is used it must not include the deliberate application of pain and must represent the least restrictive option. Staff must not use seclusion other than for people detained under the Mental Health Act 1983. Service users and families must be involved in all aspects of care and individualised support plans developed for those known to be at risk of restrictive interventions. People must be treated with compassion, dignity and kindness.

Impact on staff

Regular involvement in restriction and restraint can take a toll on the psychological wellbeing of nursing staff. The roadshows highlighted these risks and encouraged nurses to be alert to the stresses involved – and also be aware that clinical supervision, staff support groups, compassionate mind skills, training and structured self-monitoring can all help staff. The RCN recommends using The Wheel of Life, which supports self evaluation of areas of life that would benefit from being changed, and The Stress Questionnaire, which assess stress levels.

How you can help your patient

Engage with your services users and get to know them. Treating each person individually, understanding reasons for violence and aggression and users’ diverse cultural needs and religious beliefs can minimise the need for restraint and restriction. Act as a positive role model because many service users will not have had such a person in their lives. Question if restrictions in place are needed. Look after your own wellbeing and your colleagues.


Expert comment: Zeba Arif, chair of the RCN forensic nursing forum

‘Nurses at these roadshows told us that issues around restraint and restriction are difficult. They are always worried about doing the right thing in often challenging environments. Ensuring that dignity and compassion is maintained, risk management, the use of restraint and restriction in children, and young adult mental health services were all areas nurses had concerns.

Zeba Arif

‘Nurses need the right leadership, continued support, clinical supervision, mentorship and documentation to help them when service users tell them that what they are doing is not appropriate or is not right.

‘These RCN events were not about providing answers, but about making people think about their practice. It comes down to humanity and treating everyone individually – as a person and with compassion. Incorporating these principles into attitude, protocol or practice could ensure reducing the need for restrictive interventions.’

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