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Describe restrictive practices

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On this page, we will describe restrictive practices in health and social care settings.

Restrictive practice refers to a range of methods that may be used to restrain an individual. Any practice that restricts the rights or freedom of movement of an individual is considered a restrictive practice.

This can include physical restraint either by holding an individual or utilising equipment (e.g. rope, bed restraints etc.) as well as medical restraint (e.g. sedatives) or seclusion (e.g. locking an individual in a room).

Restrictive practice without legal and ethical justification is unlawful and should not be used without appropriate training, authorisation and documentation.

It should only be used as an absolute last resort to ensure the safety of the individual or others and even then, the least restrictive option should be used.

It is important to understand that some practices that were generally considered acceptable a few decades ago are considered restrictive practices today. For example:

  • An individual not being able to leave their home due not to having a set of keys to the front door
  • Having guard rails on a bed to protect an individual from falling out but also restricting them from getting out of bed on their own
  • Covert medication administration, for example, putting medication in food without the individual’s knowledge
  • Strapping an individual into a wheelchair without their consent
  • Putting a seat belt on an individual in a car without their consent (although if they refused, it would be unlawful to drive them anywhere)

Before undertaking any action that may restrict an individual’s movement or liberties, even if it is for their own safety, you should ensure there is a legal and ethical justification, preferably in writing (e.g. DOLS, care plan etc.). It is also essential to protect the dignity of the individual by remaining calm and courteous and explaining what you are doing and why. Consent from the individual may also be required.

Some examples of when restrictive practices may be justified include:

  • If an individual requires emergency medical treatment
  • If an individual is seriously harming themselves or others

In these cases, restrictive practices may only be used by individuals with proper training and as a last resort, when all other possible options have been exhausted.

Accompanying Video


Video transcript

Hi,

My name is Daniel Dutton and I run the website dsdweb.co.uk which provides free help, guidance and support for people that are studying for care qualifications.

In this video, we will be looking at what restrictive practices are in the context of health and social care. This is an assessment criterion for the Level 2 and Level 3 Diplomas in Adult Care as well as the Care Certificate.

Before I continue, I’d be very grateful if you could click on the thumbs-up button to Like this video and subscribe to my channel. This helps the video to be more visible on Youtube so that it can be easily found by other students.
So, first, let’s take a look at what restraint is. Restraint, as defined by the mental Capacity Act 2005 is:

“When someone uses force (or threatens to) to make someone do something they are resisting, and when someone’s freedom of movement is restricted, whether or not they are resisting.”

In short, anything that stops an individual from doing something or forces them to do something can be regarded as a restraint.

Sometimes restrictive practices are necessary to protect the individuals that we support. For example, we may need to use locked doors to prevent an individual with dementia from going outside on their own because there is a significant risk of them getting lost or wandering into the road and getting run over. Or, for an individual that uses a wheelchair, the lap belt must be used to prevent them from falling out.

However, restrictive practices should only be used as a last resort, be legally justified and be proportionate to the risk. In addition, the least restrictive option should always be used.

Restrictive practices should never be used as a form of punishment or to inflict suffering and should not be used for longer than is necessary. It is essential that policies and procedures are followed when planning and implementing restrictive practices.

This slide shows a list of some of the types of restrictive practices.

Physical restraint is when physical contact is used to reduce an individual’s mobility. For example, if you hold an individual that is experiencing hallucinations to stop them from running into a busy road. This is a physical restraint.

Mechanical restraints are devices that are used to restrict movement. The use of a lap belt on a wheelchair is considered a mechanical restraint.

Psychological restraints are when an individual is prevented from doing something due to threats, coercion, or even constant nagging. Preventing an individual from taking risks or making their own lifestyle choices can be a form of psychological restraint (and would also be institutional abuse).

Chemical restraints involve the use of chemicals or medications to subdue an individual. For example, an individual that is experiencing a mental health crisis may be given a sedative by a doctor if it is deemed to be in their best interests.

Environmental restraints are when an individual does not have the freedom to move around or access their environment because there are barriers or obstacles in the way. For example, food cupboards that are locked so that an individual is unable to help themselves to a snack would be an environmental restraint.

Thank you for watching and I hope you’ve found this video useful.

If you require any additional help or want to send feedback about this video, please feel free to use the comments section below or visit my website dsdweb.co.uk. More information about this assessment criterion can be found in the link in the description.

And, if you’ve not already done so, please click the Like and Subscribe buttons below.

Bye for now.

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