Examination of Ethical Dilemmas Experienced by Adult Intensive Care Unit Nurses in Physical Restraint Practices

Abstract

Nurses are more likely to face the dilemma of whether to resort to physical restraints or not and have a hard time making that decision. This is a descriptive study. A total of 55 nurses participated in the research. For data collection, a question form developed by researchers to determine perceptions of ethical dilemmas by nurses in the application of physical restraint was used. A descriptive analysis was made by calculating the mean, standard deviation, and maximum and minimum values. The nurses expressed (36.4%) having difficulty in deciding to use physical restraint. Nurses reported that they experience ethical dilemmas mainly in relation to the ethic principles of nonmaleficence, beneficence, and convenience. We have concluded that majority of nurses working in critical care units apply physical restraint to patients, although they are facing ethical dilemmas concerning harm and benefit principles during the application.

Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

“…Healthcare providers have historically justified the use of physical restraints in the ICU for many reasons including to enhance patient safety (242,249,252,262,263); prevent selfextubation, tube dislodgement, and/or medical device removal (242,246,249,255,262,263,265,266,269); control patient behavior (249,262,265,266,269); protect staff from combative patients (263); and prevent falls (242,263,266). Less commonly cited reasons include the following: preserving posture/ positioning of the patient (249,266); staffing shortages or lack of supervision during break coverage (249,263,265); and compliance with patient, family member, or other medical staff suggestions (265).…”

Reducing Use of Restraints in Intensive Care Units: A Quality Improvement Project

“…The ethical balance in restraining patients relies on the principle of beneficence or being of benefit to the patient versus the principle of nonmaleficence or contributing to a patient's harm. 18 The many studies of use of physical restraints in the ICU have ultimately yielded no absolutes for eliminating the use of such restraints but some solid recommendations for management while the restraints are in use and alternatives to help minimize their use. 1,16 Quality Outcomes…”

Etične dileme pri izvajanju zdravstvene nege v enoti intenzivne terapije

“…Najbolj pogoste etične dileme se pojavljajo v zvezi z zagotavljanjem etičnega načela neškodljivosti in dobronamernosti (Yönt, et al, 2014). Ugotovitve raziskav navajajo, da se etične dileme pri izvajanju zdravstvene nege najpogosteje pojavljajo v povezavi z informiranim soglasjem kritično bolnih pacientov, udobjem kritično bolnih pacientov, avtonomijo in zagotavljanjem dostojanstva ter nezmožnostjo upoštevanja volje kritično bolnih pacientov (Kinoshita, 2007;Chaves & Masarollo, 2009;Choe, et al, 2015;Kohlen, et al, 2015;Oerlemans, et al, 2015;Bidabadi, et al, 2017).…”