RESTRICTIVE PRACTICES IN OLDER ADULT CARE. · restrictive practices in older adult care. james...
Transcript of RESTRICTIVE PRACTICES IN OLDER ADULT CARE. · restrictive practices in older adult care. james...
RESTRICTIVE PRACTICES IN OLDER ADULT CARE.
JAMES RIDLEYSENIOR LECTURER (LEARNING DISABILITIES)
EDGE HILL UNIVERSITY
edgehill.ac.uk
AIMS
1. IDENTIFY SERVICE MODELS WHERE ‘RESTRICTIVE PRACTICE’ IS
MORE WIDELY USED IN THE SUPPORT OF OLDER ADULTS.
2. HIGHLIGHT HOW RESTRICTIVE PRACTICES MAY BE DEVELOPED
IN RELATION TO VULNERABLE OLDER ADULT GROUPS.
3. HIGHLIGHT THE LEGAL AND ETHICAL FRAMEWORKS WHICH
CAN SUPPORT PRACTITIONERS WHEN SUPPORTING OLDER
PEOPLE.
4. REVIEW EVIDENCE AND ASSESSMENTS WHICH CAN BE USED
TO SUPPORT THE REDUCTION OF RESTRICTIVE PRACTICE.
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“PREDICTABLE ENVIRONMENTS”
• ACUTE PSYCHIATRIC SETTINGS (INCLUDING
FORENSIC SETTINGS)
• SERVICES FOR PEOPLE WITH LEARNING
DISABILITIES AND CHALLENGING BEHAVIOUR
• OLDER ADULT SERVICES WHERE INDIVIDUALS MAY
BECOME AGITATED OR CONFUSED.
• (DOH 2014)
REACTIVE MANAGEMENT
• CLINICIANS ARE COMMONLY ASKED TO INTERVENE IN SITUATIONS OF
ACUTE DISTURBANCE IN CARE PLACEMENTS.
• INTENSIVE AND HIGH-QUALITY SUPPORTIVE OR BEHAVIOURAL
INTERVENTIONS MAY NOT BE AVAILABLE.
• DEMAND IS USUALLY FOR IMMEDIATE ACTION TO MANAGE
BEHAVIOUR IN ORDER TO AVOID PLACEMENT BREAKDOWN.
• (GLOVER ET AL, 2014)
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RESTRAINT!
•“THE INTENTIONALRESTRICTION OF A PERSON’S VOLUNTARY MOVEMENT OR
BEHAVIOUR”• COUNSEL AND CARE (2002).
“RESTRAINT is a RESTRICTIVE PRACTICE”
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RESTRICTIVE PRACTICE
• “RESTRICTIVE INTERVENTIONS CAN DELAY
RECOVERY, AND CAUSE BOTH PHYSICAL
AND PSYCHOLOGICAL TRAUMA TO PEOPLE
WHO USE SERVICES AND STAFF.”
• (DEPARTMENT OF HEALTH, 2014)
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FORMS OF RESTRICTIVE PRACTICE
•CHEMICAL
•MECHANICAL
•PHYSICAL
•PSYCHOLOGICAL• (RCN, 2008)
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RISK GROUPS
• PEOPLE WHO ARE DIFFICULT OR THREATENING.
• PEOPLE WHO ARE NON-CONFORMING,
THEREFORE CAUSING A MANAGEMENT
PROBLEM
• PEOPLE WHO ARE LESS PHYSICALLY OR
MENTALLY ABLE
CSCI (2007)
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WHAT IS “DEMENTIA”.
• DEMENTIA DESCRIBES A SET OF SYMPTOMS THAT MAY INCLUDE; MEMORY LOSS, DIFFICULTIES WITH
THINKING, PROBLEM-SOLVING OR LANGUAGE. A PERSON WITH DEMENTIA MAY ALSO EXPERIENCE
CHANGES IN THEIR MOOD OR BEHAVIOR.
• DEMENTIA IS CAUSED WHEN THE BRAIN IS DAMAGED BY DISEASES, SUCH AS ALZHEIMER’S DISEASE
OR A SERIES OF STROKES.
• ALZHEIMER’S DISEASE IS THE MOST COMMON CAUSE OF DEMENTIA BUT NOT ALL DEMENTIA IS DUE
TO ALZHEIMER’S.
• THE SPECIFIC SYMPTOMS THAT SOMEONE WITH DEMENTIA EXPERIENCES WILL DEPEND ON THE
PARTS OF THE BRAIN THAT ARE DAMAGED AND THE DISEASE THAT IS CAUSING THE DEMENTIA.
• ALZHEIMER’S SOCIETY (2014)
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PREVALENCE COMPARISON.
Comparative Rates of Dementia -Down’s syndrome, Learning disabilities, General Population
Cooper, personal
communication
DSLD
GP
British Psychological Society, Royal College of Psychiatrists, 2009
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ASSESSMENT DIFFICULTIES
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DIFFICULTIES IN THE ASSESSMENT OF DEMENTIA FOR PEOPLE WITH LEARNING
DISABILITIES;
• ALREADY HAVE UNDERLYING COGNITIVE DEFICITS AND IMPAIRED LIVING SKILLS.
• PRONE TO HEALTH PROBLEMS – MIMIC SYMPTOMS.
• LACK OF COMMUNICATION SKILLS TO REPORT ON SYMPTOMS EXPERIENCED.
• CARERS CHANGE FREQUENTLY – LACK OF DETAILED KNOWLEDGE OF CHANGES
IN FUNCTIONING
• GENERIC ASSESSMENTS CANNOT BE USED DUE TO THEIR LEARNING DISABILITY.
• THEREFORE IT IS VERY DIFFICULT TO IDENTIFY ANY COGNITIVE CHANGES DUE TO
DEMENTIA, FROM A ONE OFF ASSESSMENT E.G. “MINI MENTAL STATE”.
• (JANICKI, DALTON, (1999)
“DIAGNOSTIC OVERSHADOWING”
• BOTH PEOPLE WITH LEARNING DISABILITIES AND PEOPLE WITH
MENTAL HEALTH PROBLEMS EXPERIENCE “DIAGNOSTIC
OVERSHADOWING”.
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WHAT ARE THE BEHAVIOURAL AND PSYCHOLOGICAL SYMPTOMS
OF DEMENTIA (BPSD).
• BPSD INCLUDES;
• AGITATION, ANXIETY, IRRITABILITY AND MOTOR RESTLESSNESS,
OFTEN LEADING TO BEHAVIOURS SUCH AS WANDERING, PACING,
AGGRESSION, SHOUTING AND NIGHT-TIME DISTURBANCES,
PSYCHOSIS, AND, MOOD DISORDERS.
• OTHER SYMPTOMS INCLUDE SEXUAL DISINHIBITION, EATING
PROBLEMS AND ABNORMAL VOCALIZATIONS (SHOUTING,
SCREAMING AND DEMANDING ATTENTION, ETC).
• BALLARD, O’BRIEN, JAMES, SWANN, (2003),
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MANAGEMENT OF BPSD.
“Restraint amongst the
institutionalised elderly with
dementia and problem behaviour is
inevitable”Testad, Aasland, Aarsland (2005)
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HOW TIMES CHANGE!!!!!!
• CHALLENGING
BEHAVIOUR IS AN
INEVITABLE ASPECT
OF DEMENTIA,
• (STOKES AND GOULDIE, 1990)
• CHALLENGING BEHAVIOUR IS NOT AN INEVITABLE CONSEQUENCE OF THE CONDITION.
• KERR (2007)
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MENTAL CAPACITY ACT, 2005
SECTION 6:
•RESTRAINT IS ONLY PERMITTED
TO;
•PREVENT HARM,
•MUST BE PROPORTIONATE.
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HUMAN RIGHTS BASED APPROACH.
“A HUMAN RIGHTS BASED
APPROACH OFFERS ONE METHOD
FOR FACILITATING POSITIVE RISK
MANAGEMENT”.• WHITEHEAD, GREENHILL, CARNEY, (2009)
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FREDA PRINCIPLES
•FAIRNESS
•RESPECT
•EQUALITY
•DIGNITY
•AUTONOMY
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HUMAN RIGHTS RISK SCREEN.
• “USED AS A PROMPT TO
QUESTION WHETHER
APPROPRIATE
INTERVENTIONS ARE IN
PLACE.”
• GREENHILL, WHITEHEAD, CARNEY, (2009)
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REDUCING RESTRICTIVE PRACTICES.
• HEALTH NEEDS ASSESSMENT
• HEALTH ACTION PLANS
• “LIFE STORIES”
• “PERSON CENTRED PLANS”
• BEHAVIOURAL ASSESSMENTS
RIDLEY AND JONES (2012
• PAIN MANAGEMENT.
• ENVIRONMENTAL ASSESSMENT.
• MEDICATION REVIEWS
• CAPACITY ASSESSMENTS
• COMMUNICATION ASSESSMENTS.
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CONCLUSION.
• “IF ALL YOU HAVE IN
YOUR TOOL BOX IS
A HAMMER, ALL THE
WORLD LOOKS LIKE
A NAIL.”
• ABRAHAM MASLOW
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CONTACT DETAILS
• JAMES RIDLEY (SENIOR LECTURER (PRE-REGISTRATION NURSING))
• EDGE HILL UNIVERSITY
• ST HELENS ROAD
• ORMSKIRK
• LANCASHIRE
• L39 4QP
• TEL; 01695 657010
• E-MAIL; [email protected]
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REFERENCES
• BALLARD, C, O’BRIEN, J, JAMES, I, SWANN, A, (2003), DEMENTIA; MANAGEMENT OF THE BEHAVIOURAL
AND PSYCHOLOGICAL SYMPTOMS, OXFORD UNIVERSITY PRESS, OXFORD.
• BRAUN, J, LIPSON, S, (1993), TOWARD A RESTRAINT FREE ENVIRONMENT; REDUCING THE USE OF
PHYSICAL AND CHEMICAL RESTRAINTS IN LONG TERM AND ACUTE CARE SETTINGS, HEALTH
PROFESSION PRESS, SYDNEY.
• BRITISH PSYCHOLOGICAL SOCIETY, ROYAL COLLEGE OF PSYCHIATRISTS, (2009), DEMENTIA AND PEOPLE
WITH LEARNING DISABILITIES, BPS/RCP, LONDON
• BURNARD, P, CHAPMAN, C, (2005), PROFESSIONAL AND ETHICAL ISSUES IN NURSING, BALLIERRE TINDALL,
EDINBURGH.
• BOWLES, L, (1996), HOW MUCH SHOULD PATIENTS BE TOLD ABOUT THEIR MEDICATION, BRITISH JOURNAL
OF NURSING, 5, 3, 157 – 164, CITED BY; CARESS, A, L, (2003), GIVING INFORMATION TO PATIENTS,
NURSING STANDARD, 17, 43, 47 – 54.
• CARE QUALITY COMMISSION (NEE COMMISSION FOR SOCIAL CARE INSPECTION), (2007), RIGHTS, RISKS
AND RESTRAINTS; AN EXPLORATION INTO THE USE OF RESTRAINT IN THE CARE OF OLDER PEOPLE,
CSCI, NEWCASTLE UPON TYNE.
• CARESS, A, L, (2003), GIVING INFORMATION TO PATIENTS, NURSING STANDARD, 17, 43, 47 -54.
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REFERENCES
• COUNSEL AND CARE, (2002), SHOWING RESTRAINT; CHALLENGING THE USE OF RESTRAINT IN CARE HOMES, COUNSEL AND
CARE UK, LONDON.
• DEPARTMENT OF HEALTH, (2001), VALUING PEOPLE, DOH, LONDON.
• DEPARTMENT OF HEALTH, (2014), POSITIVE AND PROACTIVE CARE: REDUCING THE NEED FOR RESTRICTIVE INTERVENTIONS,
HMSO, LONDON
• DISABILITY RIGHTS COMMISSION, (2006), EQUAL TREATMENT; CLOSING THE GAP, DISABILITY RIGHTS COMMISSION, LONDON
• HOME OFFICE (2005), MENTAL CAPACITY ACT (2005), HMSO, LONDON.
• HOUSE OF LORDS, HOUSE OF COMMONS, JOINT COMMITTEE ON HUMAN RIGHTS, (2008), A LIFE LIKE ANY OTHER? HUMAN
RIGHTS OF ADULTS WITH LEARNING DISABILITIES, SEVENTH REPORT, HMSO, LONDON.
• GASHMANS, C, MILISEN, K, (2006), USE OF PHYSICAL RESTRAINT IN NURSING HOMES; CLINICAL ETHICAL CONSIDERATIONS,
JOURNAL OF MEDICAL ETHICS, 32, 148 – 152
• GREAT BRITAIN. HUMAN RIGHTS ACT 1998: ELIZABETH LL. CHAPTER 42. (1998). LONDON: THE STATIONERY OFFICE
• JANICKI, M, DALTON, A, (1999), DEMENTIA, AGING, AND INTELLECTUAL DISABILITIES: A HANDBOOK, ROUTLEDGE, NEW
YORK.
• KERR, D, (2007), UNDERSTANDING LEARNING DISABILITY AND DEMENTIA, JESSICA KINGSLEY, LONDON.
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REFERENCES
• LEADBETTER, D, (2002), GOOD PRACTICE IN PHYSICAL INTERVENTION, IN ALLEN, D, (ED), ETHICAL APPROACHES TO PHYSICAL
INTERVENTIONS, BILD, P114-133.
• OSMAN, L, ET AL, (1994), REDUCING HOSPITAL ADMISSION THROUGH COMPUTER SUPPORTED EDUCATION FOR ASTHMA
PATIENTS, BRITISH MEDICAL JOURNAL, 308, 6928, 568-571, CITED BY; CARESS, A, L, (2003), GIVING INFORMATION TO
PATIENTS, NURSING STANDARD, 17, 43, 47-54
• RIDLEY, J, JONES, S, CLAMPING DOWN ON THE SE OF RESTRICTIVE PRACTICES, LEARNING DISABILITY PRACTICE, 15, 2, 33-36
• ROLLINS, M, (2006), SAFETY ISSUES SURROUNDING THE USE OF BEDRAILS, NURSING OLDER PEOPLE, 17, 10, 20 – 21.
• ROYAL COLLEGE OF NURSING, (2008), LETS TALK ABOUT RESTRAINT: RIGHTS, RISKS, AND RESPONSIBILITIES, RCN, LONDON
• STOKES, G, GOULDIE, F, (1990), WORKING WITH DEMENTIA, WINSLOW PRESS, BICESTER.
• TESTAD, I, AASLAND, A, M, AARSLAND, D, (2005), THE EFFECT OF STAFF TRAINING ON THE USE OF RESTRAINT IN DEMENTIA: A
SINGLE-BLIND RANDOMISED CONTROLLED TRIAL, INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, 20, 587-590.
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REFERENCES
• TINETTI, M, ET AL, (1994), A MULTI-FACTORIAL INTERVENTION TO REDUCE THE LIKELIHOOD OF
FALLING AMONG ELDERLY PEOPLE LIVING IN THE COMMUNITY, NEW ENGLAND MEDICAL JOURNAL,
331, 13, 821 – 827, CITED BY; KELLY, A, DOWLING, M, (2004), REDUCING THE LIKELIHOOD OF FALLS
IN OLDER PEOPLE, NURSING STANDARD, 18, 49, 33 – 40
• WATSON, R, (2001), RESTRAINT; ITS USE AND MISUSE IN THE CARE OF OLDER PEOPLE, NURSING
OLDER PEOPLE, 13, 3, 21-25.
• WHITEHEAD, R, CARNEY, G, GREENHILL, B, (2009), ENCOURAGING POSITIVE RISK MANAGEMENT;
SUPPORTING “A LIFE LIKE ANY OTHER” USING A HUMAN RIGHTS BASED APPROACH, IN, LOGAN, C,
WHITTINGTON, R (EDS), SELF-HARM AND VIOLENCE: BEST PRACTICE IN MANAGING RISK,.
• WORLD HEALTH ORGANISATION, (1986), DEMENTIA IN LATER LIFE; RESEARCH AND ACTION; REPORT
OF THE WHO SCIENTIFIC GROUP ON SENILE DEMENTIA, WHO, GENEVA, CITED BY; BALLARD, C,
O’BRIEN, J, JAMES, I, SWANN, A, (2003), DEMENTIA; MANAGEMENT OF THE BEHAVIOURAL AND
PSYCHOLOGICAL SYMPTOMS, OXFORD UNIVERSITY PRESS, OXFORD.
Useful Reading• Abbey, J., Piller, N., Bellis de, A., Esterman, A., Parker, D., Giles, L. & Lowcay, B. (2004) The
Abbey pain scale: a 1-minute numerical indicator for people with end stage dementia.
International Journal of Palliative Nursing, 10, 6 - 14.
• Deb S., Clarke D. & Unwin G. (2006) Using medication to manage behaviour problems
among adults with a learning disability: Quick Reference Guide (QRG), University of
Birmingham, MENCAP, The Royal College of Psychiatrists.
• Department of Health (2008) End of Life Strategy; Promoting high quality care for all
adults at the end of life. TSO (The Stationery Office).
• Dodd, K., Kerr, D. & Fern, S. (2006) Down’s Syndrome and Dementia Workbook for Staff.
Down’s Syndrome Association. Down’s Syndrome Association.
• Dodd, K., Turk, V. & Christmas, M. (2002) Resource Pack for carers of adults with Down’s
Syndrome and dementia. BILD Publications.
• Evenhuis, H.M., Kengen, M.M.F., & Eurlings, H.A.L. (2007). Dementia Questionnaire for People
with Learning Disabilities (DLD). UK adaptation. Harcourt Assessment.
• Holland, A.J. (2004) Down’s Syndrome and Alzheimer’s Disease: A guide for Parents and
Carers. Down’s Syndrome Association.
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Useful reading.
• Kerr, D. (1997) Down’s Syndrome and dementia: a practitioner’s guide. Venture Press.
• Kerr, D. (2007) Understanding Learning Disability and Dementia: Developing Effective
Interventions. Jessica Kingsley Publishers.
• Kerr, D., Cunningham, C. & Wilkinson, H. (2006) Responding to the Pain Needs of People
with a Learning Disability. York Publishing Services.
• Prasher, V.P. (2005) Alzheimer’s Disease and Dementia in Down’s Syndrome and
Intellectual Disabilities. Radcliffe Publishing.
• Thomas, K. & Department of Health (2005) Gold Standards Framework. Department of
Health.
• Watchman, K. (2006) Keep Talking about dementia: Information for Siblings and
professionals about Down’s Syndrome and dementia. Scottish Down’s Syndrome
Association.
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• WWW.BILD.ORG.UK (AGEING WELL PROJECT)
• WWW.CBF.ORG.UK
• WWW.LD-MEDICATION.BHAM.AC.UK
• WWW.DSSCOTLAND.ORG.UK
• WWW.ALZHEIMERS.ORG.UK
• WWW.PSS.ORG.UK
• WWW.DISDAT.CO.UK
Useful websites
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