Ethical Dilemma Health Care Essay Assignment

Introduction

When providing care to a multitude of patients, nurses usually face ethical dilemmas. At times, these dilemmas come from a patient’s refusal of treatment based on personal or cultural ideologies or a patient’s discomfort with the treatment. Nurses need to adequately resolve ethical dilemmas to provide safe and patient-centered care. The paper analyzes the use of physical restraint as an ethical dilemma in healthcare and the accountability of the DNP- prepared nurse in resolving the ethical dilemma to ensure effective patient-centered and safe care.

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Use of Physical Restraint as an Ethical Dilemma in Healthcare

The use of physical restraint is an ethical dilemma in healthcare. Physical restraint is a manual device attached to the body of the patient that restricts the patient from moving freely. In hospital settings, physical restraints were largely utilized to stop confused patients from causing harm to others and themselves and to prevent falls.  Mehrok et al (2020) posit that confused patients usually take out their therapeutic devices and physical restraint function as a safety device. Nevertheless, in contemporary health care settings, the utilization of physical restraints is a contentious issue as it has legal and ethical issues regarding the dignity and autonomy of patients. The utilization of physical restraint causes physical injury and also has numerous sociological and psychological impacts.

Impact of the ethical dilemma impact on healthcare outcomes

Although physical restraint is used to ensure patient safety and ensure the continuation of treatment in some cases, it may have several considerable negative effects such as hallucinations, delirium, or agitation; musculoskeletal, neural, and coetaneous injuries; a longer hospital stay, and post-traumatic stress disorder.  The majority of deaths as a result of physical restraint are due to asphyxiation connected with delirium.   The potential psychological and physical harms that may be caused by the utilization of physical restraint and the effect of the intervention is the general well-being, dignity, and autonomy of the patient makes use of physical restraint an ethical dilemma(Mehrok et al., 2022).

If the dilemma is an ethical issue, a legal issue, or both

The use of physical restraint in health care is both an ethical and legal issue. Although physical restraint is utilized in safeguarding the patients and staff, it inevitably restricts patients’ free will, therefore purring their basic human needs in a compromise. Oh (2021) posits that  As there is a high likelihood for many countries to breach human rights,  there are guidelines regulations, and laws related to the utilization of physical restraint as minimum protective measure for protecting fundamental rights. Health professionals are mandated to meet legal standards when implementing physical restraint and also provide care to patients as holistic individuals and promote their psychological and physical well-being and put into account ethical issues associated with physical restraint as moral agents and advocates.

The key issues surrounding the dilemma

Respect for patient’s autonomy and dignity and ensuring patient safety are key issues surrounding the use of physical restraint in healthcare. According to Smithard and   Randhawa (2022), there is a demand to permit patients to make decisions about their care that is, they have autonomy. The utilization of physical restraint leads to loss of dignity as well as considerably impaired autonomy for the patient. When using physical restraint, there is a conflict between concerns for patients’ safety and respecting the autonomy and dignity of the patient.  According to Ye et al. (2018), autonomy is the ability of an individual to make decisions according to their value.  Therefore, informed consent is the scheme to respect patients’ autonomy. Without a doubt, using physical restraint breaches the principle of autonomy since it violates the freedom of patients.  Obtaining informed consent from patients is not possible in several situations, particularly if patients are confused or mentally ill. Using physical restraint without patients’ permission violates their autonomy

The consequences if the dilemma is not resolved appropriately and time

If the dilemma is not resolved appropriately and timely, it can have negative impacts on patients, and nurses and damage the relationship between the nurse and the patient.  Continuous utilization of restraints can result in several functional, social, psychological, and physical problems in patients.  According to Smithard and Randhawa (2022), increasingly utilizing restraint is regarded as inappropriate and also sometimes ineffective, dangerous, and demeaning.  The risk of patients removing devices, delirium, and agitation are central to the utilization of physical restraint. However, the utilization of physical restraint is likely to heighten agitation and the requirement for further restraint. The utilization of physical restraint is accompanied by adverse events or complications.

If physical restraints are to be used, their positioning (placement and tightness) should be frequently checked, usually after every two hours, to ensure the safety of patients. However, evidence suggests nurses do not frequently check whether or not restraints are still correctly positioned after every two hours and that most nurses occasionally answer the calls of restrained patients.  This is concerning because physical restraints, particularly if not correctly implemented, have negative psychological and physical patient outcomes (Smithard & Randhawa, 2022).

Differing Views that Create the Dilemma

Ensuring the safety of patients and causing psychological and physical harms are differing views that create the dilemma on the use of physical restraint. According to Salehi et al. (2019) ensuring the safety of patients and safeguarding patients against possible damages are among key tasks of nurses. For that reason, nurses might utilize physical restraint to ensure the safety of their patients.  Nevertheless, similar to the majority of clinical procedures, physical restraint is linked to different problems psychological and physical problems. Additionally, inappropriate utilization of physical restraint causes approximately one hundred deaths yearly in the United States. Also, it has negative effects on patient comfort, well-being, and freedom. Thus, the utilization of physical restraint is at times regarded as an unethical practice.

Are the views influenced by culture, socio-economic status, religion, generational differences, ethnic diversity, or other factors?

 The views are not influenced by socio-economic status, culture religion, ethnic diversity, or generational differences. The views are influenced by the requirement of health care providers to balance the ethical principles of beneficence and nonmaleficence. According to Ye et al. (2018), beneficence is the use of a measure to benefit the patient. Beneficence in the utilization of physical restraint is termed selective beneficence since the intervention is aimed at preventing patients from causing injury to themselves.  The nursing staff has the obligation to properly care for patients and promote their health.  Concerning beneficence, physical restraint is used as an immediate measure to lessen patients’ movements.

Non-maleficence means do not harm. As such health care providers are required to balance side effects and therapeutic goals. Nevertheless, physical restraint causes psychological trauma and physical harm to patients. Adverse effects of physical restraint are against the beneficence principle; therefore; the ethical dilemma on whether or not to use physical restraint is the way to balance non-maleficence and beneficence.  When the principle of double effect comes into the picture, physical restraints are utilized with the beneficial intention of ensuring the safety of staff and patients but cause injurious outcomes ( harming the patients and they are accepted of the desired impact does not directly lead to adverse effects (Ye et al., 2018).

The Stakeholders Most Impacted by the Dilemma

Patients, nurses, and patients’ families are the stakeholders most impacted by the use of physical restraint. The use of physical restraint can have mental and physical consequences on patients.  According to Salehi et al. (2021), the most cited adverse effects on patients include increased heart rate, body temperature, and blood pressure, damage to the skin and nerves,   impaired circulation;  reduced self-confidence,  disturbed body image,  loss of dignity, anger, reduced personal autonomy, and social isolation. Besides patients, healthcare professionals are also at risk for the negative consequences of physical restraint utilization. According to Sharifi et al. (2021), physical restraint use increases violence against healthcare providers and also causes negative feelings like moral distress and guilt for providers.

In addition to patients and nurses, family members are impacted by the use of physical restraints. According to Carrero-Planells et al. (2021), some family members have ambivalent attitudes toward physical restraint use or they openly oppose this practice, seeing it as humiliating and degrading.  However,   others might consider the use of physical restrain to be positive and appropriate, and support them as safety elements.

The Role of the DNP-Prepared Nurse in Resolving Legal and Ethical Dilemmas

Nursing ethics obligate nurses to ensure the safety of patients and the fundamental rights of patients. As a DNP- prepared nurse, I   would use physical restraint on a patient if other restrictive alternatives have failed according to the guidelines provided by the Joint Commission(TJC) and the Centers for Medicare and Medicaid Services (CMS)  According to Ertugrul and Ozden (2022) in the United States guidelines developed by TJC and the CMS, emphasize that the application of physical restraint should occur only when alternative, less restrictive interventions are unsuccessful or in the case of an emergency that puts the physical safety or life the patient or another person in danger.  Sharifi et al. (2021) emphasize that physical restraint should not be utilized in case of environmental unsuitability or staff shortage or for patient punishment of staff convenience. The risks associated with the use of physical restraint must be weighed against the risks of not using physical restraint. Also, physical restraints need to be utilized as the last resort for ensuring the safety of a patient and when its benefits are greater than its associated risks and disadvantages.

How I would demonstrate leadership accountability to reach a positive outcome

I would demonstrate leadership accountability by providing education and training on the use of physical restraint. Providing physical restraint education to all health professionals involved in physical utilization use (including students, auxiliary nurses, and nurses) is the most important principle in the use of physical restraint. Gunawardena and Smithard (2019) indicate that apart from maintaining paint safety, restraints are used due to low levels of staffing and the inability to keep a constant watch on patients as a result of a large workload.  An additional factor to the use of restraints is inadequate training.  Gunawardena and Smithard (2019) allege that by improving education in indirect and direct restraint and offering alternative methods, there can be the implementation of more ethical decisions and positive outcomes. Health professionals are reluctant to utilize restraint and usually use it without their realization; an assessment of their knowledge of restraint and educating them to increase awareness of the outcomes of indirect and direct methods would lead to positive steps towards minimizing their use and also provide alternatives to maintain patient liberty and dignity while upholding patient care.

Physical restraint-related educational programs need to focus on strategies for effectively managing high-risk situations so as to minimize the use of physical restraint.  Also, education programs should include the principles of intelligent decision making about the use of physical restraint, proper and safe physical restraint-related techniques, appropriate mental and physical assessment, early diagnosis of consequences related to physical restraint, and appropriate physical restraint documentation. Provision of physical restraint-related education should occur during in-service continuous education via both online and face-to-face courses (Sharifi et al., 2021).

Also, I would develop strategies and plans for eradicating physical restraint utilization. Sharifi et al. (2021) indicate that one of the principles of managing physical restraint is supporting physical restraint-free care by utilizing safety procedures. Hospital, managers, in partnership with healthcare providers, should develop guidelines and policies for physical restraint-related procedures and decision making.

How I would mitigate risk to the organization?

The use of physical restraint has lasting consequences on the relationship of the patient with the health care system.  As a DNP-prepared nurse, I would mitigate risk to the organization by using clinical decision analysis to determine a plan of action. According to Gunawardena and Smithard (2019), finding a suitable non-restraint approach to care is optimal for the prevention of harmful outcomes and ensuring patient autonomy. A clinical decision analysis model might help establish a plan of action.  By analyzing the reasons for use of restraints (for instance, to prevent patients from falling), and then evaluating the situation and c remedying potential causes and risks, there can be a reduction in restraint incidence. Lower beds,  fewer obstacles, better lighting, and mats for a soft landing are examples of measures I can implement to prevent restraint use.

Conclusion

Decision-making for use of physical restraint is usually associated with ethical dilemmas since nurses are required to weigh the outcomes of using restraint against the consequences of not using the restraint as well as consider patient autonomy and safety. Although physical restraint is used for safety purposes, it can endanger the safety of patients and cause serious mental and physical consequences.  When faced with the ethical dilemma of whether or not to use physical restraint, nurses should weigh the benefits of using restraint and the risks associated with not using physical restraint. DNP-prepared nurses are accountable for resolving ethical dilemmas in the healthcare setting. DNP-prepared nurses can demonstrate leadership accountability by providing education on the use of physical restraint. By improving education in indirect and direct restraint and offering alternative methods, there can be the implementation of more ethical decisions and positive outcomes.

References

Carrero-Planells, A., Urrutia-Beaskoa, A., & Moreno-Mulet, C. (2021).  The Use of Physical Restraints on Geriatric Patients: Culture and Attitudes among Healthcare Professionals at Intermediate Care Hospitals in Majorca. A Qualitative Study Protocol. International Journal of Environmental Research and Public Health, 18(4), 7509. https://doi.org/10.3390/ijerph18147509

Ertugrul, B., & Ozden, D. (2022). The effects of physical restraint education on the knowledge and attitude of nurse interns. Journal of Psychiatric Nursing, 13(1), 31-42. DOI: 10.14744/phd.2021.32704

Gunawardena, R., & Smithard, D. G. (2019). The Attitudes Towards the Use of Restraint and Restrictive Intervention Amongst Healthcare Staff on Acute Medical and Frailty Wards-A Brief Literature Review. Geriatrics, 4(3), 50. doi: 10.3390/geriatrics4030050

Mehrok, S., Belsiyyal, C. X., Kamboj, P., & Mery, A. (2020). The use of physical restraints- knowledge and attitudes of nurses of a tertiary care institute, Uttarakhand, India.  Journal of Education and Health Promotion, 9, 77. doi: 10.4103/jehp.jehp_451_19

Oh, Y. (2021). A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty’s Phenomenology of the Body. International Journal of Environmental Research and Public Health, 18(19), 10078. doi: 10.3390/ijerph181910078

Salehi, Z., Ghezeljeh, T. N., Hajibabaee, F., & Joolaee, S. (2020). Factors behind ethical dilemmas regarding physical restraint for critical care nurses. Nursing Ethics, 27(2), 598-608.

Sharifi, A., Arsalani, N., Fallahi-Khoshknab, M., & Mohammadi-Shabolaghi, F. (2021). The principles of physical restraint use for hospitalized elderly people: an integrated literature review. Systematic Reviews, 10, 129. https://doi.org/10.1186/s13643-021-01676-8

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Smithard, D., & Randhawa, R. (2022). Physical Restraint in the Critical Care Unit: A Narrative Review.  New Bioethics, 28(1), 68-82.  https://doi.org/10.1080/20502877.2021.2019979

Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2018). Physical restraints: An ethical dilemma in mental health services in China. International Journal of Nursing Sciences, 5(1), 68-71. doi: 10.1016/j.ijnss.2017.12.001

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Select an ethical or legal dilemma and examine the accountability of the DNP-prepared nurse in resolving ethical and legal dilemmas to ensure safe and effective patient-centered care. Please look at the uploaded file thoroughly and follow. Thank you Ethical Dilemma Health Care Essay Assignment