New guidance on the use of restrictive practices and seclusion in Northern Ireland has been welcomed by nurse leaders in the region.
The document, Regional policy on the use of restrictive practices in health and social care settings and regional operational procedure for the use of seclusion, was published by the Northern Ireland Department of Health (DOH) this week.
“It will have a positive impact in terms of safeguarding those in the care of nurses who are subject to restrictive practices”
Rosaline Kelly
The guidance aims to standardise best practice in the use of restrictive interventions, restraint and seclusion with the goal of minimising their use, and eliminating their use altogether wherever possible.
Restrictive practices are defined in the document as “those that limit a person’s movement, day to day activity or function”.
Examples cited include the use of locks to prevent a person from moving around freely; electronic monitoring; observation; the use of physical, mechanical or chemical restraint; and seclusion whereby someone is confined to a room or area.
The new guidance emphasises that although restrictive practices may be necessary on occasion, they should only be used as a “last resort” when all other interventions have been exhausted and there is an immediate risk of harm.
The guidance sets out seven standards to be met by all health and social care services in Northern Ireland.
These include using standard definitions to identify all interventions which are potentially restrictive, and making use of proactive, preventative strategies and evidence-based interventions when developing care and treatment plans.
The guidance also recommends using the Royal College of Nursing’s (RCN) Three Steps to Positive Practice Framework when considering and reviewing the use of restrictive interventions.
Th RCN framework incorporates a “rights-based approach” to ensure that restrictive practices are used only when deemed to be in the person’s best interest.
Meanwhile, the new DOH guidance also includes requirements for decision making, reporting and governance arrangements for the use of any restrictive practice.
It sets out a clear operating framework for the use of seclusion as a practice of last resort, in health and social care settings.
The guidance will need to be followed by nurses working across all areas of the health and social care sector in Northern Ireland, including those working with children, young people, adults and older people.
“The emphasis should always be on elimination of the use of restrictive practices”
Peter May
Permanent secretary at the DOH in Northern Ireland, Peter May, said: “It is accepted that restrictive practice must sometimes take place in health and social care settings.
“However, the emphasis should always be on elimination of the use of restrictive practices, therefore we must ensure that their use is minimised and only used when absolutely needed.
“Most importantly, at all times, we must consider the best interests of the person subject to the restrictive practices and how their human rights can be protected.”
Senior nurse in professional practice with RCN Northern Ireland, Rosaline Kelly, welcomed the policy which she said would support nurses in the region to practice “using a rights-based approach, within a legal framework, and in accordance with the requirements of the NMC Code”.
“It will have a positive impact in terms of safeguarding those in the care of nurses who are subject to restrictive practices, but it will also help nursing staff to recognise potentially restrictive practices and provide a clear guide and framework to work within,” Ms Kelly said.
“Importantly, this policy is a genuine example of co-production and co-design, and we commend the interdisciplinary working involved in producing this important document,” she said.
She noted that the policy applied across all areas of health and social care, not just within mental health and learning disciplinary settings.
Ms Kelly added: “Having a standardised regional approach with the emphasis on minimising the use of restrictive interventions, restraint and seclusion can only improve practice within health and social care, and improve care for patients.”
