References
Reducing restrictive practice: a pertinent issue for children's services
Abstract
The reduction of restrictive practice has gained momentum in mental health services and it is now becoming evident in mainstream adult services. There remains confusion as to the definition of ‘restrictive practices’ across all sectors of health care, including the difference between ‘restrictive practices’ (such as attitudes of control, limit setting and unnecessary ward rules) and ‘restrictive interventions’ (including physical, chemical or mechanical restraint). This article highlights the relevance of restrictive practice to children's nursing and argues that the principles apply across all health provision. Acts of restrictive practice may result in challenging behaviour, or even restrictive interventions, strategies to minimise both restrictive practice and subsequent acts of challenging behaviour are explored. Behavioural support plans adopting a bio-psycho-pharmaco-social approach have been shown to be effective in both mental health and adult nursing and are recommended for use in children's nursing.
The Department of Health (DH) (2014) set the agenda to reduce restrictive practice, initially within mental health services. There has been a general assumption that the term ‘restrictive practice’ relates to interventions such as the use of restraint (physical, mechanical or chemical), seclusion or rapid tranquilisation. However, further clarification confirmed that the term ‘restrictive practice’ relates to anything that potentially restricts a person's rights of choice, self-determination, privacy or freedom of movement (Whyte, 2016; Clark et al, 2017). It is becoming generally accepted that restrictive practices (such as strict ward rules) may bring about frustration, feelings of stigma and subsequent challenging behaviour that may lead to restrictive interventions (such as sedation or holding) (Clark et al, 2017).
The Care Quality Commission (CQC) (2017) confirmed the need for a reduction in the use of restrictive practices and stipulated that all providers must take note of the DH guidance (2014). Providers must have a strategy, policy and procedures for the management of patients who exhibit challenging behaviour and actively demonstrate that a holistic assessment has taken place. In addition, the use of positive behavioural support plans is recommended. Failure to comply with the CQC guidance will result in the commission acting against the provider (CQC, 2017).
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