Friday 27 March 2015

Hold me down

Freda, a pal o' mine, has been blogging recently about the 'need' and undesirability of applying physical restraint to those in "care and treatment settings".  The question hinges on what carers should do when faced with an angry and aggressive person in their care a) to protect themselves b) to protect others in the vicinity and c) to protect the angry one - and not necessarily in that order!  One thing that all the pundits agree on is that you should be right leery about applying physical restraint because a) it might be counter-productive b) it might be fatal.  The latter is especially true if the perp is restrained in a face-down position as shown by the death of Eric Garner in Staten Island NY, NY. last July. It's interesting to see that carers are being advised to use 'de-escalation techniques', where, using a set of tried-and-tested protocols, you attempt to talk someone down from their heights of frustration.  You can just hear the soft >!splot!< as the experienced carers throw their eyes at the ceiling.  They just don't have time for dealing with a crisis in that manner.  You might think that this is an recent issue from the relentless reduction of staffing in our institutions so the tax-payer has more to spend on electronic entertainment and foreign holidays.

But the problem goes back at least 40 years, when the Irish health service was, by today's standards, quite extravagantly staffed.  In 1977, my pal Mac, then a medical student, blagged me a job as a stand-by medical orderly in the hospital in which The Boy was born.  I used to be assigned, at no notice, to the male medical ward to act as the runner for the qualified nursing staff.  Male medical was a mix of diabetics and demented, many of the latter still in an acute ward because no accommodation could be found outside [no change there in the succeeding generations]. One of my regular tasks coming on for night shift was to tie one old buffer to the cot-sides with bandages.  As a navy-brat, I knew better knots than the woman who was instructing me.  The chap had his cot-sides up because he was in the habit of wandering about the ward at night looking for his cat; he was being restrained because the cot-sides were only an obstacle in his quest and he had fallen to the floor some nights previously when trying to get over the fence.  Accident report form, extra work, "not having that again", restraint - as easy as 1 - 2 - 3. The irony of using bandages for the task was not lost on me.

But there could be another way, that may not impact on the caring staff's busy schedule and may lead to a sustainable solution. I should add that the alternative to such draconian-Victorian restraint is to use drugs to achieve chemical restraint although this also is deprecated . . . and unsustainably more expensive than tying people down. Freda's post is called What if "Restraint" was not an option? but she looks into the possibility of What if "Restraint" was no longer necessary? . . . because we had looked more holistically at the problem and made some policy changes.  Recognising the root of the angry outburst might be a simmering frustration and dealing with the causes of the frustration might have start up costs but just might be cheaper in the long run.  What causes frustration in Institutions?  Boredom; lack of access to fresh air; failure to recognise the individual; failure to recognise a change in circumstances (bereavement for example); failure to recognise a tooth-ache; really crappy food.

It can't be beyond the wit of woman to sort out some of these at an institutional level - that's why they pay the tiers of management the big bucks after all - without significantly impinging the efforts of the coal-face workers.  Change, any change, even change ultimately for the better, causes anxiety and anxiety breeds inertia. To management it must seem that the primary role of trades unions is to block any change at all, but maybe those cot-sides can be taken down as an indication of trust.

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