One of the largest ethical dilemmas in nursing is the use of restraints. Restraints are divided into 3 types which consist of: physical, chemical, and seclusion. Physical restraints restrict normal access to the patient’s own body or prevent the patient from moving freely, chemical restraints are drugs to restrict a patient’s movement or behavior and seclusion a patient is held in a room involuntarily or prevented from leaving (Springer, 2015). Restraints are utilized by nurses in situations where a person may induce harm to themselves or others. Springer (2015) stated, “Restraints must not be used for coercion, punishment, discipline or staff convenience.” Restraints are only intended for use when much less restrictive measures have validated to be useless. Ethical dilemmas arise upon the subject of humans being confined against their will or without consent, and additionally whether or not nurses are using restraints strictly for the patient’s well-being or for the nurses’ convenience.
Physical restraints are the most commonly used restraint and is referred to “as any manual method or physical or mechanical device, material, or equipment attached or adjacent to the patient that the individual cannot easily remove and restricts freedom of movement or normal access to one’s body” (Saufl, N.M., 2004). Physical restraints are utilized by nurses in many healthcare settings. When patients require treatment, but are aggressive and/or violent to those around them or present danger to themselves, the use of physical restraints may be useful for the nurse, aggressor, and other clients. Ethical dilemmas rise up with using physical restraints because the patient’s frame is being held against their very own will without consent. Studies have shown that the leading cause of death by restraints points to asphyxiation (Ombudsman for Mental Health and Mental Retardation, 2002). Other injuries that could occur with the use of physical restraints are pressure sore from unrelieved devices, skin tears or broken bones from patients trying to get out of the restraints and emotional issues due to fear of getting in trouble from alarms going off or being locked down. Research suggests, “that there is no clear confirmation that restraints prevent injuries in clinical settings, ironically makes patients more susceptible to injuries” (Essays, 2013). There are both pros and cons that come with the usage of physical restraint. Ethical dilemmas come in when which one outweighs the other.
Chemical restraints are only utilized to prevent the patient from causing harm to self or to others by helping to decrease violent, aggressive or dangerous behaviors. The use of chemical restraints may be useful to the people surrounding the affected person who’s aggressively or violently acting out. According to Currier and Allen (2000), “The failure to restrain outward acting patients may have adverse effects on the other patients, for which practitioners and institutions will also be liable.” Like physical restraints, nurses should administer chemical restraints only when needed and after all other interventions are deemed ineffective. One ethical issue, is what constitutes needed? If the drug is being given after evaluation and rationale of the plan of care, then it is considered to be needed. If a medication is being prescribed for its reaction to the behavior then it is considered to be a restraint (Currier & Allen, 2000). Chemical restraints can be dangerous causing patients to be significantly sedated. Any patient who’s overly sedated is at high risk for falls. Ethically, chemically restraining someone can be questioned whether or not it’s being administered to prevent the patient from harming themselves or others or if the nurse is using it to meet their personal desires.
The principles for using seclusion are: containment this prevents the patient from harming themselves or others, isolation helps to distance patients from the relationship that is intense, and decrease in sensory stimulation is for patients who have heightened sensitivity to external stimuli. Ethical issues arise to whether someone absolutely needs to be positioned in seclusion for their own good, or to make things simpler for the nursing staff and that they are being held without consent. Patients may sense that they’re trapped or have no rights, freedom or dignity.
According to Rose (2015), “Restraints should only be used as a last resort.” There is a wide range of alternative methods that can be implemented so that restraints do not have to be used. Some alternative to patient restraints include, but not limited to, allowing for personal space, setting behavior limits, offering food and drink, assessing needs as bathroom usage or pain, having more activities for patients to participate in, redirection, reorientation to surrounding or making arrangement for a sitter or family visits. Restraining a patient is considered a high-risk intervention by the Center for Medicare & Medicaid Services, The Joint Commission (TJC) and various state regulatory agencies, so healthcare providers must carefully assess and document the patient’s condition when restraints are utilized (Woodard, 2015). Proper documentation and assessment of alternative interventions should be noted before the use of a restraint is implemented. When a restraint is used, staff needs to be fully educated on how to use the restraint and documentation of assessment while being used needs to be monitored closely so that the restraint is not classified as being harmful or nonbeneficial for the patient. When the use of restraint ends, a post-restraint debriefing needs to occur so that the information gained can be used to help create therapeutic interventions so that the use of restraint can be prevented in the future.