The right to health is fundamental to the physical and mental well-being of all individuals. In South Africa, the constitution guides the substantive content of all laws and policies through its Bill of Rights. The Bill of Rights regulates the content of health laws and policies, and any health care treatment should follow the guidelines set out by the constitution in order to ensure dignity and equality of all patients (Reidy, 2008). The use of physical restraints in patients have been extensively investigated with numerous recent literature supporting it, where others question, discourage and reject the use of physical constraints on patients in clinical settings (Kalula & Petros, 2016).  In many hospitals in South Africa, patients are restrained by health care professionals to ensure the safety of the patient and other patients (Lai, 2007). Restraint of patients in hospitals may be chemical or physical. Physical restraint refers to devices that restrict a patient’s movement being in the patient’s best interest (Kalula & Petros, 2016). Chemical restraint is any drug that is administered to the patient that is used for discipline or convenience and is not required to treat the patients’ medical symptoms (Kalula & Petros, 2016).

Autonomy refers to the ability of a person to make decisions according to their personal value, thus, before any medical practioners performs any treatment or assessment, obtaining informed consent is basic respect to the autonomy of patients (Ye, Xiao, Yu, Wei, & Luo, 2017). Undoubtedly, the use of physical restraints breaches the principle of autonomy because it limits the freedom of patients. Saying this, the use of restraints is the immediate measure to reduce the movement of patients to control and/or prevent self-injury or injury to those around, (Ye, Xiao, Yu, Wei, & Luo, 2017). The choice between use and non-use of restraint is argued based on practical considerations, such as how a patient’s safety (and the safety of others) may be balanced with a patient’s recovery process. Should a agitated and/or confused patient not be restrained by the medical team, the consequences thereof could be regarded as negligence as patients can pull out devices, IV lines, and oxygen masks which are essential for the treatment of the patient (Kalula & Petros, 2016).

During my time in ICU, I have experienced and seen both the use of physical and chemical restraints.  Most patients in ICU may experience some degree of agitation, confusion and delirium during their stay which is often caused by pain, underlying illness, sleep deprivation, hypoxia as well as alcohol and substance withdrawal (Abdeljawad & Mrayyan, 2016). A specific encounter where I had to face the reality of restraining a patient was when I had to treat a patient who had sustained a TBI after being assaulted (community assault). He was previously ventilated and intubated via trachea. When I started seeing him, he had been extubated and now only relied on oxygen support (T-Piece). He was awake, but clearly agitated. I had to administer chest physio but had difficulty as he continuously tried to sit up and grab my hands. I was unable to treat the patient effectively due to this, and therefore, as instructed by my clinician asked the nurses to restrain the patient’s upper limbs as lower limbs. At first, I felt uneasy and unsure of whether I was doing the right thing, but soon realized it was at the benefit of the patient although it might not always seem that way.  Although this clearly breaches the patient’s rights and autonomy, I am unsure of what the alternative would be.

The Health Professionals council of South Africa (HPSCA) firmly states that every individual has the ‘right to a healthy and safe environment whilst at the same time stating every individual has the right to ‘participate in the decision-making’ of their own health-related treatment. As stated previously, the restraining of patients clearly breaches a patient’s autonomy as well as contradicts what the HPSCA guidelines, despite being in the patient’s best interest.

Although health care practioners are aware of the ethical dilemmas arising from the use of physical restraints and are often uncomfortable with their decision to use them, up to date to there are no other alternatives to keep patients and those around them safe.

References

Kalula, S., & Petros, S. (2016). Use of physical restraint in hospital patients: A descriptive study in a tertiary hospital in South Africa. Curationis, 39(1), 1-8.

Lai, C. (2007). Nurses using physical restraints: Are the accused also the victims? – A study using focus group interviews. BMC Nursing, 1-7.

Reidy, M. (2008, February ). Rights and Wrongs of patient restraint. WIN, 16(2), 22-23.

Ye, J., Xiao, A., Yu, L., Wei, H., & Luo, T. (2017). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68-71.