Restraint interventions in people with moderate to profound intellectual disabilities: Perspectives of support staff and family members.
Petri J C M Embregts, Annemarieke Negenman, Jolanda M Habraken and 3 others
PMID 30191671WHAT IT FOUND
Support staff and family members judged most restraint scenarios as involuntary for themselves, but thought the person with moderate to profound intellectual disability would mind fewer.
They often explained this by assumed lack of awareness or habituation.
Key findings
01Nearly all support staff and family members considered seven of the 10 restraint vignettes involuntary and severe from their own perspective.
02When asked to take the client's perspective, most considered three of the 10 vignettes involuntary: squeezing the nose, chaining to the playpen, and not allowing parents to call.
03When participants thought the client would not consider care involuntary, the most important reason given was lack of understanding of the act and its consequences.
STILL TO COME
How it was doneWhat they found
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What it does not show
Only 20 support staff and 20 family members from three services in the southern Netherlands took part, and clients were selected by convenience sampling, not randomly. The people with moderate to profound intellectual disability were not asked directly. Staff and family reported what they thought the person would consider involuntary. The study used written vignettes, not real incidents, and the authors say actual reactions in daily life would need to be studied. Participants answered from their own perspective before answering from the client's perspective, which the authors say may have biased the client perspective responses. The study did not define involuntary care or severe in advance, so participants used their own meanings. The main analysis reported counts and percentages, not a statistical comparison of the two perspectives, and the authors suggest larger random samples for that.
Declared interests
The study was funded by the Dutch Ministry of Health, Welfare and Sports. The authors declared no conflict of interest.
The easy way to misread this
Do not read the lower client-perspective ratings as evidence that the person with intellectual disability accepts the restriction. The person was not asked, and staff or family often explained their view by assumed unawareness or habituation.