Hospital Restraints

A restraint is any physical or chemical measure in the healthcare setting to keep a patient from being free to move (Craven, Hirnle & Jensen, 2013). Nurses are presented with dilemmas in deciding whether to use restraints to protect the patient from falls, harming themselves or others, suppress agitation and to facilitate treatment. Improper usage and misconceptions of restraining can have negative consequences including physical and psychological issues. Physical and psychological disadvantages from restraining could include low blood pressure, decreased circulation, thrombosis, constipation, urinary incontinence, depression, fear and increased confusion (Yeh et al., 2004). Educating nurses may reduce restraint usage by increasing

Within contemporary society, the legal process of placing an individual into a detention or psychatric treatment facility is called "civil commitment." Typically, this is reserved for the mentally ill, or those people who have satisfied the Court's rule that they are a danger to others, or to themselves. Society realizes that, at times, an individual may pose a danger to themselves or to society and be unable to make rational decisions. In fact, in most jurisdictions in the modern world, involuntary commitment procedures are specifically applied to individuals who have manifested some form of serious mental illness that acts to impair their reasoning to such extent that they are unable to make cogent and logical decisions. Therefore, at these times the state (the Court system) must intercede to find ways to make the appropriate decisions under a legal template. Involuntary commitment may have, in the past, been used in certain situations, inappropriately, but the statutory criteria that indicates one is a danger to self or others usually acts as a legal axiom (Korba, 2008).

They are challenged by substandard working conditions and tension between reasonable medical practices and prison rules and culture. “Principles of ethics regarding beneficence, non-maleficence, and respect for the rights and dignity of all patients have led international and national professional organizations to affirm that physicians are ethically obligated to refrain from countenancing, condoning or degrading treatment” (Metzner and Fellner,jaapl.org). Prison rules for isolated prisoners restrict the quality, quantity and nature of mental health services that the prisoners are allowed to receive, which then forces physicians into an ethical dilemma of how to properly treat these inmates. “In recent years, physicians have increasingly confronted a new challenge: the prolonged solitary confinement of prisoners with serious mental illness, a corrections practice that has become prevalent despite the psychological harm is can cause”(Metzner and Fellner, jaapl.org). According to the authors, physicians are in ethical conflicts based on the fact that they continually perform patient rounds with mentally ill inmates, however, by not saying anything about the complications that this type of confinement causes, they too may be contributing to the continuation of harm. Studies along with the author’s clinical experience reveal that up to 19 percent of prisoners have psychiatric disorders resulting

Due to the lack of proper resources and psychiatric professionals, the main source of programming and help that the correctional client has is the medication that is being administered to them by correctional officers (Brandt, 2012). Correctional staff often lack the proper education, training and knowledge on how to properly treat individuals will mental illness (Gur, 2010). Because of this the main form of behavioral correction is the use of segregation also known as solitary confinement (Kaba, Lewis, Hadler, Lee, 2014). Correctional staff will place inmates in segregation if they are a danger to themselves or others within the facility (Kaba et al, 2014). Segregation is severely isolating and can often further damage the inmate’s mental health. It often drives them ‘crazy’ or ‘insane’ because they cannot handle the lack of social interaction or the isolation stimulates their mental illness even further. An example where is would worsen a mental illness is schizophrenia, the lack of communication and light often can cause worsening hallucinations (Kaba et al,

Finally, looking at the safety of the mentally ill inmates is crucial especially when solitary confinement is involved. It has been suggested that even inmates without mental health issues can experience psychological breakdowns when they are isolated for long periods of time. Revising protocols and procedures of solitary confinement could lessen or prevent the amount of critical incidents that are seen due to the isolation of an inmate.

The General Accounting Office and the Health Human Services Office of Inspector General both have noted the lack of known data related to the use of these practices (Joint Commission on the Accreditation of Healthcare Organization [JCAHO], 2004). Research has revealed that the use of restraints varies dramatically from facility to facility with a wide range of facility and staff knowledge on how to prevent and avoid such use. According to Castle and Mor (1998), there are a growing number of stakeholders that have developed guidelines for restraints use and the quality of these guidelines have yet to be determined and their widespread application

Solitary confinement is an important topic to shed light on because, some people believe that is a solution, that works. However, research has shown that belief is false. “In recent years, prison officials have increasingly turned to solitary confinement as a way to manage difficult or dangerous prisoners.” (Metzner, Jeffrey L, and Jamie Fellner. “Solitary Confinement and Mental Illness in U.S. Prisons: A Challengefor Medical Ethics.” analysis and commentary, Journal of the American Academy of Psychiatry and the

The use of treatments such as restraint is permitted according to the Mental Health Act (1983), for treating individual suffering from mental health disorder (Mind, 2013). This law can be applied with or without the approval of the person involved as its ultimate goal is to prevent the person from harming himself or others (Royal College of Nursing, 2015). However, with recent incidence of injuries and even death that has occurred as a result of this kind of treatment has raised doubt in the minds of on an enormous number of people (Mind, 2013). The debate over whether it is morally or professionally right to use restraint as part of the treatment for individuals suffering from mental health issues remained unabated as a

Examines join involuntary outpatient commitment with enhanced patient results, filling debate on its moral defense.The survey thinks about inpatient usage for conferred outpatients in the 1990s with the individuals who were not under outpatient civil commitment orders. Discoveries uncover submitted outpatients had higher usage of inpatient administrations and restriction scenes preceding their dedication contrasted and a control catagory. Commitment outpatients likewise will probably have been on release status at the time of confirmation, have been admitted automatically under crisis legitimate strategies, and have had a more prominent number of admissions and clinic days before their dedication. Taking after responsibility, patients had less hospitalizations, shorter lengths of stay, less isolation scenes and hours, and less restriction scenes and hours. Discoveries are talked about inside of the connection of parens patriae and helpful jurisprudence, and hold on therapeutic and public policy supports for moral needers of outpatient civil commitment laws for genuinely mentally illness individuals

This work is using two original research papers and their findings to analyse the validity of the practice of SR (seclusion and restraint) in psychiatric inpatient facilities. The research papers chosen shed light on this questionable practice by analysing multiple patient characteristics and the events leading to SR. The other chosen research paper evaluates the inpatients perception of SR.

The Joint Commission and Centers for Medicare and Medicaid Service (CMS) have acknowledged, “Physical restraints are considered an infringement of patient rights and a patient safety concern” (Mion, Sandhu, Khan, Ludwick, Claridge, Pile, & ... Winchell, 2010, p. 1279). These organizations have amended and aligned their regulation requirements on the use of restraints which is mainly focused on limiting its use and putting emphasis on staff education and training (Cosper, Morelock & Provine, 2015). The nursing discipline guided by these regulations should aim to improve standards of care and patient outcomes through best nursing practice. “Best practice supports individualized care that permits nursing the person safely and without physical or chemical restraint” (Cotter & Evans, 2010, p.197). The goal of this review is seek evidence to substantiate the implications of such guidelines.

Restraints refer to the use of belts and handcuffs, this is known as mechanical restraints. Then there are restraints known as manual restraints which is when staff physically holds the patients down themselves. Seclusion and restraints are only to be used if a person threatens to be violent or is being violent. The problem with this is threatening to be violent is very vague. There is no real definition and because of this it's a very controversial concept. Seclusion and restraint are also supposed to be a last resort to trying to get the patient under control while maintaining their safety and the others around them. The seclusion/restraint process is to protect patients from unnecessary trauma. Once in seclusion the patient should be checked on frequently. In order to suspend the seclusion/restraint the patient has to demonstrate significant behavioural change. However seclusion or restraints should only be used for a short amount of time. Patients often see seclusion and restraints as a punishment which provokes negative emotions. This not healthy for the patient. In the end run the goal may be to prevent trauma but it still

Physical restraint and sedation is often paramount to allow emergency personal to provide treatment and intervention associated with positive patient outcomes (1,5,7-9-11). Often the severe measures needed to restrain and control ExDS patients are perceived in a negative way in the public eye. The management of ExDS patients in sedation causes controversy when observed by bystanders that do not understand the importance of sedation. (1,7,9-11). A legal and ethical dilemma for emergency personal can result.

Minnesota passed a law in 1999 (Minnesota Statute 144.651, subdivision 33) which established explicitly the right of residents or residents ' decision makers to request physical restraints. It also specified that legitimate medical reasons for using a physical restraint include: "1) a concern for the physical safety of the resident; and 2) physical or psychological needs expressed by a resident. A resident 's fear of falling may be the basis of a medical symptom." Studies in the 1980’s indicated that restraints were more likely to cause harm rather than prevent it. Restraints caused many detrimental effects that included strangulation, bone loss or the patient becoming weak. Ultimately being restrained oftentimes caused an individual to be embarrassed, angry or even humiliated. Many of the residents became depressed, agitated or withdrawn;

This may also include environmental restraints, in which the patient is locked in their room or seclusion from others. These are usually used to prevent patients from injuries sustained from falls or other accidents. Also, it is used to administer treatment when a patient is not compliant with medical practitioners.