Nurses’ Decision‐Making in Cases of Physical Restraint

Widespread Use of Physical Restraints

Many countries approve of the implementation of physical restraints in patients who appear to be unstable, unruly, or violent. In some cases, they are used on mentally ill patients and those who threaten to harm themselves and others. According to Goethals, de Casterlé, and Gastmans [1], they are employed in acute and residential healthcare facilities for various reasons, most of which are patient-centered. The researchers state that it is difficult to determine the true prevalence of the use of these elements in various healthcare settings since the reported frequency of their implementation tends to fluctuate widely [1]. To analyze the necessity of utilizing physical restraints, diverse studies have been carried out and have ascertained the average prevalence rate. According to the conducted research that contained a sample of 1048 patients who had been admitted to health facilities, only 84 of them had physical restraints used against them which is reflected in an 8% prevalence rate [2]. Moreover, among 40 acute care hospitals selected in the United States within six metropolitan areas, the use of restraints accounted for the rate of 50 per 1,000 patient days [3]. Therefore, thorough research studies can be used to determine the prevalence of restraints implementation in healthcare settings.

Another important aspect of the usage of restraints in healthcare facilities is the role of medical personnel in approving of this technique. Goethals, de Casterlé, and Gastmans [1] state that nurses are of critical importance in the decisions that sanction the use of physical restraints. Another study affirms that it is true that nurses are involved in decision-making [3]. However, these decisions are not fixed but flexible since they are subject to review and possible repeal. The approvals and refusals tend to occur as a series and are ever-changing.

The Ethics of Decisions on Restraints

The decisions concerning the use of restraints pose difficulties to nurses and are ethically challenging. The possible reason is that such decisions violate patients’ autonomy, which is their fundamental right. At the global level, the use of physical restrains has been subjected to legal concern and ethical debates for their violation of patients’ dignity [4]. Undoubtedly, health practitioners are challenged when deciding whether the use of restraints is justifiable.

The ethical dilemma behind the implementation of restraints may be quelled using the approach and principle known as consequentialist ethics. The philosophy behind the approach is that an action can be considered morally right or wrong depending on its outcomes [5]. Therefore, an action that delivers more harm than good is unjustified while actions that bring more good than harm are reasonable. When the ethical principle is applied to the context of using restraints, it is determined that their implementation in certain situations is justifiable since they are instrumental in ensuring the safety of patients and medical staff providing healthcare services to them.

Supporting Nurses in Ethical Reflection

Supporting nurses during their ethical reflection concerning restraints is an endeavor that requires ethical leadership and a value-supportive environment. The propensity of nurses to use restraints can only increase if organizational leaders who base their justifications on ethics and on their benefits support them. For instance, if nurses are convinced that they are not violating any ethical requirements in implementing restraints, they will feel justified when using them [6]. However, leaders should be careful in ethical arguments to validate this technique. They should argue using consequentialist ethics rather than the duty-based policy. Moreover, the importance of a value supportive environment may be felt if organizational leaders do not punish nurses for using restraints. Instead, they should examine the circumstances that led to their use and the reasoning behind nurses’ decisions to consider these elements essential.

References

1. Goethals S., De Casterlé B., Gastmans C. Nurses’ ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study. Med Health Care Philos. 2011;16(4): 983-91.
2. Ang Y, Bakar Aloweni F, Perera K, Wee S, Manickam S, Lee J, et al. Physical restraints among the elderly in the acute care setting: prevalence, complications and its association with patients’ characteristics. Proceedings of Singapore Healthcare. 2015;24(3): 137–43.
3. Minnick A, Mion L, Johnson M, Catrambone C, Leipzig R. Prevalence and variation of physical restraint use in acute care settings in the US. J of Nurs Scholarship, 2007;39(1): 30-7.
4. Jun-Fang Z, Hong-Tao C, Wei-Ming L, Cai-Mei Z. Physical restraint using, autonomy, ethics among psychiatric patients in nursing practice in China. J Integr Nurs. 2020;2(3): 97.
5. Kalajtzidis J. Ethics of social consequences as a contemporary consequentialist theory. Ethics and Bioethics (in Central Europe), 2013;3(3-4): 159-71.
6. Goethals S, de Casterlé B, Gastmans C. Nurses’ decision-making process in cases of physical restraint in acute elderly care: a qualitative study. Int J Nurs Stud. 2013;50(5): 603-12.