Ethics of Chemical and Physical Restraints

Ethics of Chemical and Physical Restraints
A restraint is the use of some kind of equipment or drug used for the purpose of restricting a patient from free will movements. There are times when using restraints would seem like the best thing to do for a patient, but in-fact it could be quite the opposite. Agens Jr., J. (2010).
The use of restraints is mostly used to deal with an agitated patient, mainly can be found in residential-care facilities. Those 65 years and older have been reported to have higher restraint use rate in residential and acute care facilities. Many have been found with at least two different types of restraints at the same time. Mott, S., Poole, J., & Kenrick, M. (2005).
How often restraints are used often will depend on what kind of restraint is used and the setting that it is being used in. According to Agens Jr., J. (2010) that in the health care facility setting has reported a 7.4% to 17% restraint use ten years ago, and a decade before that it was 28%-37%. Thanks to the Department of Health and Human Services and the new rules that the CMS put into effect in 2007, restraint use is down about 5%.
The use of Chemical restraints is a bit higher than physical restraints that reached upwards to 34% in the long term care facilities. However, there is some hope that this number will decrease because of the US government regulation.
Chemical and physical restraint use has been known to cause many hazards, such as confusion, falls, and sores. It is also been shown that the use of these restraints could lessen someone’s sense of independence and that they will have to depend on others for everything. Using restraints may seem like the right thing to do at the time for a patients’ safety, but it is more often just the opposite. There have been some cases to where physical restraints have been the cause of death to a patient because he or she was asphyxiated from trying to get free.
The elderly that suffer from delirium or dementia that may be a danger to themselves or others and the staff no longer has the ability to protect or take care of the patient. Then some sort of restraint may need to be used but not before it was clearly documented with the situation, followed by an assessment of the patients behavior, and a physician’s order. This must be done right before or right after the institution of any restraints. No restraints should be used without failure of all other alternatives. These patients with the dementia and delirium may be given an antipsychotic drug to restrain them but this does not have FDA approval. In a meta-analysis, Agens Jr., J. (2010) it has been shown that an increase in death of 1.6 to 1.7% with the elderly patients. Different researches have also suggested that any antipsychotic medications can cause death just as easy. With this known risk it is very clear that if this medication is used that should not only be prescribed by the physician but also be documented for the informed consent process.
The Omnibus Budget Reconciliation Act of 1987 (OBRA 87) brought the results that say patients have every right to be free without the use of restraints and are not to be used for convenience or for discipline purposes. It also states that a patient being uncooperative, restless, wandering or being unsociable does not justify in the use of any kind of restraint.
In the case of delirium or dementia that opposed any danger to others or to themselves and the staffs ability to protect or take of the patient. In that case some sort of restraint may need to be used but not before it was clearly documented with the situation followed by an assessment of the patients behavior, and physician’s orders. This must be done right before or right after the institution of any restraints. No restraints should be used without failure of all other alternatives first. Agens Jr., J. (2010)
There are ways to reduce restraint use before it is needed and when they are being used. Agens Jr., J. (2010). For example better pain management, bowel, and bladder functions, sleep habits, reducing noise, and lights. These all can play a big part in the reduction of needing to restrain someone.
If those attempts have failed and it seems like restraints are still needed, the patient should be further examined for some kind of illness like and infection, respiratory, or heart. Any of these should be checked out when a patient is experiencing safety changes like falling or acting in an unusual way.
To assess a patient before deciding on the need for restraints will need to involve the opinion of physical therapist, occupational therapist, social worker, nursing staff, pharmacy, and the family. If after consulting with everyone, and they come across the cause of the change in the patient then the use of restraints can be avoided.
There are other alternative ways to see to the safety of the patient without the use of chemical or physical restraints. There are things that can be done that are as simple as lowering the bed and putting some kind of padding down on the floor for those that are known for falling out of bed, instead of using bedrails. The patient can also be given something to occupy themselves with, that way there is a better chance they will stay seated. They can be given things like a puzzle or letting them draw a picture. The use of chair alarms is also another way to avoid strapping someone in their chairs, this little device will set off a loud alarm when a patient has moved to far forward in his or hers chair.
“In essence, respect for autonomy means respect for the right of individuals to shape their own lives in terms of their own values and goals, in accord with their own insights and limitations, and despite the risks and unpredictability’s that can accompany any course of human choice and action” (Bart J. Collopy, Ph.D., 1992, pp. 10-11). This means that even though the elderly are fail and might be dependent on others for their care they still have right to be free from restraints and have control over their lives as much as possible. If at any time restraints would be required the patient would have to agree and give informed consent, unless there is another person that makes the decisions for that patient, they would then have to give their informed consent for the use of restraints.
One of the biggest ethical principles when it comes to the elderly patients or for any patient for that matter would be preserving his or her dignity. No one wants their self-esteem challenged by anyone, let alone to be challenged by a piece of equipment or a drug. The humiliation of having to be tied down to a bed or chair, being so doped up the he or she cannot even move or communicate. In many cases the staff is just trying to make thing easier on them and they just do not want take the time to evaluate what could be the true cause for the patients’ behavior. At least now patients have a fighting chance.to be free from these restraints thanks to the new rules, laws, regulations and ethics.

References:
Agens Jr., J. (2010). Chemical and physical restraint use in the older person. British Journal Of Medical Practitioners, 3(1), 34-39.
Mott, S., Poole, J., & Kenrick, M. (2005). Physical and chemical restraints in acute care: their potential impact on the rehabilitation of older people. International Journal Of Nursing Practice, 11(3), 95-101.
Bart J. Collopy, Ph.D.. (1992). The Use of Restraints in Long-Term Care:The Ethical Issues . Retrieved from Bart J. Collopy, Ph.D., American Association of Homes for the Aging website.