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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
03/05/23 Jane Buswell Independent Consultant Nurse
Difficult:Characterised by or causing
hardship or problems• Inconvenient• awkward• unfavourable• Unfortunate• inappropriate,
unsuitable • Untimely ill-timed• Inopportune• disadvantageous
• Convenient• happy
03/05/23 Jane Buswell Independent Consultant Nurse
Difficult :Not easy to please or satisfy:
awkwardTroublesome TiresomeTrying exasperatingDemandingUnmanageableIntractablePerverse ContraryRecalcitrant ObstreperousRefractory Fractious
• Accommodating
03/05/23 Jane Buswell Independent Consultant Nurse
Safeguarding Adults• The primary goal of Safeguarding is
prevention• Absence of care and compassion may
be the first sign of a failing environment
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
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?
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
Restraint Physical
(manual).
Chemical.
Environmental.
Mechanical.
Psychosocial.
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
Legal and Professional Framework
Human Rights Act Mental Capacity Act Professional Codes of PracticeProfessional GuidelinesDuty of Care
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
Clinical Holding: A Form of Physical Restraint
03/05/23 Jane Buswell Independent Consultant Nurse
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’
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
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.
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
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
03/05/23 Jane Buswell Independent Consultant Nurse
RememberLove and compassion are necessities, not
luxuries. Without them, humanity cannot survive
Dalai Lama
– Thank you