Patient restrictions: Are there ethical alternatives to seclusion and restraint?

• Published in: Nursing ethics Vol. 17; no. 1; pp. 65 - 76
• Main Authors: Kontio, Raija, Välimäki, Maritta, Putkonen, Hanna, Kuosmanen, Lauri, Scott, Anne, Joffe, Grigori
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.01.2010; SAGE PUBLICATIONS, INC
• Subjects: Adult; Aggression; Alternatives; Behavior Control - ethics; Behavior Control - methods; Content analysis; Decision Making - ethics; Ethical dilemmas; Female; Finland; Focus Groups; Humans; Male; Mental Disorders - nursing; Mental Disorders - therapy; Middle Aged; Nursing; Patient Isolation - ethics; Pilot Projects; Practice Patterns, Nurses' - ethics; Practice Patterns, Physicians' - ethics; Psychiatric hospitals; Restraint, Physical - ethics; Restraints; Seclusion; Finland; seclusion; patient restriction; aggressive patient; acute psychiatric care; inductive content analysis; restraint
• ISSN: 0969-7330; 1477-0989
• DOI: 10.1177/0969733009350140

The use of patient restrictions (e.g. involuntary admission, seclusion, restraint) is a complex ethical dilemma in psychiatric care. The present study explored nurses’ (n = 22) and physicians’ (n = 5) perceptions of what actually happens when an aggressive behaviour episode occurs on the ward and what alternatives to seclusion and restraint are actually in use as normal standard practice in acute psychiatric care. The data were collected by focus group interviews and analysed by inductive content analysis. The participants believed that the decision-making process for managing patients’ aggressive behaviour contains some in-built ethical dilemmas. They thought that patients’ subjective perspective received little attention. Nevertheless, the staff proposed and appeared to use a number of alternatives to minimize or replace the use of seclusion and restraint. Medical and nursing staff need to be encouraged and taught to: (1) tune in more deeply to reasons for patients’ aggressive behaviour; and (2) use alternatives to seclusion and restraint in order to humanize patient care to a greater extent.