Ethics Paper

Topics: Psychiatry, Nursing, Hospital Pages: 8 (2675 words) Published: May 29, 2013

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 restraint in the nineteenth and twentieth centuries. (Retrieved from

Literature Review and General Consensus
As suggested by Jenelli et al (2006), these changes in nurses’ attitudes and practices might be influenced by the recent development of regulatory standards and nursing education related to restraint use in acute settings, and they varied a great deal in diverse clinical settings such as general and psychiatric units, and across countries. In addition, an understanding of nurses’ attitudes towards restraint use should be considered when a department or hospital intends to improve nursing practice. There are a few studies found which explore the factors influencing nurses’ decision-making in restraint use, particularly in other countries where restraint use can often be seen in psychiatric and non-psychiatric settings. Understanding these factors is essential for an adequate interpretation of nurses’ perceptions and attitudes, as well as their practices, regarding restraint use. Concept of Physical Restraints

A review of the literature suggests that physical restraints can be viewed differently by nurses. A physical restraint refers to the use of belts, handcuffs and the like, which either partially or totally restrict the patient’s movements (Currier & Farley-Toombs 2002; Sailas & Wahlbeck 2005). It can be described by reference to the mechanical devices used, including various cloth or leather devices, and the methods of application such as to the patient’s body or wheelchair, or even by using bedside rails. These variations depend largely on the users’ justification of the need for restraint. Use of physical restraints in hospital is often considered to be an accepted and perhaps unquestioned practice related to patient safety. In the elderly care settings, prevention of injury to patients themselves or others, and prevention of patient falls, are the most frequently cited rationales given by nursing...
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