In many hospitals around the world and in south Africa patients are restrained by health care workers in order to prevent self-harm of the patients, or to stop the patients pulling out drips and drains, and thus damaging their own recovery. A recent study defined physical restraints as a forcible measure that may be used as a last resort to ensure the safety of patients by using external measures to restrict patient’s physical movement (Zhu, Xiang, Zhou, & Gou, 2014). Using restraints can cause major and sometimes serious medical and ethical issues within the hospital setting.

According to the Health Professions Council of South Africa’s (HPCSA) national patient’s rights charter 2008, patients have “a right to a healthy and safe environment that will ensure their physical and mental health or well-being”, it continues by saying “…everyone has the right to participate in decision making on matters affecting one’s own health”. Many may argue that this could be seen in direct contrast to hospitals being allowed to restrain patients, even when patients actively state that they do not want to be restrained. One of the major conflicting factors in using restraints in clinical settings is the patients right to autonomy.

There is no doubt that in using restraints on a patient, the very basis of autonomy is broken as it immediately breaches the freedom of the patient. (Junrong, Xiao, Yu, Wei, & Chang, 2018). When using physical restraints without the consent of a patient, breaches their right to autonomy, and thus using the restraints should be considered unlawful (Junrong, Xiao, Yu, Wei, & Chang, 2018). However, in many situations where the patient may not be fully competent mentally, or suffers from other psychiatric disorders that may not fully understand what is happening nor why they are in hospital may need restraints for their own safety, or that of the other patients or nursing staff. This is where the contradiction lies.

In terms of safety restraints are beneficial as it may guarantee the safety of most people and prevents staff, other patients and the patient involved from violence, however then alternative measures in order to receive consent need to be taken such as receiving  consent from next of kin. However, restraints do not only have an effect on the patient but may also cause internal conflicts within the staff who apply the restraints (Lai, 2007). Lai 2007 found that in staff that applied restraints many were not comfortable in doing so and were ambivalent to their use, however they used them anyway in order to prevent the patient from causing self-harm or falls out of bed.

Many different professional groups state that the main use for restraints is protection from injury such as falls and preventing disruption from treatment (Lai, 2007). This shows that many staff that issue restraints do so in order to protect the patient from further harm or injury and have done so for the good of the patient. It was also found that on administrating restraints many nursing staff felt feelings of “ambiguity, uneasiness and frustration” (Lai, 2007). Which goes to show that many nurses do not enjoy applying restraints but feel that it is necessary.

An overriding theme in the literature is that the responsibility for preventing falls was that of the nurses, and thus the use of physical restraints was a way of ensuring this from not happening or from as happening as little as possible. However, it still does not address the fact that the patients right to autonomy is been taken away from them with no regard to the freedom of the patient. This is a mighty conflict for many nursing staff who need to provide restraints for particular patients who may cause more damage to themselves if left unrestrained, which then may also fall back on the nurse’s shoulders for allowing the patient to fall. However if the patient is restrained the nursing staff could face legal action, due to not respecting the patient’s rights.

This is a massive conflict that health care staff, but in particular nursing staff face on a day to day basis and will continue to face for many years to come. There are many people who are strongly against patient restraints, but many who see the benefit of correctly applied safely administered restraints on the safety of the patient.

References

Zhu, X.‐M., Xiang, Y.‐T., Zhou, J.‐S., & Gou, L. (2014). Frequency of Physical Restraint and Its Associations With Demographic and Clinical Characteristics in a Chinese Psychiatric Institution. Perspectives in Psychiatric Care.

Junrong, Y., Xiao, A., Yu, L., Wei, H., & Chang, W. (2018). Physical restraints: An ethical dilemma in mental health services in China. International Journal Of Nursing Science.

Lai, C. (2007). Nurses using physical restraints: Are the accused also the victims? BMC Nursing.