This week, for my role and scope course, I had to write about one of the ethical position statements done by the American Nurses Association (ANA).
The ethical position statement that caught my eye, according to the ANA, pertains to the reduction of patient restraint and seclusion practices in the health care setting. As with the ANA Board of Directors, I agree that the use of restraints and seclusion can be an ethical dilemma. In addition, I too believe that such practices can arguably be justifiable, depending on the situation.
Along with the ANA, I too believe that inadequate staffing and the fear of greater liability for patient falls heavily motivate the use of such practice. Yet, I am amazed at the statistics involving the repercussions of using restraints and seclusion. The ANA statement states that, over a 5 year period, there were approximately 202 deaths related to restraint use and asphyxiation. Other complications included brachial plexus injuries, joint contractures and pressure ulcers. All of which are also great liabilities, regarding the legality of nursing care.
Nevertheless, just as the statement suggests, I am a strong advocate for the use of restraints when it comes to certain situations. From my experiences, working as a float-tech with nurses on a med-surg floor, there’s nothing more burdensome than having to worry about the insanity of a delirious elderly adult. Furthermore, again from my experiences, the idea of using restraints on someone in the ICU who keeps pulling out their IVs or just belligerently breaking other medical equipment is ideal; especially when these patients are simply too incoherent to make honest medical decisions for themselves.
With that said, however, I certainly understand the need to attempt to pursue less invasive measures first. For example, moving a delirious patient closer to the nurse’s station, attempting to calm, explain and therapeutically communicate with the patient, etc. Though, I think that if the unwanted behavior continues and the quality of care for my other patients becomes diminished, I don’t see any other better option than to advocate for restraints.