Ethical Dilemma - Research Paper Example

? Ethical Dilemma: Using Restraints and Seclusion in Treatment Facilities Introduction The nursing profession is plagued with a multitude of ethical dilemmas. Based on a ranking of compilation of nurses’ personal ethical experiences conducted by Park (2009), the most frequent issues were under the component 2 of the Ethical Issues Scale (Fry and Duffy, 2001) which are patient care issues. This included staffing patterns, child or elderly patient neglect, treatment consents, etc (Park, 2009). In fact, nowadays, it is not only in wards for psychiatric care where violent situations prevalent, but also in emergency departments. This is largely due to the inadequacy of inpatient beds. According to a study, both psychiatric and emergency nurses hold the belief that these experiences of assault from patient is part of their profession and cannot be prevented (Haddad, 2004). This is quite a disturbing finding for those involved in providing mental health care. The Ethical Dilemma of Using Restraints in Treatment Facilities A patient receiving mental care behaves unpredictably. In some cases, they seem fine but suddenly perform violent acts—throwing objects, screaming or shouting angrily, and even posing as a threat to himself or to others. For clinical nurse practitioners in the psychiatric unit, this is the new dilemma they are facing: to use restriction or not. What is the ethical dilemma here? Nurses are expected to understand their role in patients’ lives. When it comes to the psychiatric care, one particular role stands out above all else—the nurse as an advocate for their patients (Park, 2009). It may be quite difficult to fight for the patients’ rights when faced with factors such as self-harming behavior, aggression targeted towards health care professionals, and the call as to whether restrictions should be used. It is often confusing where nurses should lie now—will it be in their role in advocating patient right to life, personal freedom, safety and preservation of dignity or will the nurse follow hospital protocols and use seclusion or restriction measures to avoid in any occurrence of harm to anyone? Most often, the latter is the case not because it was the appropriate response but because it is the instinctive human response to feel anger or fear (Haddad, 2004). What guide must a nurse use in correctly addressing the situation and what is the solution to this ethical dilemma? To make a nurse qualified for their roles in the hospital, ethical theories and principles have been established. Instructions have been specified to make the right choices. To start, ethical theories aim toward the achievement of an aggregate of objectives—beneficence, least harm, respect for autonomy and justice--called ethical principles. Beneficence is concerned with “do[ing] good” and is pertinent to the principle of utility where one aims to do the highest possible proportion of good over evil (Penslar, 1995). The next objective, least harm, is quite similar to the first principle. However, this is used when any decision made will have a malicious outcome. Respect for autonomy requires an ethical theory to result in patient’s complete dominance over their lives having the privilege to control the decisions which ultimately leads to the first principle of beneficence (Ridley, 1998; Ethical Principles, 2010). In relation to that, there are various perceptions of the connection between the two. Beneficence is given first concern rather than the autonomy of a person when viewing it paternalistically or the opposite in a libertarian view. Moreover, an ethical theory must accomplish justice where fair actions are needed to resolve and is characterized by reasonable basis to (Ethical Principles, 2010). Moreover, nonmalificence differs from the least harm principle in that this aims to cause no harm at all and is considered to be of the greatest importance even if all principles are of the same significance in theory (Kitchener, 1984; Rosenbaum, 1982; Stadler, 1986). According to Rainbow’s (2002) Description of Ethical Theories, there are five ethical theories that have been founded on these principles—deontology, utilitarianism, rights, casuist and virtue. However, in Hursthouse’s comparison of the different theories, she only used three—consequentialism (utilitarianism), deontology and virtue. Deontology is the theory in which a person is ethically correct in carrying out his/her role as a nurse because that is his responsibility (in Ridley, 1998). Returning to the ethical dilemma with a psychiatric patient I have described previously, the best ethical principle to apply and utilize in that situation is the deontology theory. Deontology theory adheres to what is moral or legal. It uses reason rather than wants or character which is a humanistic flaw that could impede the accomplishment of the ethically correct outcome (Ethical Theories Compared, 2010). With this theory in mind, the possibility of achieving all of the ethical principles is highly likely with the exception of respect for autonomy and quite possibly fidelity with patients when he/she has been restrained. It is important to understand that all theories have flaws weaved in the fabric of its terms and concepts and can conflict with the other theories. I have decided that the rights ethical theory is indeed difficult to fully achieve in that the boundaries of right are complicated to understand; thus, society is left to the task of concluding this matter using their prudence and best judgment (Rainbow, 2002). Applying the steps in coming up with an ethical decision, first necessitates the identification of the problem (Forester-Miller, 1996). It has always been the nature of a nurse to initially gather and assess data. In our case, we are faced not just by any uncooperative patient but also a mentally ill person capable of doing harm to you, others, or himself or herself. The American Counseling Association established a Code of Ethics which should be the next systematic step (in Forester-Miller, 1996). However, this focuses on the usual patient cases. Problems with psychiatric cases are more sophisticated and distinct. The nurse has to figure out the character and range of the dilemma and take into consideration the aspects of the prioritization of the principles, literatures such as the Journal of Psychiatric and Mental Health Nursing, consulting co-workers or the professional associations for psychiatric nursing (Forester-Miller, 1996). The next steps are very significant and demands complete focus. The practitioner should start planning for action (Forester-Miller, 1996). In this step, there is a need to contemplate about as many as possibly acceptable decision about the problem, including alternatives for restraints. In a study among personal experiences by nurses and physicians, nursing interventions such as having conversation with the patient, giving responsibility to a patient, or readjusting the environment of a patient could serve as alternatives to seclusion or restraint (Kontio, et al. 2010). In a separate research, they have also attempted the effectiveness of recreation or relaxation, involvement of support group, and unusual methods (use of hand mitts, alarms). Most uncomfortably described performing restraints as degrading of one’s dignity and more disorienting (Janelli, Stamps, & Delles, 2006). On the other hand, restrictions such as seclusion have complicated ethical even legal aspects to consider. It is regarded as a method of imposing control over the confinement of another human being rather than a part of the healing process (Muir-Cochrane, 2001). Once one has established possible solutions, think about the outcomes of all the choices then weigh them to conclude the correct action (Forester-Miller, 1996). In a research done among nurses, they have found that most of the participants were unable to meet the requirement of knowledge about the results of this controversial procedure (Suen, et al. 2005). A nurse must have proper education and know the instructions for interventions such as restraining procedures to qualify for the practice (Moylan, 2009). The conclusion of the decision making steps is further validation of the option which has been chosen (Forester-Miller, 1996). Finally, one has to implement the course of action. In reality, all non-restricting measures should be done first before using restriction as implementing this will risk the patient, other patients and the nurses even. Studies have supported that further research is necessary to decipher the complexity of the nature of this procedure (Marangos-Frost, Wells, 2000). For instance, use of restraint in patients who are at risk of delirium and agitation in intensive care units are showing benefits but findings suggest that it may actually cause more harm (Hine, 2007). Conclusion Restrictions should be the last option if not possibly avoided (Moylan, 2009). Nurses, unlike any other health care professionals, are usually placed in positions where they try to build rapport and unique relationships in aiding the patient and even their families in decision making (Briggs & Colvin, 2002). In turn, if nurses find success in their attempts, the patient or the relatives may reciprocate. To see patients who are considered dangerous, need to be subdued and restrained is truly distressing for anyone as you are stepping over the right for autonomy of a patient and possibly inflicting more harm (Cheung, Yam, 2004). To learn and master the ethical decision making theories through sufficient training are not only a beneficial tool for nurses but a crucial necessity in which they will require when faced with dilemmas they need to objectively resolve and be able to act as skillfully adequate nurses (Bunch, 2001). It should be performed not for the sake of low staff count or control of the patient but for a dire reason which unfortunately up to this point is unclear. Nurses are defined by compassion and should be sensitive to the needs of a patient (Cheung & Yam, 2004). References Briggs, L. & Colvin, E. (2002). The nurse’s role in end-of-life decision-making for patients and families. Geriatric Nursing, 23(6), 302-307. Bunch, E. H. (2001). 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