The recent report of the inquiry into complaints at Ashworth Hospital (1) recommended that control and restraint techniques, used to contain violent conduct, should be used as a last resort, 'and should be subject to careful scrutiny to determine system failures'. This article, which points out that nurses in many areas are victims of increased levels of violence, defines control and restraint techniques, who should use them and in which situations their use may be sanctioned. The author concludes that although preservation of the patient's rights and dignity is paramount, nurses who have undergone control and restraint training are more confident practitioners when they are confronted with violent situations. In a second article next month, Tarbuck will look at issues of ethics and the human rights of patients.
Several centres are engaged in work to construct mental health screening and assessment tools for use with young offenders. Psychometric measures are being used to determine their validity and reliability. The work has highlighted deficiencies in the healthcare of young persons involved in criminal justice systems but should assist policymakers, healthcare strategists, planners and commissioners to come to better informed decisions about how to utilize most appropriately the limited mental health expertise that is available and how to enhance awareness of nonhealth professionals of basic mental health risks, problems and disorders.
Work-based learning and collaboration between students, employers and higher education institutions can be used to enable managers and students to unravel the network of factors which affect advanced practice in health and social care. Additionally, collaborative working can help to create opportunities to develop strategies that will facilitate change. Implications for nursing management Sustainable change concerned with the introduction of advanced practitioner roles present a real challenge for managers at a strategic and operational level. Commissioning flexible, collaborative and service-led educational programmes can assist in ensuring that change is sustainable and produce practitioners who are fit for practice, purpose and award.
Behavioural disorders present extreme problems for clients and careers. In this article, the authors discuss a definition of challenging behaviour. Types of behaviour classified as 'challenging' and possible responses to them, are also considered. Some of the points are illustrated with short case studies.
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