Abstract
Restraint use in Australian residential aged care has been highlighted by the media, and investigated by researchers, government and advocacy bodies. In 2018, the Royal Commission into Aged Care selected ‘Restraint’ as a key focus of inquiry. Subsequently, Federal legislation was passed to ensure restraint is only used in residential aged care services as the ‘last resort’. To inform and develop Government educational resources, we conducted qualitative research to gain greater understanding of the experiences and attitudes of aged care stakeholders around restraint practice. Semi-structured interviews were held with 28 participants, comprising nurses, care staff, physicians, physiotherapists, pharmacists and relatives. Two focus groups were also conducted to ascertain the views of residential and community aged care senior management staff. Data were thematically analyzed using a pragmatic approach of inductive and deductive coding and theme development. Five themes were identified during the study: 1. Understanding of restraint; 2. Support for legislation; 3. Restraint-free environments are not possible; 4. Low-level restraint; 5. Restraint in the community is uncharted. Although most staff, health practitioners and relatives have a basic understanding of restraint, more education is needed at a conceptual level to enable them to identify and avoid restraint practice, particularly ‘low-level’ forms and chemical restraint. There was strong support for the new restraint regulations, but most interviewees admitted they were unsure what the legislation entailed. With regards to resources, stakeholders wanted recognition that there were times when restraint was necessary and advice on what to do in these situations, as opposed to unrealistic aspirations for restraint-free care. Stakeholders reported greater oversight of restraint in residential aged care but specified that community restraint use was largely unknown. Research is needed to investigate the extent and types of restraint practice in community aged care.
Highlights
Over the past decade, there has been increased scrutiny on high rates of psychotropic use and restraint practice in Australian residential aged care from researchers [1,2,3,4], the media [5], policymakers [6,7], human rights [8] and advocacy groups [9]
From the residential focus group: “All of our facilities say they don’t use any physical restraint, but we found physical restraint: the pushing the chair under the table, the locked doors to outside areas, so a whole lot of things that aren’t seen as hard physical restraint but are definitively restraining.”
This study was conducted to inform and update Government resources on restraint to align with legislative changes and contemporary best practice
Summary
There has been increased scrutiny on high rates of psychotropic use and restraint practice in Australian residential aged care from researchers [1,2,3,4], the media [5], policymakers [6,7], human rights [8] and advocacy groups [9]. This attention led to restraint being highlighted as a key area of focus for the Royal Commission into. The use of restraint must be the least restrictive form only after
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