NRNP 6665 Discussion WEEK 2: RESPONSE TO MY COLLEAGUE NO 2 (AMARACHI, E)

NRNP 6665 Discussion WEEK 2: RESPONSE TO MY COLLEAGUE NO 2 (AMARACHI, E)

Ethical and Legal Foundations of PMHNP across Lifespan

Topic: Restraints

Restraints are the physical, environmental, or chemical interventions that healthcare professionals use to control undesirable behaviors among patients. In most cases, psychiatric mental health nurse practitioners (PMHNP) use restraints to limit unnecessary movements among patients in psychiatric care to minimize their threats to others or prevent them from experiencing injuries during their medication process. One of the primary types of restraints is physical equipment, such as straps that limit patients from moving. PMHNPs also use chemical restraints that involve injecting the patients with drugs to sedate them, thus preventing them from showing undesirable behavior. Finally, physicians use environmental restraints, which are structures in the patient\’s surroundings, to limit their movements from one place to another. Environmental restraints are vital in determining the places where a patient can go.

Articles’ Summary

Ethical and Legal Issues Related to Restraints as they Concern Psychiatric-Mental Health Practice for Children/Adolescents.
Scheuermann et al. (2016) argue that some of the ethical issues that emanate from the use of restraints among children include lack of appropriate professional training and monitoring, leading to physicians’ failure to comply with safety standards when treating patients. Also, hazardous interventions result in injuries on adolescents, thereby negatively impacting their welfare (Scheuermann et al., 2016). Besides, when retraining patients, it is prudent to use the least invasive approaches before advancing to complex strategies to enhance their wellbeing (Scheuermann et al., 2016). The ethical issues above concern non-maleficence and beneficence principles, which require that nurses not intentionally harm the patients.

When treating children, it is prudent to consider the legal provisions, such as the Children’s Health Act (2000) which requires that individuals and professionals not engage in activities that negatively impact the health of mentally ill persons (Day et al., 2010). Besides, the physicians should consider the international position statements concerning physical restraints among children. For instance, the International Society of Psychiatric-Mental Health Nurses has issued a Position Statement on the Use of Restraints and Seclusion among children, which recommends that physicians restrain children as the last strategy (Day et al., 2010). Therefore, restraints among children should be applicable in instances where they are at risk of self-injury and where there are no alternatives to managing their undesirable conduct.
Ethical and Legal Issues Related to Restraints as they Concern Psychiatric-Mental Health Practice for Adults.
Duwadi et al. (2018) argue that the use of restraints among adult patients often leads to the contravention of ethical principles of autonomy, non-maleficence, and beneficence. As a result, practitioners should adequately balance the necessity of restraints and the patient’s welfare when making decisions on controlling behaviors among their patients (Duwadi et al., 2018). When treating critically ill adult patients, it is prudent to engage in activities that will enhance their benefits from the treatment programs. Therefore, a practitioner should avoid coercive approaches that can negatively impact the patients\’ physical or psychological well-being.

According to Recupero et al. (2011), the federal policies have restricted the use of restraints and seclusion among adults in psychiatric care. When using restraints and seclusion, physicians must effectively manage the pain the patients can experience. According to Recupero et al. (2011), legal issues emanated from failure to comply with the Americans with Disabilities Act (ADA) and proper supervision and training of the staff to enhance patients’ safety. Therefore, patient-centered, and treatment-oriented strategies are vital in mitigating physicians’ legal liabilities when applying restraints and seclusion.

Application to My Practice

In the state of California, the information concerning legal issues relating to treating patients with disabilities will be vital in ensuring that I enhance the patients\’ welfare. In particular, the ADA requires that professionals treat mentally ill patients with dignity. Therefore, when treating children or adults with mental disorders, it will be necessary not to use restraints in a manner that disparages their dignity. Further, legal considerations such as the Children’s Health Act will influence my practice by first considering their interests when treating them. On the other hand, the ethical issues in using restraints will influence my practice by adhering to the nursing principles of non-malfeasance, beneficence, and autonomy. Therefore, I will effectively engage the patients or their families to get informed consent before using restraints or seclusion.

References

Day, A., Daffern, M., & Simmons, P. (2010). Use of restraint in residential care settings for children and young people. Psychiatry, psychology, and law, 17(2), 230-244. Doi:10.1080/13218710903433964
Recupero, P. R., Price, M., Garvey, K. A., Daly, B., & Xavier, S. L. (2011). Restraint and seclusion in psychiatric treatment settings: regulation, case law, and risk management. Journal of the American Academy of Psychiatry and the Law Online, 39(4), 465-476.
Scheuermann, B., Peterson, R., Ryan, J. B., & Billingsley, G. (2016). Professional practice and ethical issues related to physical restraint and seclusion in schools. Journal of Disability Policy Studies, 27(2), 86-95. Doi: 10.1177/1044207315604366

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