Training Needs Analysis for Restraint Reduction

This is an excerpt from our 18-page Case-Study about how we achieved significant Restraint Reduction outcomes with a training programme.  To read the case study and learn about the project, please visit our Restraint Reduction page.

In line with our accredited quality assurance process with the Institute for Conflict Management, and with the cooperation of our client’s management team, we began to gather training needs data from the staff and the service managers.

We surveyed all staff, we worked with the nursing leads to review incident data and then discussed all of these with the training team and management. Importantly. key questions at each stage addressed the needs of the service users and how any changes would impact upon them.  This is how we started our Training Needs Analysis for Restraint Reduction.

Reducing Restraints – The client and our team were very focussed on any potential to reduce the use of floor-based restraints. One the one hand, we knew that there is rarely any therapeutic benefit from holding a service user on the floor (and indeed, plenty of risk of the opposite!). On the other hand, some service users in the service seemed to feel most able to cope, after reaching a certain point of escalation, if the staff stabilised them on the floor.  In the background, the inspectors were looking at the data and asking for changes to be made to how things were being done – the needle had to move!

We would need to look at how these situations were arising, and see if a root-cause could be identified.  We would also need to look at how these situations, if they were going to happen, could be brought to an alternative conclusion.

At Dynamis we have a variety of ways to gather information about the real needs of a service when it comes to training, and over the years we have learned how to approach different layers of the organisation with different questions, so as get a comprehensive understanding of how to meet the organisation, the teams’ and the individuals’ needs.

Training Needs Analysis for Restraint Reduction

We embarked on the TNA journey:

• interviews with key board-level management stakeholders
• surveys of service managers and supervisors
• surveys of the staff
• discussion with nurses about the needs of the service users

The service was split over a number of buildings and sites, with service users of different dispositions placed throughout. Incidents of conflict, challenge and disagreement between service users and staff were relatively common, as can be expected in a residential learning disabilities/mental health setting.  

Incidents of violence were not infrequent, however they did tend to gravitate around a subset of the service users whose needs were more complex, and who therefore tended to have more high-risk encounters.  One or two service users posed a particularly high risk if circumstances were not carefully managed – they had caused injuries to themselves or others in the past when not properly managed.

One important fact began to stand out – it became clear from the survey of staff that fear was a significant effect within the service.

• Fear of being hurt during an incident of violence
• Fear of hurting the service user during an incident
• Fear of being disciplined (or worse) after an investigation into an incident 

We needed to address the culture of fear that was abroad in the team, if we were going to improve the culture of care for the service users and everyone working in the organisation.  We were pleased that the rigorous Training Needs Analysis for Restraint Reduction was uncovering deep and crucial aspects of importance to the staff team.

Peace Stories, not War Stories

One issue was that ‘War Stories’ about incidents that had happened, and the repurcussions for staff afterwards, were being shared by staff and contributing to a lack of confidence and motivation.

Using one of the foundational pillars of the Vistelar method, we would start to tell ‘Peace Stories’ and we would celebrate them.

Rather than sharing War Stories, we would ask the staff to tell their tales of when they had talked a situation down, or when they had persuaded a service user to take a safer path, or comforted their client who was in distress. These are ‘Peace Stories’ and they change the focus!

These success-stories, when shared and celebrated, have created virtuous ripple-effects in services where we have worked previously, turning a group of staff who are walking on egg-shells for fear of making a mistake into a group of people more aware of the positive moments they create on a daily basis, growing in confidence that they are ‘moving the needle’ for their service users in each interaction.

This ‘peace story’ focus would help us to shift the lever and begin focussing on the positive, towards confidence and motivation. 

Over the months since we completed this project, the staff morale has utterly changed in this service, towards one where the team feels safer and offers a more consistent face to the service user – treating every person with dignity by showing them respect in every encounter.

In the next blog post in this series we will look at how the Vistelar system helped this team to achieve a consistent approach in dealing with difficult, distressed and dangerous behaviour.

Learn more about our Trainer Development Programme for your service here.