Physical Restraint Safety in Secure Children's Homes

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Restraint Safety. 1. What specific factors should be considered when undertaking a risk assessment in relation to physical restraint? (e.g. Contra indications) Life experience and physical characteristics: - Age - Gender/Sexuality - Race/Culture - Physical Health - Psychological reaction - History of physical/sexual abuse Contra indications: Take medical advice on the use of physical intervention if the service user has: - A history of heart disease or heart problems - Difficulty in breathing: a history of respiratory illness - Problems with digesting food; gastro-intestinal conditions - Recent fractures; a history of dislocated joints - Downs syndrome (vulnerability to neck/spine injury) Other factors suggested by research include: - Obesity - Sickle Cell Anaemia - Drug/Alcohol abuse 2. What factors can act to compromise safety during restraint? Be aware of own mindset: - Punitive staff attitudes (‘I’ll show you who’s boss’) - Fear ( leading to indecisive staff action – or – conversely use of excessive force) - Misinterpretation (the restrained person often explicitly states ‘I cannot breathe’, before dying. Staff did not believe them) - Ignorance (lack of knowledge of risk factors and symptoms of distress) Danger is increased by: - Time – the restraint goes on too long - Prolonged struggle – Lactic acid may build up (Acidosis) - Ignoring distress – Have a non involved staff member monitoring the subject at all times - Restricting breathing – Restricting the free movement of the diaphragm 3. What is your understanding of the term ‘Positional Asphyxia’ in relation to restraint? Positional Asphyxia is a syndrome which in which the free movement of the diaphragm is restricted, resulting in an inability to breathe. Death can therefore result as a consequence of hypoxia which may disturb heart rhythm.
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