Physical Restraints And Nursing Homes : Clinical Ethical Considerations By Chris Gastmans And K Milisen

As a registered nurse practicing in the state of California I am responsible for practicing within my states legal regulations and nursing scope of practice. My concern for the welfare of the sick and injured allows me to practice ethical provisions of nursing. These are required if I am to carry out competent and effective nursing care. Nursing encompasses the prevention of illness, the alleviation of suffering, and the protection, promotion, and restoration of health in the care of individuals. Therefore, as health care professionals we must be familiar with the different philosophical forces, ethical principles, theories and values that influence nursing. At the same time, we must be respectful to our patient’s

The topic of ethics is prevalent in health care and addresses a broad range of topics in nursing. In almost every interaction with a patient there could be a situation that may bring up the question of ethics. Fortunately, there is the realization that placing the nurse in the care of a patient, may put the medical personnel in an environment where the ethics are questioned. There are whole departments dedicated to advising nurses in these situations. There are also ethic committees to help guide you when you find yourself in a situation that may question your practice or circumstances.

Nurses rely on personal knowledge and their professional skills to provide ethical care (Creasia & Friberg, 2011). In everyday practice, nurses must balance the needs of their patients against those of the organization, society and themselves. They strive to deliver the highest level of care for patients, but adjusting for limited organizational and personal resources often requires difficult decisions. This paper explores the following scenario suggested by Maville and Huerta: “You are a nurse providing home care to a mother, and you suspect child abuse after observing the mother’s reaction to her child” (as cited by Arizona State University, 2014). When faced with a moral dilemma, a competent nurse incorporates ethical, bioethical and legal considerations. In the proposed story, incorporating the nursing ethics of advocacy, beneficence, nonmaleficence and collaboration will guide the nurse towards an appropriate and legal course of action.

Any of these issues have the potential to extend the patients length of stay in the hospital. The restraints have the potential to make the patient more agitated, thus increasing his risk of injury. Understanding the nursing-sensitive indicators can greatly contribute to a better outcome for all patients.

Hospital data on the use of restraint can also be analyzed to improve patient outcomes and satisfaction. This information could be scrutinized to determine if restraints were truly warranted in that particular situation, or if another method could have or should have been utilized first. Documentation should also be examined to determine if the patient was adequately cared for during this time period. In my hospital, the patient must be released from the restraints at least every two hours, and must be toileted at that time. The nurse must also do range of motion exercises with the extremities affected by the restraints. The skin and circulation should be assessed at this time. Every hour, the nurse is required to check the pulses in the extremity affected by the restraint. The nurse’s documentation should reflect that all of these assessments were performed and the appropriate precautions were taken.

Restraints prevalence is another NIS that could assist the nurses in the above scenario to identify

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

J’s scenario is pressure ulcer. From analyzing Mr. J’s case one can see the correlation between the use of restraints and pressure ulcers. Obtaining data listed on the Braden Scale such as moisture, mobility, activity, and nutrition are important when assessing for pressure ulcer risks. Once the collected data indicates the patient is high risk then the established pressure ulcer protocol needs to be followed. Nurses will need to minimize friction, support bony surfaces, manage moisture, and maintain adequate nutrition to advance quality patient care. The other nursing-sensitive indicator in this case is restraints. As I have mentioned earlier the use of restraints in Mr. J’s case seems appropriate as he pose great fall risk which may further complicate his current health condition. However, it is important to perform a complete assessment on the parameters for restraint such as cognitive functioning, history of dementia, physical impairment, and drug interactions to determine the need for restraints. When restraint is clinically indicated, and the benefits outweigh the risks then protocol for restraints has to be followed. Once the patient is restrained, it is standard practice that restraints are to be removed as soon as possible, and the patient in restraints will need assistance to change position every two hours. B) To improve quality patient care throughout the hospital, the quality improvement department should scrutinize, and keep track of the

Restraints is an intervention used to confine a person to prevent injury to self or others. Different types of restraints include physical, chemical and seclusion. A physical restraint is anything that prevents the patient from being able to freely move. This can include seat belts, wrist restraints, vests, bed rails, etc. A chemical restraint is using a drug for sedation which also restricts movement or freedom. An example of a chemical restraint can be an antipsychotic. These drugs can be used to reduce anxiety, aggression, and violent behavior. Lastly, seclusion is isolating or confining the patient to a room where they cannot leave. This form of restraint is also to protect the patient from harming them self or others. The use of restraints or seclusion can be a useful intervention if all other interventions have failed. Patients should not be harmed with these restraints so it is crucial they are done properly. Patients who are put in restraints

This assignment will explore a case study on an episode of care where a patient with chronic pain was hoisted. This will be written from the perspective of the author, a student nurse. The purpose of this assignment is to underline the ethical, legal and professional issues surrounding the episode of care during nursing practice and how these issues influence the role of the nurse and their professional judgement in delivering holistic, person-centred care for the patient. The author will cover the complications on delivering care when healthcare professionals should consider and respect the patient’s decisions and personal preferences whether it may benefit the patient or not. Therefore, the author will argue the principles of the

The issue of elder abuse is clearly an ethical concern. As a caregiver, the nurse has the responsibility to ensure that the environment of the patient is safe and supportive of health and wellness. In the case of an elderly patient who is too frail to engage in effective self-care, the demands upon the nurse increase as the nurse must

Nurses are constantly challenged by changes which occur in their practice environment and are under the influence of internal or external factors. Due to the increased complexity of the health system, nowadays nurses are faced with ethical and legal decisions and often come across dilemmas regarding patient care. From this perspective a good question to be raised would be whether or not nurses have the necessary background, knowledge and skills to make appropriate legal and ethical decisions. Even though most nursing programs cover the ethical and moral issues in health care, it is questionable if new nurses have the depth of knowledge and understanding of these issues and apply them in their practice

`Ethics' is defined as ."..the basis on which people...decide that certain actions are right or wrong and whether one ought to do something or has a right to something"(Rumbold, 1986). In relating `ethics' to nursing care, "Nursing decisions affect people... nurses have the power to good or harm to their patients" (Bandman et al, 2002). In this essay, the author will also identify the most important ethical principles and concepts of Evan's case, will outline the different stages of one's approach to ethical decision-making by utilising the "DECIDE Model for Ethical Decision-Making" founded by Thompson et al (2000) and will make a decision on the best course of action to take as a nurse in this

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.

Codes of ethics contain a coherent set of normative principles underlying a nurse’s purpose and associated values (Vanlaere and Gastmans, 2007). Two perspectives of ethics are the ethics of justice and the ethics of care (Botes, 2000). The ethics of justice constitutes an ethical perspective in terms of which ethical decisions are made on the basis of universal principles and rules, and in an impartial and verifiable manner with a view to ensuring the fair and equitable treatment of all people (Botes, 2000). The ethics of care, on the other hand, constitutes an ethical approach in terms of which involvement, harmonious relations and the needs of others play an important part in ethical decision making in each ethical situation (Botes, 2000).