What are the most common restraint techniques taught by expert practitioners?

Abstract

WHAT IS KNOWN ON THE SUBJECT?: Physical restraint is used across the NHS in Mental Health, Learning disability and other specialist settings. Physical restraint should be used as a last resort, with least amount of force for the minimum amount of time. There is no national set of skills from which trainers or practitioners choose what might be appropriate for them and the population they care for. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: A national online survey gathered insights from representatives of public and private training services in relation to 20 selected techniques and their perceived risks. The most frequently taught techniques are identified and evident trends were seen among respondents according to their perceived suitability for different population groups. The need to be able to compare and contrast techniques is discussed, and the utility of developing an evaluative framework is outlined. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: In England the restraint training is now being regulated. This survey reveals the variation in the techniques used across groups or settings. The ability to compare techniques and make informed decisions around which techniques to commission, specify or use, could support the aims of the RRN Training Standards (RRN, 2020a) and Towards Safer Services (RRN, 2020b) and in so doing support the goals of safer, less restrictive person-centred practice. Individuals are encouraged to reflect on their practice and think critically about what is a good restraint technique. ABSTRACT: Introduction Despite widespread use of restraint techniques, it is unclear what techniques are taught. Aim To identify the types of techniques commonly taught. Method A national online survey was developed through iteration and stakeholder involvement. Ethical approval was obtained and it was disseminated through the Positive and Safe network, and the Restraint Reduction Network Community of Practice where expert practitioners answered questions relating to 20 randomly selected used physical 'Holds'. Results One hundred seventy-two people completed the survey. The most commonly taught techniques were a Guiding Posture (71%), a Guiding Hold (44%), a Two-Handed Forearm Hold (36%), a Finger, Thumb & Wrist Hold (27%) and a Cupped/Capped Fist Hold (26%). The Guiding Posture (71%), and Guiding Hold were used most commonly across populations. Despite the potential to induce pain, the Finger, Thumb and Wrist Hold was deemed suitable for Adult populations, but not Older Adults, Young Persons and Children. Wrap-Type Holds were seen as unsuitable for all populations. Discussion There is currently high variation in which techniques are taught across different settings. An evaluation framework could be beneficial. IMPLICATIONS FOR PRACTICE: An evaluation framework could aid training commissioners, providers and practitioner reflect on what constitutes a good restraint technique.

Keywords: physical restraint; restraint reduction; restraint training.