ETHICAL ARGUMENTS

Ethical Arguments

Ethical Arguments

According to the case studies, restraint use in aged care has been the topic of much discussion and many papers over the past 20 years or so. It is often an emotive subject for those working with older people, as many staff perceives themselves to be using restraint to increase the safety of those they care for. This is despite a large body of research indicating that the use of physical restraint as a care strategy is 'ineffective and hazardous'. Many discussions centre on defining precisely what is meant by restraint. This can often be far from straightforward. For instance, a table that locks onto a chair is usually classed as a restraint. However, is it still a restraint if it is requested by a resident to enable them to read the newspaper? Cockburn (2004 S65-6) propose a definition that is specific to residential aged care, and seeks to clarify the difference between restraint and other care practices. According to their definition, restraint is:

Case 1 says any physical, chemical or environmental intervention used specifically to restrict the freedom of movement - or behaviour perceived by others to be antisocial - of a resident designated as receiving high or low care in an aged care facility. It does not refer to equipment requested by the individual for their safety, mobility or comfort. Neither does it refer to drugs used - with informed consent - to treat specific, appropriately diagnosed conditions where drug use is clinically indicated to be the most appropriate treatment. Thus restraint by definition may be seen to be a human rights rather than a medical issue.

Re-framing restraint as a human rights issue has implications for staff accustomed to working within a medical model of care, where they see their role as that of a protector. Many nurses feel that resident falls would increase if restraints were ceased, and that they would be at risk of litigation from families of residents, and some nurses also fear an increase in their workload through a decrease in restraint use.

Case 2 exclaims that restraint use can be segmented into four types of practices: physical restraint, chemical restraint, aversive treatment practices/punishments and environmental restraint. This project focuses only on physical restraint use in residential aged care settings. A systematic review found wide variation in reports of the proportion of residents restrained in studies analysed, from 12% to 47%, with a mean of 27%.5 Evidence shows that physical restraint use may lead to direct and indirect injuries for the restrained person.4 Cotter states 'physical restraints should be eliminated as an intervention in older adults with dementia because they are also very likely to cause acute functional decline, incontinence, pressure ulcers and regressive behaviours in a short period of time'. A review of qualitative research shows that the experience of being restrained can be negative and detrimental to the restrained person. Comments such as 'I'm in a jail, stuck' and 'Like a caged bird' describe people's feelings about being restrained (Sullivan-Marx 2001 ...