The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay

Assignment 3: Ethical Issue Scholarly Paper (40% of total grade)

Purpose of Assignment

1. To present a balanced view of an ethical issue; to clearly articulate both sides of an ethical issue;
2. To identify an ethical framework, model, theory, or set of principles and describe its application to an ethical issue.

Assignment Guidelines

• Choose an ethical issue in health care and/or nursing. State why this issue is of importance to society.
• Clearly state your evidence-based position as a nurse on this issue. Identify the values (personal, professional, and/or institutional) underpinning your position. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.
• Clearly state at least one other position (or “side”) to this issue. This position also needs to be grounded in the evidence. Speculate as to the values (personal, professional, and/or institutional) underpinning this opposing position.
• Include a discussion describing the use of an ethical framework, model, theory, or the ethical principles to support your position on this issue.
• Conclude with a brief summary as to why you believe your position is the best position on this issue.
• Paper should be eight to ten pages in length, excluding the title page and references list.

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Content of Paper (70%)

• Each element of the assignment guidelines is addressed.
• Paper integrates material from the textbook, course references and/or other scholarly sources including at least four peer-reviewed journals.
• Critical inquiry, analysis, and synthesis are evident.

Scholarly Format of Paper (30%)

• The paper:
  • is clearly written;
  • is within page limit;
  • contains accurate spelling, grammar, and punctuation.
  • adheres to APA (6th edition) format. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.

Helpful Hints for Getting Started: 

• When choosing an issue, look for one that is currently being debated. Consider what you have heard, seen or read online, on the TV news, in newspapers, and at your workplace.
• Whether you are a Post LPN BN or Post RN BN program student, you may find it helpful to review the content in the 2016 NCLEX-RN Detailed Test Plan to guide your choice of a topic. For example, you may choose to explore ethical issues regarding informed consent, client rights, organ donation, advance directives/self-determination/life planning, use of restraints/safety devices, end of life care, abuse/neglect, information technology etc. The 2016 NCLEX-RN Detailed Test Plan-Candidate Version is like a blue print and study guide for the NCLEX-RN exam and it provides detailed information about the content areas tested in the NCLEX-RN exam. It can be accessed through the National Council of State Boards of Nursing (NCSBN) at https://www.ncsbn.org/testplans.htm or https://www.ncsbn.org/2016_RN_Test_Plan_Candidate.pdf . The NCSBN is the organization which develops the NCLEX-RN exam. Please refer to the NCSBN website regularly for information regarding the NCLEX-RN exam https://www.ncsbn.org/nclex.htm
• For a review of course content related to values (personal, professional, and/or institutional) refer to Unit 3: Values Clarification and Development.
• For a review of course content related to ethical frameworks, models, theories, or the ethical principles, refer to Unit 6: Ethical Theories in Nursing.

The Use of Medical Restraint to Control Behavior in Dementia Patients

Introduction

Aggression behavior in patients can cause harm through body injuries, increase the chances of patient falls and as well, it may lead to damaging the medical equipment. As such, patients with aggression behavior may be subjected to restraints either physically or in form of medications. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay. One vulnerable group which usually faces the restraint are the elderly patients, especially those with dementia. The symptoms common with the dementia patients such as unsteady gait, lack of safety awareness and poor judgement may necessitate the use of restraints to control behavior in dementia patients (Cadore et al., 2014). This essay is an argumentative position on whether it is ethically fit to apply medical restraint to control behavior in dementia patients.

The Ethical Issue of Medical Restraint to Control Behavior in Dementia Patients and Its Importance to Society

The world population is rapidly aging and likewise the number of people with dementia is increasing at an alarming rate. People with dementia exhibit symptoms that are aggressive with poor memory and judgement being a common condition (Cadore et al., 2014). The resultant for such behaviors calls for application of various medical restraints to control the patient’s behavior in order to ensure safety both for the patient and the care giver. This is applicable to both home-based care or in a hospital setting. With such global trends on dementia, there is need to observe carefully on the methodologies and ethical implications of the application of medical restraint to control behavior in dementia patients.

My Evidence-Based Position as A Nurse on This Issue

My personal position on the application of medical restraint to control behavior in dementia patients is that I am against the medical restraint of any type in controlling the behavior of patients with dementia. In the recent past, there has been evidence-based research that has proven that medical restraints are not safe for the dementia patients and may work against the intended outcomes in the long run. The institutionalized policies of control and containment of such patients through the environmental, physical or chemical restraints have for a long time been the traditional restraints applied by a number of institutions to control behavior in patients with dementia (Peri et al., 2015). The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.

However, in the recent past, there has been a growing concern on the application of restraints especially in the elderly due to the psychological and physical consequences as well as legal implications associated with the restraints. This has often placed the care givers in an ethical dilemma which makes decision making process complex and sometimes difficult to implement or disseminate the much-needed primary care for the patient (Isaac et al., 2018).

In most clinical cases, the physical and chemical restraints are taken as the first line response in curbing behavioral symptoms in people with dementia. However, it should be understood that the two methodologies should only be applied as the last resort after failure of other safer methodologies which have been found to be more effective, especially with the elderly people. According to the most recent clinical guidelines, psychosocial approaches have been found to be more effective to be applied as the first line response for people with dementia (NSW Ministry of Health, 2013).

People with dementia have been found to be having difficulties in communicating their needs which makes it complex to be involved in clinical-decision making and thus the elimination in this process may create a gap which the caregivers usually apply the restraints without the consent thus ending up complicating the patients psychological and social well-being. Its quite agreeable that some behavioral symptoms in people with dementia can put them at risk or harm other patients or staff. Such situations have been found as the most appropriate to apply restraints but as such, the psychosocial approaches are also proven to be the best outweighing any other form of restraints.

On matters to do with nurses’ attitude towards restraints, it has been found that there has been a negative feeling towards the application of the restraints especially on the elderly patients. Most medical professionals have an ethical feeling that it is not right to apply restraints to the elderly patients but cites some situations that warrant the application, lacing the caregivers in a difficult situation in deciding on the best methodology to apply when it comes to elderly patients with dementia.

Psychosocial approaches have been proved to enhance the emotional well-being, decrease behavioral symptoms, improve on cognitive abilities and as well, promote everyday functioning of the involved patient (Halek et al., 2017). As such, due to the risks associated with restraints on psychological and physical effects, the psychosocial approach remains the best methodology for the patients with dementia.  The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.Each patient is unique in a way and the psychosocial approaches may vary depending on the dementia symptoms that they exhibit most. For those with poor memory for example, involving them in simple exercises, engaging them in playing mind games, as well as involving them in interesting discussions can improve their memory functioning. On the other hand, those with increased unnecessary movements can be contained by increasing surveillance or involving them in interesting activities such as watching TV or engaging them in a guided outside walk. These are just some of the much safer psychosocial approaches that are alternative to the medical restraints that can bring more harm than cure to the involved patient (Halek et al., 2017).

Although it is difficult to handle most of the dementia patients due to the behavioral symptoms that they exhibit, its advisable that the proxy or medical professionals be guided by the established ethical standards and in every situation, the psychosocial approach should be the first and possibly the last line of response to patients with dementia (Isaac et al., 2018). Applying restraints can sometimes be misused, especially in homebased care where the care givers may be having little or no knowledge on how to safely apply the restraints whether physically or chemically, putting the health well-being of the patient in jeopardy.

Other Differing Positions on The Issue and The Speculations as To the Values Underpinning This Opposing Positions

Dementia patients may exhibit symptoms that as the last resort or at an emergency situation, they may warrant application of medical restraints, whether physically or chemically. According to Burns et al., (2012), such situations should be targeted to be a short-term solution and monitoring should be done frequently to eliminate the restraint as soon as the patient situation improves. Aggressive behavioral situations are sometimes complex to handle and may warrant restraints as they may cause harm to the patients themselves, the medical staff or other patients. On the other hand, restraints can also be applied to reduce the patient falls. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay. Due to the poor safety awareness and decreased judgement, the rate of falls in dementia patients is at times all high and thus qualifying restraints as a risk management methodology (Peri et al., 2015).

Nevertheless, as earlier cited, the restraints should always be a short-term solution and upon the improvement of the patient’s situation, they should be withdrawn at the earliest possible time. In any decision concerning the application of the restraints, there should be adequate consultation with the caregivers or the legal representatives for the dementia patients. Emergency cases may not warrant for this and therefore, the consultation should take place as soon as the situations warrants (Isaac et al., 2018). Although there have been legal provisions that permit medics to act on their own consent where the patient is not in a position to make a medical decision (consent), such situations should always be guided by the established clinical guidelines and existing ethical standards.

According to NSW Ministry of Health (2013), the application of Psychotropics medications as a chemical restraint can sometimes best fit situations where comorbid pre-existing mental conditions have been recorded with the dementia patients (NSW Ministry of Health, 2013). This has been proved to be effective in controlling the associated behavioral symptoms and as well, improve the situations by establishing a calm environment where clinical interventions are possible to administer (Shaw et al., 2017). Chenoweth et al., (2009) on the other hand cites that Psychotropics medications when applied to patients with dementia are found to be beneficial, especially where the patients have exhibited aggression behavior that may greatly cause physical harm on their side (Chenoweth et al., 2009).

On the other hand, Behavioral and psychological symptoms of dementia (BPSD) is a disturbed mood behavior symptom that is common with the dementia patients. As such, an individualized comprehensive approach that applies personal-centered primary care is recommended to address the overall underlying issues for the patient exhaustively (Burns et al., 2012). The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.  Although there has been recommendations for the situations that warrant physical and chemical restraints, there has been notable discouragement through research, especially on preventing falls where the restraints have been cited to cause harm or death, placing the patient care at more risk as compared to the psychosocial approaches (Chow & Koh, 2012).

A Discussion Describing the Use of An Ethical Principle to Support My Position on This Issue

Ethical frameworks when it comes to the healthcare sector refers to the moral principles and values that act as a foundation for the medical professionals and caregivers to practice safety and exercise ethical practice when handling patients. With the dementia patients, application of ethical framework is vital both in ensuring a comprehensive and a personal-centered care, as well as assuring safety of the patient at hand. As such, the most appropriate ethical principle for the dementia patients is the principle of beneficence (Kelleher, 2014).

Beneficence is the act of kindness and mercy that translates to doing good to others (Kelleher, 2014). This principle dictates the moral obligations of acting on benefiting others who are in need. For dementia patients, they require close monitoring and as it has been notable with many dementia patients, behavioral symptoms such as acts of aggression requires a deep understanding and kindness on the side of the care giver in order to make an informed decision that will be of maximum benefit to the patient (Sagbakken et al., 2017).

On this note, it is evidence that following the principle of beneficence as the baseline for ethical practice, handling patients with dementia thus should not involve use of restraints and the more effective approaches that have been recommended by the clinical guidelines such as the psychosocial practice should replace such restraints (Halek et al., 2017). Dementia patients are mostly the elderly and restraining them does not only cause the physical damage, but also creates mental disturbance further affecting the patient’s well-being (Kelleher, 2014). To avoid such occurrences there should not be applied any form of restraints for the patients with dementia and instead, psychosocial approaches such as increased surveillance, strength promoting and activity-based measures that are safe and more effective compared with the restraints approach.

Therefore, the medical professionals and caregivers are bestowed with moral obligations to exercise ethical practices that will maximize the benefit of the patient and improve their overall health well-being (Isaac et al., 2018). In ethical dilemma cases or emergency ones, a wide range of consultation should be encouraged in order to reach out to the best approach that is agreeable and best fits the situation at hand. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay. The principle of beneficence is thus the most appropriate ethical principle to be applied in this situation and one that justifies the elimination of medical restraints in the control of behavior in dementia patients. Furthermore, it closely relates to the Mill’s theory which states that the principle of utility allows us to decide objectively what is right and wrong in the process of balancing the beneficial consequences (Kelleher, 2014).

The beneficence as an ethical principle should always be applied as the baseline for practice in the care giving situation especially where the patients are elderly to ensure that the patient dignity is protected and the practice of moral obligation is at core with a direct aim of achieving the best care that will befit the patient and improve their overall health well-being.

Conclusion

In a recap, the dementia patients are delicate and at the same time complex to handle. Most of these patients are elderly as is common with the disease. Attending them requires mercy and kindness as dictated by the ethical principle of beneficence. Application of restraints thus should be avoided as evidence in past research continue to find negative effects that includes both physical and psychological harm that further deteriorates the already delicate status of the dementia patients. Both physical and chemical restraints have been advocated to be effective in some situations such as reduction of falls in dementia patients but with more research, it has been proven otherwise as they have been found to cause serious complication and to the worst even death of the patients. With all these evidence at hand, and considering other psychological and social aspects, the application of the restraints in patients with dementia is not advisable at all and therefore, strict measures should be observed when administering care for such patients and where need be, the psychosocial approaches are the best practice that ensures patient safety and overall wellbeing of the dementia patient. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.

References

Burns, K., Jayasinha, R., Tsang, R., Brodaty, H. (2012). Behavior management a guide to good

practice: managing behavioral and psychological symptoms of dementia. DCRC and DBMAS Commonwealth, Canberra. http://dementiaresearch.com.au/images/dcrc/output-files/328-2012_dbmas_bpsd_guidelines_guide.pdf

Cadore, E. L., Moneo, A. B., Bays, Mensat, M. M., Muñoz, A. R., Casas-herrero, A., . . .

Izquierdo, M. (2014). Positive effects of resistance training in frail elderly patients with dementia after long-term physical restraint. Age, 36(2), 801-11.

Chenoweth, L., King, M. T., Jeon, Y. H. Broadaty, H.,Stein-Parbury, J., Norman, R., Haas, M. &

Luscombe, G. (2009). Caring for aged dementia care resident study (CADRES) of person-centered care, dementia care mapping, and usual care in dementia: a clusterrandomised trial. The Lancet Neurology, 8(4), 317-325.

Halek, M., Holle, D., & Bartholomeyczik, S. (2017). Development and evaluation of the content

validity, practicability and feasibility of the innovative dementia-oriented assessment system for challenging behavior in residents with dementia. BMC Health Services Research, 17

Isaac, L. M., Buggy, E., Sharma, A., Karberis, A., Maddock, K. M., & Weston, K. M. (2018). The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.

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Enhancing hospital care of patients with cognitive impairment. International Journal of Health Care Quality Assurance, 31(2), 173-186.

Kelleher, J. P. (2014). Beneficence, justice, and health care. Kennedy Institute of Ethics Journal,

24(1), 27-49.

NSW Ministry of Health. (2013). Assessment and management of people with behavioral and

psychological symptoms of dementia: a handbook for NSW clinicians. http://www.health.nsw.gov.au/dementia/Publications/assessment-mgmt-people-bpsd.pdf

Peri, K., Kerse, N., Moyes, S., Scahill, S., Chen, C., Hong, J. B., & Hughes, C. M. (2015). Is

psychotropic medication use related to organizational and treatment culture in residential care. Journal of Health Organization and Management, 29(7), 1065-1079.

Sagbakken, M., Naden, D., Ulstein, I., Kvaal, K., Langhammer, B., & May-Karin Rognstad.

(2017). Dignity in people with frontotemporal dementia and similar disorders – a qualitative study of the perspective of family caregivers. BMC Health Services Research, 17

Shaw, E., Sivananthan, A., Wood, D. P., Partington, J., Alison, P. R., & Fishwick, H. J. (2017).

Use of prone position restraint within a mental health trust. International Journal of Health Governance, 22(1), 52-60. The Use of Medical Restraint to Control Behaviour in Dementia Patients Essay.