Capstone Project

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Ethics of Restraints
Capstone Project
NRS-441V
10/18/15

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The Question
Among health care professionals and nurses in a psychiatric hospital, does therapeutic therapy
and communication prove to be more effective than the use of restraint and seclusion.
Ethics of Restraints
Issue: Restraints versus therapeutic therapy
One of the main reason why restraints and seclusion are used in a psychiatric setting is
for the protection of the patient and/or health care providers. This method is only used after all
medication and verbal therapies are unable to control a potentially dangerous patient. The
restraint of a violent patient provides safety for the health care providers to provide
psychotherapeutic tasks that are ordered to prevent or avoid further escalation. Some patients
fear the abuse of restraints and view it as a violation of human rights (AJOL,2014).
Detailed Description
The use of restraints in a psychiatric setting is a rising concern among health care. Patient
aggression in psychiatric settings continues to be an issue which is why some facilities still use
restraints as a measure to control an aggressive patient (Nursing Times, 2011). The question is
would patients have a better attitude towards treatment knowing that they will not have to be
restrained. Some of the things that cause aggression is overcrowding, staff that is unexperienced,
and poor staff retention. It takes a specially trained health care provider to care for patients in a
mental health facility. Staff can be at fault for the escalation of a patient if their communication
skills are used in a provoking style. While restraints are used in violent scenerios there has been a
report of restraints being misused and causing harm or even death for patients. Nursing Times
lists 5 key points on the topic of restraints.
1. A National Audit of violence in mental health units found 73-86% of nurses have
experienced violent and aggressive behavior (Nursing Times, 2011)
2. Physical restraints are still common in multiple countries despite
recommendations of other measures to control behavior (Nursing Times, 2011)
3. Physical interventions can cause injury to the staff (Nursing Times, 2011)
4. Restraint incidents are often followed by more containment measures (Nursing
Times, 2011).

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5. Nurses should use advanced directives to negotiate intervention strategies to
manage patients behavior (Nursing Times, 2011).
Impact of the Issue
The use of restraints is making a huge impact in both positive and negative aspects. The goal that
comes from restraints is not to make a patient fearful but yet keep some order and safety for
other patients and staff. At Aurora Behavioral Hospital in Arizona they have a policy that only
chemical and physical holds are allowed, not mechanical restraints. Through many patient
surveys patients felt a calmer accepting stance on receiving treatment knowing that they
wouldn’t have to deal with the use of mechanical holds. This debate can cause an impact in the
care of mental health patients because although the patients’ rights are important, the safety of
the staff is as well. The primary goal of Restraints and Seclusion in an inpatient psychiatry
facility is to uphold the safety of everyone in the treatment environment.

Gravity of the Issue
The use of restraints in a mental health facility bring forth many safety precautions in
itself. The staff involved must be trained to perform patient assessments on the patients before
being restrained in case of any conditions that would put the patient at risk for physical or
psychological injury during an attempt of any restraint. The involved staff must also be trained in
monitoring the patient during a restraint or seclusion, all vital signs must be monitored as well as
monitoring patients safety at all times during a restraint or seclusion episode. Communication
and support should also be exercised among the staff and the patient involved following a
debriefing to discuss the reasons that this took place (JAAPL, 2011). The staff must also be
trained on mental health behaviors failing to recognize worsening psychiatric symptoms can lead
to undertreating the patient, thereby increasing the risk to himself and to others on the unit
(JAAPL, 2011).
Proposed Solution and Conclusion

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The use of restraints and seclusion can be an effective measure used in the appropriate way but
can also cause controversy among the health care community. In hospitals that still use restraints
and seclusion, they must uphold the policies and training that is involved therefore ensuring
patients safety. For the hospitals that refrain from restraints and seclusion, they must use a
therapeutic approach in calming down and deescalating patient preventing aggressive behavior.
The overall effort must focus on improving the quality of treatment to increase the safety of
patients and staff, while protecting individual liberty and autonomy.

References

American Journals Online (AJOL). 2014. The Use of Restraints in Psychiatric Patients.
Retrieved from http://www.ajol.info/index.php/sajpsyc/article/viewFile/50432/39115
Nursing Times. (2011). Should Nurses Restrain Violent and Aggressive Patients?.
Retrieved from http://www.nursingtimes.net/Journals/2013/01/18/l/w/g/080311Should-nursesrestrain-violent-and-aggressive-patients_NEW.pdf
Journal of the American Academy of Psychiatry and the Law Online. (2011). Restraint
and Seclusion in Psychiatric Treatment Settings: Regulation, Case Law, and Risk Management.
Retrieved from http://www.jaapl.org/content/39/4/465.full

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