Co-Development of a Digital Intervention to Aid Decision-Making that Supports Minimal Use of Restrictive Practice in Care Homes

Dr Gary Mitchell | Senior Lecturer (Education) | Queen’s University Belfast E: Gary.Mitchell@qub.ac.uk | Twitter: @GaryMitchellRN

Maintaining safety can be challenging for care homes due to the range of complex medical conditions with which their residents live (for example dementia, frailty, complex mental health behaviours and learning disabilities). Sometimes care home staff utilise restrictive practice with the primary purpose of ensuring the safety of their residents. Nonetheless, they must remain cognisant about the regional, national, and international legislation relating to the use of restrictive practice (General Assembly of the United Nations, 1948; Council of Europe, 1950; Donald et al. 2009; Freeman, 2011). As such, restrictive practice may indeed improve resident safety, but it is very often something which also deprives people of their freedom. Restrictive practice within care home settings is a complex issue for the care home organisations, care home staff, their residents, and relatives.

To our knowledge, there have been limited educational interventions which have supported care home nurses to identify restrictive practice, understand the associated legal and ethical issues and provide practical, evidence-based support with regards to decision-making about restrictive practice.

As a result, Queen’s University Belfast and Focus Games Ltd received funding from the Burdett Trust for Nursing to codesign a digital resource to aid decisionmaking that supports minimal use of restrictive practice in care homes. The digital intervention was co-developed using existing legislation, clinical guidelines and evidence relating to restrictive practice (e.g., Mental Capacity Act NI, 2016) alongside the experience of older people, family members/carers of older people, care home healthcare staff and other key stakeholders using co-design methodology. The e-resource can be accessed here: https://play.restrictivepractice.co.uk/ www.riseandshinegame.com

In a sample of 203 care home nurses, we saw improvements in knowledge and self-efficacy about how to use alternative strategies to restrictive practice. Before using the educational resource, the group of care home nurses had a mean score of 34/65 (52%). After completing the educational resource, the group of students had a mean score of 55/65 (85%), reflecting an increase in knowledge and self-efficacy score of 33%. When analysed using a pairedsamples t-test, this increase from pre-test to post-test was statistically significant (p<0.001).

Following receipt of the e-resource about restrictive practice, we also asked care home managers to conduct an audit before and three months after learning to determine if the staff education had led to changes in practice. On posttest analysis, we determined that there were statistically significant reductions in the amount of restriction used across 15 nursing homes in Northern Ireland because of this learning (e.g., reductions in the use of lap belts and bed rails). The findings of this intervention are currently being written up for publication with the e-resource.

Further to this, Queen’s University Belfast and Focus Games Ltd have subsequently received funding for two further projects in care homes. The first is funded by Northern Ireland

Chest Heart & Stroke and is about codeveloping an e-resource to support nursing care of residents living with heart failure in care homes. The second project is funded by the Burdett Trust for Nursing and is about co-developing an e-resource to optimise diabetes care to residents living in care home settings. References available on request.