Control and restraint in contemporary psychiatric nursing: some ethical considerations

Abstract

This paper begins with an exploration of current attitudes towards the use of physical restraint in psychiatric nursing, and the contributions which the 1985 Ritchie Report and the 1991 Report of the Committee Of Inquiry Into Ashworth Hospital have made to the debate on the use of control and restraint within psychiatric institutions. The main focus of the paper, though, is an evaluation of the ethical justifications for and the ethical and political objections to the use of physical restraint techniques as a response to aggressive and self-injurious behaviour in contemporary mental health nursing practice. The author concludes that the number of situations where control and restraint techniques are used might be reduced by the development of new therapeutic approaches. Such approaches should allow for more negotiation regarding care between clients and nurses, and acknowledge the potential benefits of clients resisting supposedly therapeutic interventions which they find unhelpful.

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

“…D'Orio et al [5], for example, report a 39% reduction in coercion following introduction of a package which included enhanced access to expertise during emergency situations. Involvement in the use of these measures or witnessing their use can be highly distressing for both service users and staff [6][7][8] and few are likely to remain neutral about them. Attitudes toward different types of coercive measure are likely to vary between and within service user and staff groups but little is known about the preferences of staff and service users when comparing different measures.…”

Ethics and Praxis: Alternative Strategies to Physical Restraint and Seclusion in a Psychiatric Setting

“…Strumpf and Tomes (1993) trace the historical and philosophica l controversy of restraining the mentally ill throughout the last 200 years. The literature is burgeoning with references as to the questionabl e ethics of restraining and secluding patients in healthcare settings (Blakeslee, Goldman, Papougenis, & Torell, 1991;Bower, 2000;Dawkins, 1998;Haddal, 1999;Hopton, 1995;Marangos-Frost & Wells, 2000;Mattiasson & Andersson, 1995;May, 1995;Moss & LaPuma, 1991;Strumpf & Evans, 1991), the therapeutic effectiveness (Cashin, 1996;Martinez, Grimm, & Adamson, 1999;Johnson, 1998), and the inherent dangers in these practices (Crenshaw & Francis, 1995;Maier, VanRybroek, & Mays, 1994;Miles & Irvine, 1992;Mohr, Mahon, & Noone, 1998;Patter, Leadbetter, & McComish, 1994;Way & Banks, 1990;Weiss, 1998). In addition to physical harm, restraint and seclusion can cause psychologica l harm and negative attitude toward treatment (Cashin, 1996;Dawkins, 1998;Martinez, Grimm, & Adamson, 1999;Sullivan-Marx, 1995).…”

Selvskading og sykepleie

“…Det kan ligge en fare i å tolke alt i et overføring/motoverføringsperspektiv. Hopton (16) hevder at skading også kan vaere et uttrykk for rettferdig harme fra pasientens side over den behandlingen hun får. Kontroll og makt bør kun brukes der man vet at metodene er sikre og effektive, og bare som siste utvei når andre metoder har vist seg å ikke fungere.…”