Training Staff in Physical Restraint Methods: The Evidence.
Despite the importance of the debate, there appears to be little hard evidence for the effectiveness and safety of different methods of restraint. The evidence for training staff in these methods is considered to be at best crude (Allen 2000), with evaluation of training programmes being the exception rather than the rule (Beech & Leather, 2006). Despite these limitations, vast numbers of care staff are trained in so called ‘physical interventions’ including physical restraint, with the difficulty that the skills taught begin to decay as soon as the person leaves the training room. In addition, although many staff are taught these methods, in some cases they rarely employ them in practice. It is accepted that staff training in physical interventions can increase carer confidence, but, is that sufficient justification for the general implementation of such training? The limited evidence of staff training has long been regarded with some degree of scepticism. Cullen (1992) maintained that staff training was necessary but not sufficient on its own for behavioural change to occur. In sum, we have a large number of untested training systems routinely in use in care environments. It would appear to be sensible to reduce the numbers of staff who receive such training and to exclude physical methods which may be implicated as ‘high risk’. In the absence of hard empirical evidence, what measures can be adopted to limit the use of physical interventions in care environments?
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