In Perspective: Implications of Using Physical Restraints in Clinical Settings
This argumentative essay is directed toward the healthcare professionals and especially the nurses who are most of the time in contact with the patients and are better aware of their needs and feelings. Based on the following arguments I will try to defend that the use of physical restraints in clinical setting should be avoided as it is ethically, physically and psychologically harmful for the patients.
Firstly, every individual has the right to be respected and to be autonomous in making choices. Wanda (2009) states that, “it is incumbent upon professional caregivers to strive to create environments that foster patients’ autonomy.” Use of restraints is unethical as it lowers down the dignity of patients and violates their right to chose or refuse treatment. It also limits and restricts their freedom against their will.
However, many people believe that at certain situations when the patient is unable to make the right choice, it is acceptable to violate autonomy in order to achieve beneficence and non-munificence through a paternalistic approach in the form of restraints. Wanda (2009) emphasizes that restraints are the only available choice for caretakers who are concerned for their patient’s safety. Moreover the author states that “the absence of less coercive tools, they are forced to breach patient autonomy at times when it is unavoidable”.
While it is true that violation of autonomy may be in favor of the patient, and it prevents them from potential harm, it takes us towards the paternalistic approach where it is not necessary that the intervention may be in favor of the patient. As far as the nonmaleficence is concerned, no evidence proves restraints to be therapeutic and if the harmful effects of restraints are taken in consideration, then the idea of promoting nonmaleficence is questionable.
Secondly, restraints are coercive measures of treatment which can cause serious physical injuries and self harm to the patients. This can even result in death of the patient. “In one case an elder man admitted to hospital with atrioventricular conduction abnormalities had limb and vest restraints applied and after a period of prolonged agitation and struggling suffered sustained ventricular tachycardia and died”. (Robinson et al. 1993)
In contrast, the use of restraints becomes the only choice of intervention in some situations where other means have failed, for e.g. when the patient becomes violent or aggressive. It may be true but most of the time it has been seen that when patient’s movements are restricted, they feel helpless and become more violent and retaliate thus causing more potential for harm as well as violence and agitation. Recent studies also suggest that restraints can serve as potential triggers of violence and aggression(Kahng, Leak, Vu & Mishler, 2008). Moreover, restraining is considered to be a short term intervention which can cause a lot of harm, for e.g. fracture, strangulation, anger and fear, where as anger and agitation could be managed in many other ways(Lewis, 2002).
Thirdly, application of restraints creates a negative psychological impact on the minds of the patients. They consider themselves as being punished and develop feelings of worthlessness, dependency and mistrust. Gwen (2008) affirms that impact of restraints could range from minimal effects to distress and even post traumatic stress disorder. On the contrary, it is believed that the psychological health of healthcare professionals is equally important who cannot put their safety and security at stake just to prevent patient from getting psychological harm.
Mohr (2009) also supports that “the staff members themselves have a right to expect to be safe and to have the tools at their disposal to assure that they and their charges are protected against bodily harm”.While it’s true that the psychological health and well being of the healthcare professionals is evenly important, but it should be kept in mind that if once patients lose their trust, it would be very difficult for the healthcare professionals to build the same rapport again.
As far as the psychological impact and threat to safety is concerned, itcould be a sound preventive approach if nurses develop a therapeutic relationship with their patients, timely inform them about the interventions they would do and what would be the impact of those interventions. For e.g.in intensive care unit,Lorraine(2008) suggests that to avoid any uncertain situation, patients should be well informed and made sure that disruption in life saving therapies like invasive monitoring would cause them significant damage and that they should be kept in place. Interventions like these would minimize the use of restraints and will be psychologically beneficial for the patients, as it creates a bad impression of the restrained patient on the family and visitors and is distressing for them too.
In conclusion, the above stated arguments prepare a sound ground for the healthcare professionals especially nurses and the doctors to limit the use of restraints in healthcare settings on the basis of its ethical, physical and psychological implications.
Evans. D., Wood. J. &lambert.L. (2003) Patient injury and physical restraint devices: a systematicreview.journal of advanced nursing 41(3), pp.274–282.
Lewis.D.M (2002) Responding to a violent incident: physical restraint or anger management a therapeutic interventions. Journal of Psychiatric and Mental Health Nursing 9, pp.57-63.
Mion. L.C.(2008) Physical Restraint in Critical Care Settings: Will They GoAway? Geriatic Nursing 29, pp.421-423.
Mohr,W.K.(2009) Restraints and the code of ethics: An uneasy fit. Archives of Psychiatric Nursing.0(0). Pp. 1–12.
Bonner.G. (2008)The psychological impact of restraint in acute mental health settings: the experiences of staff and inpatients. Retrieved, December 1, 2009 from http://www.home.wolfson.tvu.ac.uk/…/docs/Bonner%20Gwen%20PhD%20Abstract.pdf
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