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The Use of Restraints versus Patient Autonomy
Kerry B. Bledsoe
MidAmerica Nazarene University

The Use of Restraints versus Patient Autonomy
The use of physical restraints has been a controversial yet frequently used nursing intervention for confused and hospitalized patients with severe mental disorders over the past two decades. In many Western countries there were between 3.4% and 30% of acute elderly care and rehabilitation patients subjected to some form of physical restraint during their hospitalization (Evans & FitzGerald 2002). Patient safety has always been a priority in healthcare. Regulatory organizations like that offered by the Joint Commission on Accreditation on Healthcare Organizations Committee for the Prevention of Torture and Inhuman or Degrading Treatment of Punishment. The practice of physical restraint on patients remains widespread and appears an ethical issue. History of Physical Restraints

Archival records of physical restraint usage at the St. Louis Insane Asylum (now the St. Louis State Hospital) were examined from January through June 1885. The demographics of restrained patients were determined from archival admission records. In the 6-month (181-day) sample period, 53 patients accounted for the total of 2,537 incidents of night restraint. Sixty percent of the restrained patients were women and 53% were immigrants. By far most (98.5%) of the incidents of restraint were brought on by violent behavior (fighting, destroying property, injury to self) while most incidents in modern hospitals result from verbal threats or shouting. When these records were combined with day restraint records from the same 6-month period in 1889, an overall incidence rate of 9.7% per month was estimated. This is similar to rates reported from modern psychiatric hospitals. Possible reasons for the discrepancies and similarities in the types of patients restrained and the activities which brought on...
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