ethical dilemma of restraints

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The themes can, … Use of restraints should be minimized because it increases unnecessary demands on the healthcare system by increasing nursing workload, which results in poor quality of care and also provides the bases for an increase in budget for healthcare. Facebook Depression! Bio: Peggy Schaefer Whitby is an associate professor at the University of Arkansas and serves as the program coordinator for special education. Retrieved from 9927120, Moran, A., Cocoman, A., Scott, P., Mathews, A., Staniuliene, V., & Valimaki, M. (2009). Toronto: Pearson Canada Inc. Yamamoto, M., & Aso, Y. if (d.getElementById(id)) return; Nursing practice revolves around patients’ care, wellbeing, safety, non-pharmacological interventions, and nursing outcomes. In such situations, it may be ethically justifiable for physicians to order the use of chemical or physical restraint to protect the patient. Ethical Dilemma Factor in Regarding Physical Restraints to Elderly of Female Nurses with the Living Together Experience 330 . Physical Restraint in Health Care: Is Paternalism Justified? Psychological impact of restraints in psychiatric patients includes feelings of annoyance, helplessness, uncertainty, loss of control, lack of ability to trust, feeling of anger and all negative past experiences as well as past use of restraints strike back to their memory in the form of flashbacks and nightmares (re-traumatizing). The decision made for not restraining the patient against his wishes is supported by the institutional policies and CNA codes of ethics. The areas for further research might include how physicians can help reduce the use of restraints and the use of restraints from patients’ perspective. However, I thought about the consequences of leaving him unrestrained. Relying on Restraints in Psychiatric Settings: Distasteful yet Necessary? The Role of CNA Codes of Ethics in Decisions Making and Outcomes. Restraints and the code of ethics: An uneasy fit. }(document, 'script', 'facebook-jssdk')); Peace In-Home Health Care is a family run business based in the province of Ontario. Understanding and providing support also speed up recovery of a patient after restraining. This paper examines the ethical actions of nurses based on theories of nursing ethics, the codes of ethics, nursing standards, and views of nursing scholars for the use of restraints and some alternatives to cope with particular nursing scenarios. In addition, choosing restraints often revokes ethical issues with regard to human rights, dignity and well-being (Gallagher, 2011). (2007). Ethical issues in patient restraint. Leaving the patient unrestrained did not further harm the patient. The reasons for not restraining the patients involved the images of cruelty and imprisonment (Hine, 2007). According to Felicia “Liz” Stokes, JD, RN, senior policy advisor at the ANA’s … Often applied in intensive care units with patients experiencing agitation and insufficient sedation, physical restraint techniques are advised for prevention of self-harm and unplanned extubations. De-escalation techniques should be explored, furthermore, reducing environmental stimuli would also minimise violent behaviour. This might be one of the reasons that the family members requested to remove the restraints when relatives were present with the patient. She hit and abused the ward staff. Author information: (1)International Centre for Nursing Ethics, University of Surrey. Abstract This article discusses the use of restraint with disabled adults and children and uses a case study of one particular child to explore issues related to the use of restraint, including the consent of the person subjected to restraint, their human rights, and the balancing of these rights with the need to reduce the risk of harm. Physical restraint in a therapeutic setting; a necessary evil?. The clients feel feeble and anguish, they need someone to talk to. 43). fjs.parentNode.insertBefore(js, fjs); Talking to the patient with due respect helped the nurses to overcome the circumstances. Demented patients are agitated, confused, and many times become aggressive. Significance The decision for not restraining the patient is also supported by many authors. At times, however, health conditions may result in behavior that puts patients at risk of harming themselves. no. The quality of nursing care can be assessed by positive outcomes which are the prime objective of nursing care. Patient restrictions: Are there ethical alternatives to seclusion and restraint? As described by the CNA codes of ethics (2008), every patient has the right to be treated as a human being. It is human nature to feel discomfort against restrictions, especially when it comes to physical or emotional harm (Lai & Wong, 2008). While dealing with the situation in respect to Mr. A.C., who was left unrestrained, the actions resulted in positive outcomes. They further explain this connection as nurses’ moral obligation to their jobs. At first they tried the method of de-escalation by having words with the client. As a student nurse, I was looking at the situation and trying to figure out what actions to take for handling such circumstances. The ethical dilemma was whether to use physical restraints for the client to prevent further harm or whether to go with the client’s wishes. Journal of Psychiatric and Mental Health Nursing, 9(4), 465-473. Nurses were obligated to honor his wishes morally and ethically because those restraints were positioned to protect him from self-extubation. These nurses felt that it was a dehumanizing treatment to use physical restraints on patients (Moran et al., 2009). In our society, people have different opinions about the use of restraints. Seclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. The use of alternatives was also helpful in conquering the aggressive behavior of Mr. A. C. The staff nurses and I used therapeutic touch and addressed the patient with his name to settle the war which was going on in his mind. (Demir, 2007). In order to make sure that I was making an ethically right decision and staying within the boundaries of my limits, I asked the staff nurses for their suggestions to handle this situation. These include the right to autonomy, dignity, respect, justice and equality. Paternalism simply means to take a decision on behalf of someone for her/his benefit. Based on the team work, keeping in view the patient’s benefit, and providing patient autonomy and freedom of choice, it was decided not to restrain the patient. However, it is also a moral and professional dilemma for health care members, when to use restraints and when to respect their patients’ autonomy. Advertisement: Call for Papers for Journal of Pioneering Medical Sciences ( Submit Original Article, Review Article, Case Report, Letter to the Editor, News Article, Clinical Images, Perspectives or Elective Report to JPMS. Physical restraint is a controversial topic and it is important for nurses to remain up to date with clinical governance strategies, regulation and policy developments. Trauma for all: a pilot study of the subjective experience of physical restraint for mental health inpatients and staff in the UK. restraints that are intended to protect the older adult. The best ethical justification for restraining patients is that it prevents them from harming themselves. Nursing practice is for the beneficence of the people who are suffering and fighting for their lives against diseases. doi: 10.1177/0969733009350140, Lai, C., & Wong, I. The position paper described ethical dilemmas inherent in the use of seclusion and restraint, and reviewed research that suggested ways to reduce the use of restrictive interventions and prevent violence. In general terms, to restrain is to limit someone’s liberty. Her research interests are in the area of implementing evidence-based practices and sexuality education. The writer of these articles authorize Peace In-Home Health Care Services Inc to use these articles on their website as an additional resource for their clients. An informed consent was also obtained from the family to restrain the client for his beneficence and to provide the family with satisfaction regarding the expected outcome. It offers no speci c answers to individual operational problems, but a methodological matrix is proposed as an aid to experts in the … Families’ perspectives on the use of physical restraints. Fundamental principles to guide future action on the issue of seclusion and restraint … Nurses’ personal moral values play a significant role in dealing with ethical dilemmas in their practice. Leaving him without restraints would also help nurses to handle the patient and reduce the staff’s emotional distress (Moran et al., 2009). Psychiatric patients exhibiting violent, agitated or aggressive behavior are restrained in order to prevent harm to self and others. Retrieved from 546326, Kontio, R., Valimaki, M., Putkonen, H., Kuosmanen, L., Scott, A., & Joffe, G. (2010). These considerations include why physical restraints are used, what is the importance of using physical restraints, and who is affected the most, the patient, family, or nursing staff. According to Perkins, E., Prosser, H., Riley, D., & Whittington, R. (2012), “best practice means practitioners will strive to de-escalate buy maxalt behavior and so avoid restraint” (pg. The goal of all nursing interventions, nursing theories, institutional values, country laws, and bioethics is to enhance the beneficence of such nursing interventions for patients (Oberle & Bouchal, 2009). All this adversely affects their mental health and patient may end up having severe depression. This should be kept in mind that restraints are not a preferred choice to control agitated behavior of patients, even for patients’ beneficence. Given that the ethical issue is an essential dimension of nursing practices, the use of physical restraints has caused an ethical dilemma because balancing the human rights, ethical value, and clinical effect is challenging. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Canadian Journal of Psychiatry, 48(5), 330-337. (function(d, s, id) { The physical restraints were removed during the visit of a family member, as requested by the family. Facebook alone has an estimated over 500 million users. restraints without consent in order, as they it, to prevent physicalperceive harm such as falls. For nurses to make ethical decisions about the use of restraints, involves high quality of nurse-client relationship, nurses’ morality, truthfulness with their profession, accountability, and team approach (Oberle & Bouchal, 2009). Reflection on the Situation and Literature Support. Submit online via:, We also publish Sponsored Articles. The primary purpose of physical restraint in intellectual disability care is to prevent injury or harm to the service user or others, yet research evidence shows it can cause trauma and injury. Adverse effects associated with physical restraint. A discussion of the ethical, legal, practical, and professional issues follows, to help nurses understand the difference between unacceptable or … The family was involved in this decision making. Restrained patients increase the workload for nurses by increasing the documentation work and hourly checks for skin integrity. •       Mohr, W. K., Petti, T. A., & Mohr, B. D. (2003). The use of Physical restraints should be minimized by using the alternative ways to defeat the emotional distress among agitated patients. Undoubtedly, mental health-care workers primarily involve psychiatrists and nursing staff. It is also important to involve patients in the decision-making process as much as possible. Restraint and seclusion: A distressing treatment option? Hine, K. (2007). Therefore, ethical principles should be seriously considered before drawing an ethical conclusion. Patients’ families often believe that the hospital staff is restraining a client as punishment, retaliation or for their own conveniences. Nursing Ethics, 17, 65–76. This article does not reflect the policies of JPMS or its Staff or Editorial nor does it intend to provide legal, financial or medical advice. At this juncture also the principle of beneficence and non maleficence is applied. The father noticed …, Copyrights: Journal of Pioneering Medical Sciences,,,, In Perspective: Implications of Using Physical Restraints in Clinical Settings. To ensure safety of the staff and patient herself, the psychiatrist decided to restraint the patient. They state that physical abuse of patients is against the law. Some families consider restraints a good tool for their dear family members; while others believe that restraints are not the only solution to the problems. For details email us at or follow the link for details: It also examines where the necessity to use restraints in the absence of empirically supported alternatives leaves professionals in terms of conflicts between ethical principles and makes recommendations for changes in education … Archives of psychiatric nursing, 24(1), 3-14. (2009), it was shown that physical restraints also caused emotional distress for nurses. js.src = ''; This practice can be considered as silver. No paper submission or publication charges. Refer to Disclaimer and Policies section for more details. In some cases, they seem fine but suddenly perform violent acts—throwing objects, screaming or shouting angrily, and even posing as a threat to himself or to others. However in the case described, human rights and patient’s bill of rights were violated since the patient’s right of self determination was sacrificed. Broader ethical issues. The use of physical restraints poses dilemmas for die nursing staff. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The client became aggressive as soon as the visitor left and he pulled his PEG tube half way out; he refused the nurse’s use of physical restraints on him. The second option was to honor the patient’s wishes, which would make the patient happy and calm him down. All individuals have a fundamental right to be free from unreasonable bodily restraint. As mentioned earlier, some researchers believe that use of restraints have a negative impact on agitated patients; they should not be restrained if there is no harm involved in the situation. In another study conducted by Moran et al. Unintentionally, if a wrong decision is made, it would impact the patients’ outcomes dramatically; these decisions would also cause distress for families and the nursing staff (Moran, Cocoman, Scott, Mathews, Staniuliene, & Valimaki, 2009; Lai, & Wong, 2008). It was nurses’ knowledge and experience which worked as a protective shield and prevented further harm to the patient and nurses.

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