Dealing with challenging behaviour (also known as violence in the workplace) is a highly complex area which is dealt with at length in my soon to be published book: Dealing with Challenging Behaviour in the Education and Care Sectors.
Main areas focused upon tend to be the service user / client and the actual physical intervention techniques used.
However, other areas need to be addressed:
- The management of challenging behaviour (link to Corporate Manslaughter or Health & Safety Legislation).
- The staff member (link to their well being and safety plus Manual Handling Regs, Health and Safety at Work Act etc).
- Other people (link to duty of care to other occupants who may become physically or mentally hurt by watching such behaviour).
- Environment (costs through acts or omissions in practices or adaptations of surroundings).
It is essential that all work places and service providers conduct assessments of risk for their staff and clients. We need to know what physical or psychological risks are highlighted for our staff and service users so we can properly assess our needs.
Assessing the need will then look at service users and staff based upon their unique demographics and underlying medical conditions. Intervention techniques may well be effective and appropriate with most people but may not be suitable for particular service users or for particular staff members to apply.
The unique and individual assessment of risk and need approach will assist greatly in ensuring professional and safer handling of intervention incidents.
Ultimately if a service user dies during a physical intervention incident then the service provider (individuals and/or organization) can be liable.
Firstly I must emphasise that no physical intervention or restraint is guaranteed safe. There are always risks for the service user, the staff members and others nearby. The Safer Handling of challenging and/or vulnerable people is a target but management and staff need to adopt a risk based approach for knowledge and skill to reduce likelihood of severity.
Many individual issues will impact upon the safety of intervention processes and these include:
- Special Educational Needs and Disabilities.
- Neurological issues such as dementia or alzheimers.
- Suicide and self harm tendencies.
- Acute behaviour disturbances.
- Physical issues such as asthma, infections, head injuries, heart disease, diabetes, sickle cell, excited delirium, positional asphyxia, etc.
- Psychological issues such as depression, anxiety, claustrophobia, OCD etc.
Positional asphyxia is a risk when a person is being restrained. Safer airway positions are the target at all times. History shows that laying people down (prone or supine) reduces the airway management. Any airway management compromise has potential catastrophic risks and should be avoided if possible and if not possible then the risk removed urgently.
Positional asphyxia is not a straight forward suffocation – it is having the body in a position where by the oxygen intake is lower than the demand. As time passes this creates a lower oxygen saturation in the restrained person causing organs to fail. The time limit can be from seconds to hours, and beyond.
Body weight of the staff member on the service user should be avoided.
Factors that increase the risk of positional asphyxia include:
- Positions that result in complete or partial obstruction of the airway
- Pressure applied to the back, neck, torso or abdomen
- Person in the prone position (laid on their front face down)
- Restriction of the shoulder girdle or accessory muscles of respiration
- Child, small adult or elderly person
- Person with underlying health problems
- Heightened stress levels
- Respiratory muscle failure related to earlier violent muscular activity e.g. violent struggle
High quality advice, training and consultancy should always be a priority to ensure professionalizing safer handling of challenging behavior and management of violence.