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

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

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.

Following the appropriate ethics is of extreme importance in the nursing profession. “Ethics are of universal concern and crucial in all professional healthcare” (Gustafsson & Stenberg, 2017, p.420). The leading goal in nursing is to achieve patient-centered care. According to Arnold and Boggs (2016), “Patient centered care focuses on fully partnering with the client to provide care that incorporates his or her values and preferences to give safe, caring, compassionate and effective care” (p.25). In order to provide a well-grounded, caring environment, nurses need to be able to balance their personal differences with the ethical care standards they are obligated to provide patients (Gustafsson & Stenberg, 2017). Nurses spend the most time with patients; therefore, they eventually will develop a “sense of rightness” (Gustfasson & Stenberg, 2017, p.420).

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

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

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.

Given the aging of the population, elder abuse has become more a prevalent and a more serious issue in recent years. "Every year, an estimated 4 million older Americans are victims of physical, psychological or other forms of abuse and neglect. Those statistics may not tell the whole story. For every case of elder abuse and neglect reported to authorities, experts estimate as many as 23 cases go undetected" (Elder abuse and neglect, 2013, APA report: 1). Elder abuse is both against the law and an ethical issue for the nurse. The nurse must find a way to ensure that the needs of the patient are taken care of, and the stress of the caregiver of the elderly person is managed appropriately. This paper will apply the five steps of ethical decision-making to dealing with the issue (Swinton 2007). The ethics of elder abuse deal with a number of issues that can be extremely sensitive subjects for the nurse; including parent-child relationships; past relationships amongst different members of the family; the responsibilities of caregiving; and the autonomy of the patient.

The use of restraints is seen in the Emergency Department(ED) on a regular bases and has been a new experience to myself as a student nurse. The College of Nurses of Ontario Restraints Practice Standard (2009) explains restraints may be used where patient are at risk to themselves or others, for treatment purposes and controlling behaviours. Restraints may be chemical, physical or environmental. Restraints have limited increase in patient safety and can increase the agitation, confusion and health risks present. In the emergency department majority of bed rails are kept in the up position regardless of the patients’ mental, physical or emotional state. A bed rail is considered an environmental restraint and therefore should be kept in the down

Physical/manual restraint by a team, mechanical restraint and seclusion should only be used for people detained in a mental health facility under the NSW Mental Health Act 2007 or the Mental Health (Forensic Provisions) Act 1990. If one of these interventions is applied to a voluntary patient, a Medical Officer (M.O.) must assess them as soon as possible after the event to review their status under the Mental Health Act.

Admissions in general acute hospitals for patients over the age of 65 is 38% with 60% of those patients ending up on a medical surgical unit (Boltz, 2013). The number of restrained patients within this age range varies from 13-27% for medical surgical or non behavioral restraints, this number can significantly decrease based on alternative interventions attempted prior to restraint application with the number of restrained days varying from 3 to 123 out of every 1000 days (Enns et al., 2014). Reasons for non behavioral restraints are when a patient is; pulling at lines/tubes, removal of equipment/dressing, inability to respond to direct requests/follow instructions, intubation, or falls/risk of injury/keeping patients safe. A typical hospital

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.

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

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).

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.

`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