The use of physical restraint is quite common among caregivers in health facilities when dealing with geriatric patients. Yet this topic is one of the most debated issues in healthcare and medicine. The purpose of medical restraints is to prevent patients from harming themselves or those around them. It seems to be a simple solution and panacea for unruly patients who needs to be treated. However, ethical implications surround its usage as the practice of physically restricting people strips them of their autonomy as well as other psychological factors, such as agitation and trauma. Therein lies the dilemma on how to approach such an issue.
Proponents of physical restraint believe that the use of it can assist healthcare providers in treating geriatric patients with conditions ranging from dementia to incontinence. Utilizing medical restraints is necessary for the well-being of patients, as it will be more beneficial for them. However, opponents of physical restraint argue that it causes more harm than good. Along with the physical and psychological trauma that it may bring, it also violates a person's autonomy and decision-making. While the main goal of using restraints is to assist a patient and prevent harm from occurring, the opposite may happen from a mishap by inexperienced or immoral practitioners.
To improve the understanding on this topic, background information must be supplemented. According to the State Operations Manual Appendix PP of the Centers for Medicare and Medicaid Services (CMS), or formerly Health Care Financing Administration (HCFA), the term physical restraint is defined as “any manual method or physical or mechanical device, material, or equipment attached or adjacent to the resident’s body that the in...
... middle of paper ...
...L. B., and M. Cullinan. "Frequency of Assault and Severity of Injury of Psychiatric Nurses in Relation to the Nurses' Decision to Restrain." CINAHL Plus with Full Text. EBSCO, Aug. 2011. Web. 21 Nov. 2013.
Rutledge, Dana N., and Eliza Schub. "Restraints: Minimizing Usage in Skilled Nursing Facilities." CINAHL Plus. EBSCO, 7 June 2013. Web. 18 Nov. 2013.
"State Operations Manual: Appendix PP." CMS.gov. Centers for Medicare & Medicaid Services, 10 Jan. 2011. Web. 18 Nov. 2013.
Tzeng, Huey-Ming, and Chang-Yi Yin. "Physical Restraint Use Rate and Total Fall and Injurious Fall Rates: An Exploratory Study in Two US Acute Care Hospitals." Open Journal of Nursing 2.3 (2012): n. pag.SCIRP. Scientific Research Open Access, July 2012. Web. 20 Nov. 2013.
Veer, A. J. E., Anneke L. Francke, Rian Buijse, and Roland D. Friele. Nursing Journal. Wiley, 2009. Web. 18 Nov. 2013.
Increasingly, people know from their own experience some painful dilemmas involving elderly or handicapped individuals who are in pain. While the achievements of modern medicine have been used to prolong and enhance life for many, they have also helped create an often dreaded context for dying. Costly technology may keep persons alive, but frequently these persons are cut off from meaningful relationships with others and exist with little or no hope for recovery. Many fearfully imagine a situation at the end of their lives where they or their trusted ones will have no say in decisions about their treatment.
There have been problems within Long-Term Care and many of these abuses were turned over to the patients, there was hardly any direction on how to handle Long-Term Care. “Poor houses and Almshouses and developed in response to an impoverished, aging, and mentally and physically disabled population who lacked informal caregivers.” (Sarah Thompson, 2008 ) When Long-Term Care was in the infancy stage of developing there were many problems, issues that were created because there was not much direction. In developing in taking care of the elderly there were poorly trained nurses, medical workers and many of them were not qualified to work within the medical field. There were problems, many issues and multiple levels of abuse because of poorly trained medical workers where there was no direction.
Client safety is a primary role of the nurse, but the use of physical restrains with clients is an ethical issue when other important ethical principles such as autonomy and non- maleficence, as well as nurse's code of ethics, are considered (Schenker, Fernandez, Sudore, & Schillinger, 2010). In this scenario, Sam is agitated and physically aggressive with Camilla, a nurse. So, the medical team reviewed him and suggested to restrain and Julia, team leader of nurse advice Camilla to restrain and focus on care of other patient and states that patient like Sam is waste of time and they don't have enough staff to worried about him. In this general scenario, it shows that health care staff lacks understanding of the genuine requirements of restorative administrations sharpens which is imperative to shield patients from abnormal limitation. Furthermore, restriction ought to be considered if all else fails and specialists ought to consider elective mediation to advance security and regard the respect of the individual.(Kerridge, Low, & McPhee, 2009). However here in this scenario, medical team and nurse including team leader left Sam on physical restraint without supervision avoiding harm. Therefore, it clearly depicts the ethical issues
In the medical field, the workers are highly trained to be able to make a distinction between what is right and what is wrong. Elder abuse is becoming a serious issue in the health environment. As defined in the website, MedicineNet.com, elder abuse is: “the physical, sexual, or emotional abuse of an elderly person, usually one who is disabled or frail”. The older population consists of people over sixty-five years old. They are very fragile and sometimes they are forgotten or abused. The elderly can be victims of mistreatment in nursing homes, hospitals, or even in their own house. Nursing is the act of promoting health for others, and of providing care and security with the skills nurses have acquired. However, those who are nursing can also harm, or hurt people by advising them. Elder abuse can take many forms such as financial abuse, physical abuse, sexual abuse, and emotional abuse.
Of nursing home staff interviewed in 2004, nearly 40% admitted to committing at least one psychologically abusive act toward a resident and 10% admitted to physically abusing a resident in the preceding year.[1] Not only are nursing home residents at risk of being abused by their caretakers but they are also at risk of being restrained, which may lead to a form of abuse. With five percent of the elderly population, or one to two million instances of elder abuse occurring yearly there is no doubt that elder abuse deserves serious consideration.[2]
We all know someone who has been placed in a health care setting such as a rest home or hospital because their needed care is out of their families own ability; whether it’s our own grandma or the neighbor’s great aunt. Many people in this day and age are getting care from health care workers on a daily basis and need constant watch and care. Many of those in the older population are put into rest homes where they can spend the rest of their lives in comfort, while others are placed in hospitals to recover from a stroke or a mental illness. At times, many patients become abusive or unresponsive by choice or not. Because of this abuse and also less control over thoughts and feeling restraints are used to keep them safe. Many believe that last statement; that they are completely safe. With my knowledge, the use of physical and chemical restraints in geriatric health care settings, such as rest homes, should be lessened because they cause injury, require patients to need more care and they take away necessary freedoms.
Many seniors around the world are being abused and harmed in some substantial way often by people who are directly responsible for their care (Robinson, 2016). Neglect of all forms causes harm to a patients overall well-being. Neglect happens in 60% of people and physical abuse happens to 15% of people (Franklin, 2013). There are three different types of neglect that can happen especially to the elderly. The three types of neglect are mental, emotional and physical neglect. Mental neglect, is basically ignoring or just not showing care or love for the patient. Emotional neglect is not only ignoring, but isolating the patient from others. Physical neglect which is causing physical injury to the body from rough handleing or non-supervision. Neglect is damaging not only to a body but also to the mind and over all
There has been an increase in the number of elderly that have been subjected to violence and mistreatment. This type of treatment is associated with the individual’s dependency on others; whether it be a relative, acquaintance and/or institution (Meadows, 2010). According to estimates “between 1 and 2 million Americans aged 65 years or older have been injured, exploited, or otherwise mistreated by someone on whom they depended for case or protection (National Research Council Panel to Review Risk and Prevalence of elder abuse and neglect, 2003)” (Meadows, 2010, p. 87). The type of abuse that elderly get subjected to is not only physical, it may also be emotional. Obviously, abuse may take on many different forms and may include: financial abuse, physical abuse, emotional abuse, and neglect. This abuse is not limited to certain circumstances it can happen in poor, middle-class or upper income household. This includes a variety of demographs and ethnicities (Meadows, 2010). Anyone may potential cause abuse and/or neglect.
This literature review is focusing on discussing the effects of seclusion and restraints on treatment consequences of patients in mental health area. Seclusion and Restraint are used for controlling the behavioral patterns of the mentally ill patients in different surroundings consisting of psychiatric management facilities and hospitals (Kentley, 2009). Over past decade, comprehensible consensus has come out that seclusion and restraints are secure interventions of last alternative and application of those interventions should and can be diminished significantly (Knight, 2011). However, recent studies indicated that it is traumatic for patients experiencing or witnessing restraint and seclusion traumatic; patients can feel high levels of anxiety, fear, and anger once aware that restraint is going to take place, sometimes it could resulting in an exacerbation of patient’s mental status (Stewart et al, 2010). Due to the humanitarian, ethical, and legal issues which could lead to, seclusion and restraints are known as the most controversial management strategies (Holmes, Kennedy & Perron, 2004). Previous studies and researches could not analyze this topic adequately; thus, further researches and studies related to the effects and risk managements of using seclusions and restrains will be discussed in below.
In 2001, over 450 million people worldwide suffered from mental illness (World Health Organisation, 2001) and these numbers have increased by a wide margin since then. Using restraints in treatment for those who are mentally ill is a topic that creates a large amount of controversy. Many are concerned with how the use of restraints can affect the person and if they are necessary or if alternative measures could be used. The National Alliance of Mental Illness has indicated their position on restraints, “The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to a patient or others.” (The National Alliance of Mental Illness, 2001) There have
Ethical Practice: Physical Restraints and Planned Parenthood Nurses face ethical issues every day. Knowing how to spot them and respond appropriately to them is so important that it’s taught early on in nursing school and continues throughout the nurse’s career. Ethics is defined as “the discipline dealing with what is good and bad and with moral duty and obligation” (Merriam-Webster, 2017). What is “good” and “bad” have different meanings for some people. Because of this, several codes of ethics have been created as a general guideline for medical professionals.
There has been debate on whether or not restraints are safe for patients. Tammelleo (1992) states that the use of restraints cause approximately 200 deaths every year, some of which include instances where a restraint was not necessary for the patient. Misuse is another important factor in the safeness and effectiveness of bed restraints. Misuse and tragic accidents have lead to the involvement of the FDA and recommendation calls that every medical institution must have and practice protocols for proper use of restraints (72). Tammelleo goes on to discuss recommended alternatives that should be explored before resorting to the use of restraints. Restraining patients may seem like the easier and quicker way to handle a patient, it is not always the best. Some alternative measures include wedging pads or pillows against the sides of a wheelchair to keep the patient in a good position, soften lights, provide soft music, spend extra ...
Hyman (1989) says corporal punishment refers to intentional application of physical pain as a method of changing behavior. It includes a wide variety of methods such as hitting, slapping, punching, kicking, pinching, shaking, choking, use of various objects (wooden paddles, belts, sticks, pins, or others), painful body postures, use of electric shock, use of excessive exercise drills, or prevention of urine or stool limination (p.161).
The use of restraints for medical purposes have been in effect for many years. Whether it be in a nursing home setting, mental health, ICU, emergency department, or even a possible school setting. The effectiveness and/or overall harm essentially caused by restraints is an issue that has been argued and studied by many health care professionals throughout time. Restraints are oftentimes used to either protect a patient from harming themselves, or even harming the nurses or other medical personnel that is assisting with their care. Even with the current research and studies whether or not the services provided by restraints will continue to be utilized is still unknown. Although there are a lot of questions
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.