ETHICAL ASPECTS OF HEALTH & SOCIAL WORK

Ethical Aspects of Health & Social Work

Ethical Aspects of Health & Social Work

Introduction

This article examines the use of physical restraints through the four broad principles of ethics common to all helping professions for commission of social care. It asks whether the continued use of physical restraints is consistent with ethical practice through the lens of those principles. It also examines where the necessity to use restraints in the absence of empirically supported alternatives leaves professionals in terms of conflicts between ethical principles and makes recommendations for changes in education and clinical practice. It concludes that an analysis through a bioethics lens demonstrates that the use of restraints as a tool in psychiatric settings is a complex and multifaceted problem. Principles of ethics may often be in conflict with each other in instances where patients must be physically restrained.

Task 1

Physical restraints are often used to prevent falls, yet researchers using control groups have found that restraint use was associated with increased falls rates in this case study. Restraints have also been associated with increases in moderate and severe injuries and death (Evans & Lambert 2003 274-282). One estimate suggests that one in a thousand nursing home deaths are a direct result of physical restraint use. There are also negative psychological consequences from restraints including fear, anger, resistance, humiliation, demoralization, discomfort, resignation and denial. Other negative consequences of physical restraints include incontinence, pressure ulcers, dependence in activities of daily living, disorientation, infections, chronic constipation, loss of bone mass and decreased tone, strength and ability to walk.

Psychotropic medications affect psychic function, behaviour or experience and can therefore be used as a form of chemical restraint by controlling behaviour. Use of medications for discipline or convenience of staff would be considered misuse and a form of restraint. Medications used for restraining residents often have side effects, particularly for older people. Benzodiazepine use has been associated with a 24% increased risk of hip fracture after controlling for other factors in people 65 years of age and over (Nay & Koch 2006 33-38). Antipsychotic and antidepressants have also been associated with an increased risk of falls amongst older people in residential care. Other effects from psychotropic medications include confusion, lethargy, sedation, hypotension, endocrine changes, drug-induced Parkinsonism, cardiac slowing, delirium and acute glaucoma.

There has been less research investigating environmental restraints in residential elder care settings. Environmental restraints include isolating someone in a locked room and locked facilities. Locked wards and facilities are common practice in facilities where people with dementia reside but they can have detrimental psychological impacts on residents. One study with cognitively impaired older males found that being in a locked unit led to feelings of injustice, frustration, distress and residents described it as being like 'a prisoner' and 'in jail'.

In UK, the Aged Care Act 1997 and the UK Standards and Guidelines for Residential Aged Care Services (Hewawasam 2006 41-44) paved the way for a new focus on improving quality of care in elder care facilities and recognized the ...