Capítulo VI De los Recursos Humanos
5. CONCLUSIONES Y RECOMENDACIONES
All Codes Phase 1 & 2 July 2016 Attendance at Positive
Behaviour Management (PBM) training
Access to Supervision Staff acknowledging gender and carer issues
Attendance at Prevention & Management of
Violence & Aggression (PMVA) Training
Access to supervision – ‘if you ask for it’
Professional protection – staff avoiding allegation of assault
The importance of de- escalation
The importance of MDT discussion and peer support
Staff disregard for gender and carer preference
Training to use covert medication
‘Common Sense’ Female pts should be asked if male carers are acceptable
A lack of understanding what it means to ‘detain’ a pt
Availability of specialist mental health workers
Advocating ‘gender matching’ where possible
The pragmatic approach – you use the staff available
Importance of support for novice mental health workers
People are individuals – different preferences
Expression of stereotypical views
Experience informing practice and knowledge by experience
We need to ask about gender and carer preferences The importance of
historical abuse issues + gender and carer
preference
The workload is too high The fluid nature of gender related acceptance of care
Assessing risks to the pt Giving time to pts is essential
Increasing age decreases gender and carer
preference
Assessing risks to staff There is not enough time The importance of clinical judgement
Assessing the risk of falling
There is a perception of not enough time
Assessing the risk of absconding
Using ‘loaded’ language to describe male pts
The risk of secondary impact of restrictive intervention: distress, harm
Assessing the risk of skin breakdown
Expression of stereotypical beliefs
Ways to mitigate risk
Assessing the risk to others
Describing walking as wandering
Promoting safety
Assessing the risk of self- neglect
Using the MCA The importance of
assessment to define risk Trying to ‘do the right
thing’ for the pt
Using DoLs Confusion about legislation Making decisions as a
team
Using the MHA We must listen to carers
Trying to be least restrictive
Legislation to give medication
Life history work is key
Intervening in Best Interest The carer is the historian for the pt
Carers are important
Giving clarity to the pt and carer
Assessment is important Carers need information
Upholding professional obligations
Records and care plans Loaded language about male pts
Involve carers in RI planning and feedback
Uniforms identify helpers Staff are stressed
Fear of getting it wrong The person needs accessible information
It’s so complex it’s a minefield
‘registered’ training majors in the MHA
Voice tone is relevant AMHP training emphasises least restrictive practice You need to use yourself
as a communication tool
Restrictive Interventions are a last resort
Ask - Is this the least restrictive option? A ‘fresh face’ approach
works
Being positive about PBM Observation is an RI
Staff should take
responsibility for trying to understand the person
Being positive about PMVA
De-escalation is first and foremost
Dementia needs
innovative communication
We see medication as a restrictive intervention
Physical interventions are less restrictive than medication
These are normal
behaviours in an abnormal setting
We see covert medication as a restrictive intervention
Age is a characteristic which affects RI practice
Share the care and control with carers
The ward environment restricts everyone
Gender is a characteristic which affects RI practice Carers need support to
understand what is going on for the person
The ward environment can be designed to promote least restriction
Physical size and fitness is a characteristic which affects RI practice Build positive relationships Plan the RI – be prepared Continence aids are a
form of restriction Be consistent Nominate a leader for
every RI
Frailty is a characteristic which affects RI practice You need a team
approach to RI decision making
Female staff can assist de- escalation
Size matching is more important than gender
Gender ‘awareness’ is there – but expressed in practical terms (tacit?)
Being least restrictive does take time with the pt
Shared bedrooms are restrictive – they lower the threshold for RI’s
The staff are in a position of power Legislation guides safeguarding practice Legislation lends sophistication to care delivery
We must be clear about why – when we use RI’s
Pre-MCA – de-facto detention was practiced
The Bournewood ruling changed things
All people are individuals Pre-MCA there was a patriarchal approach.
Pre-legislation there was more task orientation You must know the pt Pre-MCA – someone with
dementia was presumed to lack capacity
2 sets of legislation = complexity at the interface
Use distraction first There is a
misappropriation of ‘an assumption of capacity’
Capacity is sometimes used as a currency to access services Use occupation first There is a ‘well-meaning
disregard and negation’ of the MCA
The legislation is forever a minefield
143 codes
RI – Restrictive Interventions There are professional disputes about DoLs and MHA application
The MHA process
demands evidence of least restrictive consideration
Compliant and
incapacitated pts – are probably now detained The MHA provides
safeguards for pts that the MCA does not
AMHPs have differing opinions about MHA and DoLs
Staff refer to Policy and not the law
BME as a characteristic that impacts on RI
National strategies have increased awareness of RI
Physical intervention (PI) policy advises gender matched teams You need enough trained
staff to make a PI team – so all have to be trained in the same approach
PMVA approaches can be risky for older people
All older adults should be restrained using the same approach
We need data to understand RI’s
We need to separate PI for personal care and PI for V&A
PI promotes a graduated approach
It’s better to avoid
admission (and therefore restriction) altogether
There is a national postcode lottery for services
Environmental restrictions increase behaviours that challenge
The MHA = longer admissions = more restrictions
The MCA drives least restrictive practice
Ward staff understand least restriction – they don’t understand the law The Cheshire West ruling
changed practice
The MHA can mean free aftercare via 117 – which is a good thing for pts
Detention is detention – it makes no difference to the pt
PI training = least restrictive first
PI training = try not to use PI