Ethical Issues in Patient Restraint Summary

It was a long time ago since it became major ethical issues in the healthcare practice. The question is: In what circumstances, if any, might restraint in care be justified? Nurses from different states and places have different opinions and views in the application of restraints to different patients and circumstances. Nurses from the UK are not favor in using restraint among their patient in protecting their rights while nurses from US has been practicing it to promote wellness and life. Nurses from US clarify that it easier to explain to relatives why they put a restraint to a patient rather than explain why the patient got injured. UK nurses emphasize the value of dignity of patients. This revealed that restraints among patients are very challenging and controversial. Putting restraint could be beneficial in maintaining patient s safety though it also poses a great deal of liabilities should in case it resulted to serious harm and death. There were different kinds of restraints used for different situations among different patients. The five types of restraints are physical, chemical, mechanical, technological, and psychological. All of these restraints, though differ in the manner of application has only one goal. It is to limit one s movement or ability to perform activity in his free will. Different scenarios were given wherein the use of restraint can be justified. In conclusion, restraints shouldn t be treated as a nursing intervention that is beneficial for any circumstances. As mentioned, it should always be considered as last resort as it also presents significant threat to human rights, dignity, autonomy and well being. Nurses must understand that it may be the easiest option but it s unethical. It represents a compromised because it has the potential to undermine the values of nursing.

Reaction: Restraints are very sensitive issues to discuss in nursing profession nowadays. Many nurses are utilizing this intervention in providing care for their patient. For me, it is one of the best forms in discussing paternalism . We know for a fact that we use restraints because we are preventing more harm to be inflicted to our patient. But it tarnishes our quality care because we undermine the dignity of our patient. I have a personal experience in applying restraint to a patient. I have this private duty patient last year, which is a post operative patient in cardiac bypass. He developed a complication in his nutrition since the problem in his swallowing or gag reflex is diminished. He rarely eats and soon his body deteriorates. He is weak and felt dizzy when walk, sit or move. He only eats 3-4 spoons of any food served to him. After many weeks he is continuously getting weaker. One day, I witnessed him experiencing petit mal seizure. We immediately hurried him into a hospital. One of the reason he had the seizure is because of fluid and electrolyte imbalance. Since he cannot eat and tolerate oral feedings we put a NG tube to support his nutrition. When putting an NG tube he is being resistant and when it is established he had removed it for several times, along with his IV line. After which, we decided to put a restraint on him as indicated of his attending physician and family. We tie both of his hands in the side of the bed. After putting a restraint on my patient, I pitied him so much to see in a state wherein he couldn t move freely. It hurts to see him that way, that s why I tried to make him understand that he shouldn t remove his contraptions so that we can go home. After sometime he finally agreed to put the NG tube and he understand its importance. Restraint is useful, though it shouldn t be included in everyday practice of our profession. We need to instill in our mind that we have to look into our options before resorting to restraints. There are many harmful effects that restraints can put our patient into so be careful in choosing and applying restraints. Though, I wouldn t want to have my patient fractured or injured I wouldn t choose restraint to prevent this. Instead I would try to examine and analyze what other interventions I can implement to guard the safety of my patient. As included in our vows, we should be the one who protect our client s rights and dignity. This is why we are called as patients advocate. Come to think of it, who else would safeguard this right of a patient when we ourselves have been doing something to limit it? For the record, I am not against restraint. I just want to emphasize that we should be more careful in using restraints as an interventions. Our critical thinking and sound decision making would greatly help in analyzing if and when the need of restraints is inevitable.

BALIUAG UNIVERSITYSchool of Graduate Studies and Continuing Education Baliwag, Bulacan

ETHICO-LEGAL BASIS OF NURSING PRACTICE NRS 501

Journal

Vernalin B. Terrado, RN MSN Student