Restraint removal: tension between protective custody and human rights

Aims and objectives.  To describe the culture of an aged care facility relating to restraint use and provide insight into the process of changing to minimal restraint care. Background.  In 1999, the accreditation process for residential aged care facilities (This term has been used in Australia since around 1997 and replaces the terms 'nursing homes' and 'hostels') in Australia was extended to include a review of restraint use, with the view to minimization. As using restraint had traditionally been viewed as acceptable, it was expected that there would be tensions involved for staff making the transition to providing minimal restraint care. Design.  The research was situated within the qualitative paradigm and guided by symbolic interactionism, grounded theory, and case study. Methods.  Data were collected through observation of instances of restraint, individual interviews with staff, and document analysis. Results.  The transition to minimal restraint care was associated with tensions for staff. Whilst efforts had been made to make the facility restraint-free, bedrails were still in evidence, and were not necessarily viewed by staff as constituting restraint. Conclusions.  Nurses may experience a tension between human rights and duty of care when adopting restraint-minimization practices. Relevance to clinical practice.  Tensions may be alleviated by adopting a universal definition of restraint, acquiring physical resources and new skills in care delivery and modifying staff, resident and family attitudes towards the delivery of care.