Difficult situations and 'safe services

Difficult situations and “Safe Services”

Jane BuswellIndependent Consultant Nurse

Sit&See facilitator

03/05/23 Jane Buswell Independent Consultant Nurse

Difficult: Needing much effort or skill to

accomplish, deal with or understand

• Strenuous• Arduous, • Onerous• Burdensome• Demanding• Back-breaking• Painful

• Easy• Straightforward• simple

Difficult:Characterised by or causing

hardship or problems• Inconvenient• awkward• unfavourable• Unfortunate• inappropriate,

unsuitable • Untimely ill-timed• Inopportune• disadvantageous

• Convenient• happy

Difficult :Not easy to please or satisfy:

awkwardTroublesome TiresomeTrying exasperatingDemandingUnmanageableIntractablePerverse ContraryRecalcitrant ObstreperousRefractory Fractious

• Accommodating

Safeguarding Adults• The primary goal of Safeguarding is

prevention• Absence of care and compassion may

be the first sign of a failing environment

Safetyis the state of being "safe" (from French sauf), the condition of being protected against physical, social, spiritual, financial, political, emotional, occupational, psychological, educational or other types or consequences of failure, damage, error, accidents, harm or any other event which could be considered non-desirable.

A Place to call Home?Key conclusions 3 & 5

• The emotional frailty and emotional needs of older people living in care homes are not fully understood or recognised by the system and emotional neglect is not recognised as a form of abuse.

• The vital importance of the role and contribution of the care home workforce is not sufficiently recognised

Outcome 3 & 5• All staff working in care homes understand

the physical and emotional needs of older people living with dementia and assumptions about capacity are no longer made

• Emotional neglect of older people is recognised as a form of abuse and appropriate action is taken should it occur

• Older people receive compassionate and dignified care that responds to them as an individual

So- difficult situations- or ethical dilemmas?

Consent or Non Compliance?Autonomy or Deprivation of Liberty?Decision making- who is calls the shots?Technology – Enabling or big brother?Restraint or Clinical Holding ?Best interest decisions- whose best

interests?

Signs of distress- “difficult behaviours” that challenge us:

• Angry (aggressive) behaviour.• Excessive walking (wandering

behaviour).• Repetitive behaviours.• Vocally disruptive behaviours • Sexual expressive behaviours

Jane Buswell Southwest Care Skills

Meeting Needs and reducing distress

A great deal has been spoken about the effect of the mind on the body…

However, I wish a little more emphasis was placed on the effect of the body on the mind! Florence Nightingale 1897

NHS Protect Guidance 2013• www.reducingdistress.co.uk

Restraint An Unpalatable and Taboo Subject

What we knowNo one wants to do it.Most people have done it.It causes many personal and professional dilemmas.We don’t like to talk about it.

Restraint Physical

(manual).

Chemical.

Environmental.

Mechanical.

Psychosocial.

Balancing Needs, Rights and Risks Key Legal Issues

Mental Capacity Act (Section 6).-Acts of restraint may include:

o Steadying someone’s arm to give an injection.

o Holding someone to give a sedative.

o Locking external doors to prevent someone from leaving the building.

Balancing Needs, Rights and Risks Key Legal Issues

Mental Capacity Act (Section 6).-Sets limitations to the protection of Section 5 with regard to the use of restraint:

o To prevent harm.o Proportionate to the likelihood and

seriousness of harm.o In the person’s best interests.

Legal and Professional Framework

Human Rights Act Mental Capacity Act Professional Codes of PracticeProfessional GuidelinesDuty of Care

Human Rights based approach

• The use of any restrictive practice must be lawful

• Their use must not breach a persons rights, particularly

• Article 5: right to liberty• Article 3: prohibition on inhumane and

degrading treatment• Article 8: right to private life

Clinical Holding: A Form of Physical Restraint

The use of restrictive physical interventions that enable staff to effectively assess or deliver essential care and treatment to individuals who

lack capacity’

‘holds to assist or support a patient to receive care or treatment where their behaviour may limit the ability to effectively deliver such treatment’

Dammed if we do dammed if we don’t

Failing to safeguard a person during a clinical procedure or treatment may be considered negligent, particularly if the treatment is deemed in the best interests of the individual.Failing to act (e.g. not holding an individual during clinical care or treatment) may constitute an offence of ill treatment or wilful neglect.

Balancing Needs, Rights and Risks

Safeguarding Misuse and AbuseActs of Necessity and Best Interest Decision.Last resort.Reasonable, proportionate, least restrictive.Shortest amount of time.Minimise injury and avoid pain.Benefits must outweigh risks.

Clinical Holding is ‘Restraint’ by another name! It requires the same level of scrutiny.We need to ensure that vulnerable people receive the same treatment outcomes as others.We need to ensure staff are trained and prevent the misuse and abuse of restraint.We need to improve our performance by ‘targeting measures’ instead of ‘measuring targets’.

Balancing Needs, Rights and Risks

Clinical HoldingCrisis Prevention Institute

The Restraint Reduction NetworkTM was launched at the CPI European Conference on Restraint Reduction. Sign the pledge –Demonstrate your belief that everyone deserves person centred care and support, and should be treated with respect and dignity.www.restraintreductionnetwork.org

Become a Member of the Restraint Reduction

NetworkTM

RememberLove and compassion are necessities, not

luxuries. Without them, humanity cannot survive

Dalai Lama

– Thank you

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