Rights, risks and restraint – free care of older people. person-centred approaches in health and...

professionals, along with piloting in dementia settings. Thisis evident in the language used throughout and in the sequen-tial and logical way in which it is presented. An educationalprogram, which includes recorded practical demonstrationsof how to conduct interviews with people with dementiausing the profiling described in this guide, would be of greatbenefit to carers.

Deirdre FetherstonhaughAustralian Centre for Evidence Based Aged Care,La Trobe University, Bundoora Extended Care Centre,Bundoora, Victoria, Australia

Rights, risks and restraint – free care of older people.person-centred approaches in health and social careR. Hughes. Jessica Kingsley Publishers, London, 2010. 224 pp.ISBN 978 1 84310 958 7 (paperback). A$39.95.

The issue of restraint use has long been a source of tension forclinicians. However, one of the biggest issues is in relation tohow one defines physical and chemical restraint. In Part 1 ofthe book, Types of Restraint, Patterns and Trends, RhidianHughes discusses the trends of restraint use. This chapter islimited by its focus on USA-based literature. This is becausethe USA was the first country to provide evidence regardingthe use of physical restraint on older people. It is fair to saythat researchers and policy-makers in the USA were the firstto define what constituted physical restraint and used it as adriving force to implement change. More recently, we haveseen the definition of physical restraint focus less on thedevice and more on the intent. The situation for CovertMedication and Chemical Restraint (Chapter 3) is similar.Anecdotal evidence suggests that clinicians only seek toadminister medication as a form of restraint when physicalrestraint is not permitted. We have seen the inappropriate useof medications as a means to provide staff with a manageableclient. Again, the USA is leading the way in providing alegislative response to this issue.

In Australia, researchers have also been asking for a legaldefinition of restraint. However, to date, the Australian Gov-ernment has offered definitions that can be used by cliniciansbut these are not defined by law. This book highlights thehost of ways in which restraint has been defined by research-ers and clinicians.

It should be noted that much of the literature cited in Part 1refers to work undertaken within residential care and thismay limit the readership.

Part 2 of the book discusses Perspectives across Health andSocial Care; this includes descriptions of changes in practicethrough teamwork. The examples provided include a psychi-atric setting and a nursing home in the USA, and examplesof issues and suggested strategies in the UK. The case studies

highlight how far Australia has come in the elimination ofphysical restraint use with residential aged care settings.However, for change to occur, it is critical to both empowerstaff and listen to the voices of those receiving the care.

When making change regarding the use of restraint, there isdisagreement on whether the goal should be elimination orreduction of its use. I advocate the elimination of restraintuse on older people, especially because of its consequenceson physical, emotional and psychological well-being. Apositive move to eliminate the use of restraint could be tohave non-use of restraint as an indicator of the quality ofcare being provided within a facility or health-care setting.Work is currently being undertaken by the Department ofHealth, Victoria, to develop restraint use as one of the suiteof quality indicators within public sector residential agedcare. The challenge is to extend this development to otherproviders.

Part 3 of the book presents Issues and Innovations from avariety of countries. This is the weakest section of the book.It presents a more academic focus on a range of topics, suchas ethical issues and decision making; discourse analysis onrestraint use; de-escalation techniques for behaviours that areproblematic for the clinician; wandering; and falls. Whileit presents very little new knowledge, a novice clinician orsomeone who has very limited knowledge of the alternativesto restraint and how to implement person-centred care mayfind the chapters enlightening.

The book is of interest to anyone who wishes to know moreabout the use of physical restraint, medications as a form ofrestraint and associated issues. I particularly liked the book’suse of case studies to provide examples for the topic beingdiscussed.

For me the key messages coming out of the book were:• Staff need to be empowered to make change• Staff need to work as a team to effect change• Sometimes for change in practice to take place there

needs to be a change in legislation.

At first glance, the book’s audience may seem limited.However, I can see it being used by academics and cliniciansalike. It provides several good case studies that facilitate theexamination of a range of approaches to restraint-free care.An excellent example of the role of politics in reducingrestraint use is provided in Chapter 5.

I would recommend this book. The chapters are easy to readand the use of diagrams, drawings and particularly the casestudies bring the book to life.

Susan KochHelen Macpherson Smith Institute of Community Healthand La Trobe University, Melbourne, Victoria, Australia

B o o k s h e l f

143Australasian Journal on Ageing, Vol 29 No 3 September 2010, 142–143© 2010 The AuthorAustralasian Journal on Ageing © 2010 ACOTA