What Is Physical Intervention? A Complete Carer Guide.

Working in healthcare brings rewards but also challenges. Patients sometimes act aggressively or display behaviour that risks their own safety or that of others nearby. In these scenarios, staff may feel physical intervention is necessary to prevent harm.

However, manual restraint often escalates crises and inflicts trauma. This article explores evidence-based techniques to defuse tensions without force, upholding dignity and human rights.

---

---

What Is Physical Intervention?

Physical intervention means any direct physical contact a staff member makes with a patient to restrict or control their movement.

This includes manual restraint like holding someone by the arms or shoulders, dragging them away from danger, pinning them to the floor, or forcing injection of medications.

It also includes use of wrist or ankle cuffs and clothing that constricts free movement. Any action that interferes with a person’s ability to move of their own free will qualifies as physical intervention.

What is Physical Intervention?

Physical intervention means any direct physical contact a staff member makes with a patient to restrict or control their movement. Examples are manual restraint like holding someone by the arms or shoulders, dragging them away from danger, pinning them to the floor, or forcing injection of medications.

Key Principles of Safe Physical Intervention

• Least Restrictive Approach: Interventions should use the minimum force needed to achieve the desired result.
• Proportionality: The level of intervention should match the level of risk involved.
• Dignity and Respect: All interventions must respect the individual’s dignity and human rights.
• Safety First: The main goal is to ensure the safety of everyone involved.
• Training and Competence: Only trained and competent staff should carry out physical interventions.

What is Physical Intervention Training?

Physical Intervention Training is a specialised course that equips individuals with the skills to safely manage and de-escalate challenging or potentially violent situations using physical techniques, ensuring the safety of all involved parties.

The keyword here is safely managing the situation by applying applying best method to difficult situations using physical methods, with a focus on ensuring safety for everyone involved.

This type of training is often provided to professionals in various fields, including healthcare, security, law enforcement, and social services, who may encounter situations where physical intervention is required to ensure safety and prevent harm.

You can book a group training on physical intervention training here.

What is Physical Intervention Training?

Physical Intervention Training is a specialised course that equips individuals with the skills to safely manage and de-escalate challenging or potentially violent situations using physical techniques, ensuring the safety of all involved parties.

Types of Physical Intervention Training

Here are the main physical intervention training types:

Physical Intervention Training usually teaches different techniques, from those that don’t involve much physical contact to those that involve more control.

The types on intervention techniques include:

• De-escalation Techniques: These are ways to calm down a situation using words or body language, so that physical intervention isn’t needed.
• Personal Protection Techniques: These help create a safe distance between staff and someone who may act aggressively.
• Non-Restrictive Techniques:
  • Physical prompts and guidance
  • Escorting
  • Redirection These techniques allow more freedom of movement and are seen as less intrusive.
• Restrictive Techniques:
  • Manual restraint
  • Seated restraint
  • Standing restraint
  • Supine restraint (lying face-up)
  • Side restraint These techniques involve more physical control and are only used when absolutely necessary.
• Breakaway Techniques: These teach staff how to break free if someone grabs or holds them.
• Emergency Physical Intervention Plans: Training on how to create and use specific plans for dangerous situations.
• Positive Behaviour Support: While not physical, this approach helps reduce the need for physical intervention by encouraging positive behaviour.

The training encourages using the least controlling method first and covers legal and ethical rules, risk assessment, and support after the situation is over.

What Does UK Law Say About Physical Intervention?

The use of physical intervention must comply with laws and regulations, such as:

• The Mental Capacity Act 2005
• The Children Act 1989
• The Human Rights Act 1998
• The Care Act 2014

These laws and relevant NICE guidelines aim to protect patient rights and restrict the use of force.

Key principles include:

– Force should only be used as an absolute last resort when risks are grave and imminent. All other options must be attempted first.

– Any force applied must be reasonable and proportionate to the risks involved, using minimum strength for the shortest time.

– Intervention should never be used to inflict pain, punishment or force compliance.

– Patients should give informed consent when possible. If they lack mental capacity, decisions must follow best interest principles.

– Manual restraint procedures should be officially documented, time-limited, and subject to rigorous oversight.

– It must be in the best interest of the individual.

– Used for the shortest time possible.

Staff have a legal duty of care but physical force often violates patient rights. Organisations must provide proper training in de-escalation approaches to avoid the need for restraint altogether.

Alternatives to Physical Intervention

While physical intervention may sometimes be needed, it should always be the last option. Some alternatives are:

• Positive Behaviour Support: A way to understand and address the causes of challenging behaviour.
• De-escalation Techniques: Talking or using body language to calm someone down and reduce stress.
• Environmental Modifications: Changing the environment to reduce things that may trigger behaviour and help the person feel calm.
• Sensory Interventions: Using tools to help individuals manage their emotions and behaviour.
• Therapeutic Approaches: Using therapies based on evidence to treat mental health or behaviour problems.

---

We offer carefully designed Positive Behaviour Support Training to help with the unique challenges faced by individuals in your schools, care and nursing homes. To learn more and find solutions that suit your needs, contact our course advisors at enquiries@caringforcare.co.uk or call us at 01782 563333.

---

What Are Specific Risks of Physical Intervention?

While intended to ensure safety, physical restraints pose many risks including:

1.    Injury and Distress 

Restraint use can result in bruises, cuts, broken bones, and other injuries as patients resist or staff handle them forcefully. There is also immense psychological trauma and re-triggering of past abuse when physically forced against one’s will. These effects create lasting damage.

2.    Loss of Trust

Relationships and treatment progress get severely impacted when patients feel violated or neglected. Force destroys therapeutic alliances needed for care.

3.    Deprivation of Rights

Manual restraint contradicts basic human rights principles like autonomy, dignity, and freedom from harm that organisations must uphold.

4.    Legal Problems

Injuries or unneeded use of force make facilities liable to lawsuits or sanctions for violating laws and patient protections.

What are the main types of physical intervention techniques?

Physical intervention encompasses actions that employ physical contact to curtail an individual’s freedom of movement. It is a measure of last resort, used to prevent harm to individuals or others.

It involves both restrictive, non-restrictive, and hybrid techniques. Caution must be exercised to ensure safety and respect for the individual’s rights.

Non-Restrictive Techniques

These techniques guide or prompt an individual without restricting their movement too much. They are often the first line of physical intervention:

• Physical Prompts: Light touch to guide the individual’s movement.
• Escorting: Walking alongside the individual with minimal contact.
• Redirection: Using presence to guide the individual away from a dangerous situation.

Restrictive Techniques

These techniques involve more physical control and are used in more serious situations:

• Manual Restraint: Holding techniques that limit movement.
• Seated Restraint: Controlling the individual while they are seated.
• Standing Restraint: Controlling the individual while standing.
• Supine Restraint: Controlling the individual while they are lying on their back.
• Side Restraint: Controlling the individual while lying on their side.

It’s important to avoid prone restraint (face-down) as it carries high risks.

Restrictive Physical Intervention Techniques (Exercise Caution):

Physical Restraint Techniques:

1. Prone Restraint: Restraining an individual face-down on the ground. This technique is considered risky and controversial and should be used with extreme caution and only when absolutely necessary.
2. Supine Restraint: Restraining an individual face-up. Like prone restraint, it is considered high-risk and should be used sparingly, if at all.
3. Lateral Restraint: Restraining an individual on their side. This is considered a less risky alternative to prone or supine restraint.
4. Two-Person Holds: In some situations, two trained staff members may work together to control an individual safely. Examples include:
   • Two-Person Supine Control Hold: Restraining an individual face-up with two staff members.
   • Two-Person Prone Control Hold: Restraining an individual face-down with two staff members.
5. Manual or Physical Restraint Devices: These are specialized devices designed to limit an individual’s ability to move. They should be used with caution and as a last resort.
   • Limb Restraints: Used to immobilize arms or legs.
   • Belts and Body Restraints: Used to limit overall body movement.
   • Blanket Wraps: Used to immobilize the entire body by wrapping the individual in a blanket.
6. Seclusion Rooms: A designated room or area where an individual can be placed temporarily to prevent harm to themselves or others. Use the room with caution, and ensure that you comply with safety guidelines when using it.

Specific Safe Physical Intervention Techniques

1. Single Person Escort: One staff member guides the individual with minimal physical contact, placing a hand on the forearm or elbow.
2. Two-Person Escort: Two staff members guide the individual, offering more control and support if needed.
3. Figure of Four Hold: Controlling the individual’s arm in a figure-four position, providing control with less discomfort.
4. Seated Restraint: Controlling the individual while seated by positioning staff members on either side to control their arms and upper body.
5. Standing Restraint: A technique similar to seated restraint but while standing. It requires careful coordination between staff members.
6. Supine Restraint: A last-resort technique where the individual is controlled while lying on their back. This requires multiple staff members and careful monitoring.
7. Side Restraint: An alternative to supine restraint where the individual is controlled while lying on their side. This position can be safer for breathing and reduces the risk of aspiration.

Non-Restrictive Physical Intervention Techniques (Can Be Used with Caution):

De-Escalation Techniques: While not physical interventions in the traditional sense, these techniques aim to verbally and behaviorally de-escalate a situation. They can be used with caution and are generally considered safer alternatives to physical restraint.

1. Active Listening: Giving the individual your full attention and showing empathy.
2. Verbal Communication: Using calm and non-confrontational language.
3. Distraction Techniques: Redirecting the individual’s attention away from the source of distress.
4. Time-Outs: Allowing the individual a brief break from the situation to regain control.
5. Medication: In some cases, prescribed medication may be used to manage extreme agitation, aggression, or psychotic symptoms. This should be administered by a qualified healthcare professional.

Hybrid Physical Intervention Techniques (Use with Caution):

Physical Prompts and Guidance: Used primarily in educational or therapeutic settings, these techniques involve gently guiding an individual’s movements or providing physical prompts to help them complete a task. They can be used with caution and should prioritize the individual’s safety and comfort.

Preventative Physical Intervention Techniques (Use with Caution):

Emergency Physical Intervention Plans: Professionals develop these individualized plans for specific individuals who may require physical intervention in emergencies.

The plans outline the least restrictive methods for intervention and specify when and how you should use physical intervention.

You should use these plans with caution and only when necessary to prevent harm to the individual or others.

---

We offer Managing Challenging Behaviour Course to help you manage the unique challenges faced by individuals in your care or nursing home. For expert advice and customised solutions, contact our course advisors at enquiries@caringforcare.co.uk or call us at 01782 563333.

---

What Are Risk Factors That Increase Likelihood of Physical Intervention?

Certain factors correlate with higher use of restraint on vulnerable individuals:

– Staff shortages increase caregiver stress and limit time for de-escalation.

– Lack of staff training in non-physical crisis response methods.

– Poor ward design with limited personal space.

– Underlying medical issues like dementia or mental illness.

– Communication barriers impeding needs being met.

– Disruption from changes like construction or staff turnover.

– Previous trauma leading to aggressive responses when feeling threatened.

Organisations must examine their own practices to address potential risks and replace force with care.

Physical Intervention Training Best Practices 

While training to use physical restraint could seem to promote its practice, proper education focuses on holistic prevention. Effective programs teach:

– Legal, ethical and human rights concerns regarding use of force.

– Risks and potential harm associated with physical intervention.

– Verbal and non-physical de-escalation strategies. 

– Avoiding manual restraint except as an absolute last resort.

– Using least restrictive options to minimize harm when needed.

– Meeting patient needs holistically to preempt crises.

– Tracking data to monitor and reduce use of restraint.

With emphasis on restraint as a never first option, training promotes a culture of care over control.

Alternatives to Minimise Need for Physical Intervention

Before considering restraint, organisations and staff must first exhaust all evidence-based options:

1.    Understand Triggers

Look beyond behaviour to identify unmet needs like pain, hunger, distress over changes, lack of control, miscommunication and more. Address the causes, not just the symptoms.

2.    Communicate with Compassion

Practice active listening, ask open questions, reflect feelings, and validate emotions without judgement. Ensure directions are given simply, slowly and patiently. Kindness calms distress. 

3.    Provide Physical & Emotional Space

Offer options to walk, move freely, spend time alone and disengage from stressors or overstimulation. Distance and autonomy restore a sense of control.

4.    Employ De-escalation Techniques

Strategies like distraction, humour, validation, relating, flexibility, compromise, praise, or suggestions of alternatives redirect behaviour. Defuse anger and confusion before it intensifies.

5.    Individualise Responses

Note successful techniques in care plans. Identify motivators, triggers, abilities and background to customise support. Universal approaches rarely work. Know each person at their level.

6.    Review Medications

Assess side effects that may increase agitation like pain or confusion. Adjust dosages timing and combinations carefully in collaboration with the care team and patient consent.

7.    Make the Environment Safe

Remove nearby objects that could cause injury. Use minimal, non-restrictive safety measures like cushioning or sensor mats. Ensure adequate lighting, space and familiar surroundings to prevent disorientation.

8.    Adjust Communication Methods

Use drawings, gestures, boards and other adaptive ways to connect with those unable to speak or understand traditionally. Identify nonverbal cues and preferred options.

When healthcare providers make physically restraining patients the exception rather than the norm, they protect their rights and wellbeing. But organisations must devote resources and training to make this culture shift possible.

Key Steps to Follow During and After Physical Restraint

In crisis scenarios, staff should remember: 

1.    Exhaust all alternatives first

Only utilise physical intervention when risks are immediate and grave with no other options. Start with de-escalation and addressing unmet needs.

2.    Use least restrictive means briefly

If you absolutely need to use restraint, you should choose the least intrusive technique, such as guiding, to apply minimal force for the shortest time until you resolve the risk.

3.    Avoid pain or punishment

Restraint should never be used to cause pain or penalise behaviour. The motive must be preventing harm, not enforcing compliance.

4.    Ensure safety 

Frequently reassess patient condition including circulation, breathing, distress levels and immediate needs like medication or bathroom. Discontinue at the first safe chance. Monitor for injury after.

5.    Debrief respectfully 

Discuss the incident, offer genuine apology, validate feelings, explain necessity, thank them for trying alternatives, and clarify how to prevent recurrence. Reaffirm dignity.

6.    Follow reporting procedures

Promptly complete required documentation like incident reports detailing justification, duration, observations and follow up plans to address gaps. Ensure oversight.

With commitment to care and accountability, physical intervention becomes obsolete, replaced by understanding, empathy and prevention. When organisations value patience over power, helping hands replace hands of force. And when care guides over control, trust endures.

---

Conclusion

Safe physical intervention methods are crucial for managing challenging behaviours and crisis situations in various care settings. They should always be used as a last resort, with a focus on prevention, de-escalation, and the least restrictive practices.

Effective training, clear policies, and ongoing review are essential to ensure that when physical interventions are necessary, they are carried out safely and ethically.

By prioritising the dignity and rights of individuals while ensuring safety, professionals can handle challenging situations effectively and promote positive outcomes for everyone involved. For those in care homes, you can combine behaviour management courses and mental health awareness training.

---

Frequently Asked Questions

Below are answers to some common queries about physical intervention:

Why does intervention sometimes increase after training?

After learning techniques, staff may rely on them before trying alternatives. But quality training stresses it as a last resort. Culture change takes time but data should show reduction.

What determines use of force was justified?

You only need to justify the use of restraints in documented high-risk imminent situations like significant self-harm or harm to others that you could not prevent by any other safe means in that moment. You do not need to routinely justify restraint use.

How long can manual restraint be applied?

No legal limit but restraint should be brief as possible – just long enough to mitigate immediate danger, usually minutes. Prolonged restraint increases severe harm risk.

What role can families play?

They can share insights on patient triggers, de-escalation approaches, culture, past trauma, and ways to rebuild trust after incidents. Including families reduces use of force.

When should you involve the police?

As an absolute last option if all other attempts fail and waiting poses risks of death or destruction that staff are unqualified to handle. Most situations can resolve without law enforcement.

What reduces need for restraint facility-wide? 

Leadership commitment to culture change, investing in staff training, adequate staffing ratios, reduced stimulatory environments, rigorous data monitoring, and transparency around use of force.

What replaces restraint?

Prevention through addressing unmet needs, therapeutic communication, de-escalation techniques, tailored support, calming spaces, sensory tools, flexibility and unconditional positive regard. Physical restraint, even when legally defensible, inflicts lasting damage.

But when healthcare centres value patience over power, empathy over enforcement, prevention over reaction, possibility over protocol, and care over control, mechanical bonds transform into human bonds. With compassion, crises give way to healing.

Change requires commitment but is possible when we recognise force fractures trust – and true safety