Jordan Deanna Johnson
MondayMar 4 at 8:52am
Restraints
Restraints can be both physical and chemical devices or interventions used in mental health settings that are used to restrict a person’s movement or action. They are specifically used only for the intent of protecting both the person and others around them. The use of restraints is considered a controversial topic, raising legal and ethical concerns.
Ethical Considerations
In their article, Yo et al. (2018) addressed ethical considerations related to using restraints, including the principle of autonomy. Autonomy refers to a person’s ability to make his or her own decisions. Thus, the use of restraints then violates the person’s freedom. However, restraints must be a last resort when all other options have been used. The patient’s protection from hurting oneself or others is a priority. The patient’s autonomy must continue to be respected using the least restrictive environment and involuntary treatment. (Ye, et al., 2018)
The article by Nielson et al. (2020) discusses how physical restraints are intended. They are intended to prevent or restrict a patient’s harm to self or others. Despite the risk of injury, sometimes the implementation of restraints is necessary to maintain the safety of the child and adolescent. Ethical considerations associated with utilization include disproportionate use, needless risk for injury, and death. Restraints can lead to not only physical but also psychological consequences. Considerations for future restraint use must be considered, including the impact of the restraint on health outcomes. Less invasive interventions should be considered before the application of physical restraints. (Nielson, Bray, Carter, & Kiernan, 2020)
Legal Considerations
The article by Parkes and Tadi (2022) reviews how restraints and seclusion are controversial yet necessary in medicine. Legal issues with adults include involuntary use of restraints. Some examples that could cause legal issues towards the provider include accusations of battery, false imprisonment, competence, and duty not to harm. The provider must be confident in their decision that all other less invasive options have been used to de-escalate and protect the patient’s rights. Healthcare workers must monitor patients following restraints and seclusions and watch for skin breakdown, pressure ulcers, skin tears and abrasions, asphyxia, strangulation, incontinence, depression, social isolation, drug overdose, or interaction. (Parkes & Tadi, 2022)
The article by Neiman and Pelkey (2016) reviews federal and state laws regarding restraint use. The states highly regulate the use of restraints and seclusion in all ages. Restraints are prohibited from being used as punishment or discipline, and they may only be used for providing immediate physical safety to the patient or others. The restraint must be released and discontinued at the earliest viable time. In federally regulated psychiatric residential treatment facilities, restraints and seclusion are prohibited. However, restraints may be used in hospitals if the minor is being monitored by staff. (Neiman & Pelkey, 2016)
Understanding ethical and legal considerations surrounding the use of restraints is very important. I must be knowledgeable of the laws in the state I work in, ensure compliance, and protect the rights of my patients. Under Florida law, restraints are considered a last resort and may only be used when less restrictive interventions have been tried and found ineffective. By prioritizing the legal and ethical considerations, I can promote high-quality care to my patients in the future.
References
Neiman, E. J., & Pelkey, E. (2016). An Analysis of Legal Issues—Child and Adolescent Behavioral Health, Part III: Patient Safety— Identifying and Addressing Legal Issues Involved When Treating Pediatric Patients with Behavioral Health Needs. AHLA, 1-22.
Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2020). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342-367. doi:10.1177/1367493520937152
Parkes, D., & Tadi, P. (2022). Patient Restraint and Seclusion. Treasure Island: StatPearls Publishing.
Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luob, T. (2018). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68-71. doi:10.1016/j.ijnss.2017.12.001
