The Use of Physical Restraints for Patients Suffering from Dementia

Abstract

This study reviews the ethical dilemmas of nursing staff about using restraints on patients suffering from dementia in two types of health care settings in Israel: internal medicine wards of three general hospitals; and psychogeriatric wards of three nursing homes. The nurses' level of knowledge about the Patient's Rights Law, the Israeli Code of Ethics, and the guidelines on restraints was analysed. The purposes of restraints were defined as beneficial to: (1) the patient; (2) other patients; or (3) the institution. The concept was evaluated in a realistic situation (expressing views of daily practice) and in an idealistic situation (expressing personal and professional beliefs and values). It was shown that nurses in internal medicine wards of general hospitals agreed more with the use of restraints than those in psychogeriatric wards in nursing homes. Differences were more pronounced when restraints were beneficial to the institution. In addition, nurses working in psychogeriatric wards of nursing homes had more knowledge about the guidelines on restraints and were less inclined than their counterparts to agree with the use of restraints for the benefit of other patients or the institution.

Nurses’ perceptions and practice of physical restraint in China

“…15 The most common treatment instruments removed by patients are endotracheal and nasogastric tubes. 3,4 Studies have indicated that physical restraints are more likely to be used in patients who are 65 years or older, 16 in patients with poor mobility and impaired cognitive status, and in patients who require extensive and complicated therapy and have a history and risk of falls. 15 Men are more likely to be physically restrained than women.…”

The experience of caring for patients with dementia within a general hospital setting: a meta-synthesis of the qualitative literature

“…When considering the experiences of staff in general hospital settings, the quantitative literature primarily focuses upon the management of aggressive behaviour, the challenge of high workloads and low staff levels, as well as the perceived need for dementia training (Bradshaw, Goldberg, Schneider, & Harwood, 2013;Gandesha, Souza, Chaplin, & Hood, 2012;Nnatu & Shah, 2009;Weiner, Tabak, Bergman, 2003). While this provides useful insights, such research is also constrained by the limitations of structured questionnaires which do not necessarily permit the exploration of in-depth participant views.…”

The ethics of coercive treatment of people with dementia

“…The choice of strategy could depend on the RNs' knowledge of legislation, gerontological nursing and what constitutes adequate staffing to ensure human rights and freedom, topics dealt with in earlier studies. 5,9,10,13,16 However, all participating RNs based their actions on ethical considerations. Some RNs defended their actions, saying that coercive treatment was the right strategy and based on residents' best interest.…”

“…12,14,17,18 Despite coercive measures' harmful effect on quality of life, use of them is probably primarily based on lack of education and unawareness of alternative measures. 9,10,13,15,20 To enhance the legal security of persons with dementia in Sweden and to ensure the legitimacy of legislation, especially in situations involving physical violation and detention, a governmental commission was appointed. 1 New legislation, allowing coercive treatment in the care of older people with dementia, was proposed.…”

“…5,6 Understanding when established constraints are to be perceived as an enforced physical violation or detention, and reflecting over existing norms and attitudes in care of older people, requires legal knowledge, competent staff, committed leadership and multi-professional teamwork. 1,[7][8][9][10][11] Historical background Swedish studies 1,5 have revealed how coercive treatment regulations in municipal dementia care were used incorrectly. Physical restraints were used to a greater extent than permitted by legislation, and the decision to use such restraints had been made by professional healthcare staff other than physicians.…”