Implementing Physical Restraints Without a Physician's Order: A Reflection on False Imprisonment Introduction For patien

Implementing Physical Restraints Without a Physician's Order: A Reflection on False Imprisonment

Introduction

For patient safety and ethical standards to prevail in healthcare, the use of physical restraints is an area of responsibility where, with great caution, every step taken must be considered. During my preceptorship at a critical access hospital when, I observed a nurse use physical restraints on their patient without an order from the physician. These actions also concern false imprisonment and violate ethical standards and established protocols stated in The Joint Commission's National Patient Safety Goals (NPSGs).

Description of the Incident

It happened on a night shift during which a nurse was restraining a patient, acting aggressively out of fear for the safety of the patient and the staff. The nurse felt that the restraints were necessary so the patient would not hurt herself. That use of physical restraints, however, was not given as a physician's order at the time of application. More than that, this situation entailed destroying the patient's autonomy and dignity as well as threatening the nurse with the risk of legal experiences over false imprisonment. (Al-Worafi, 2023). 

Physical Restraint Facility Policy

Preceptorship took place in the Critical Access Hospital, they have a policy in place regarding the use of physical restraints. The hospital policy states that physical restraints are to be used only in the patient's best interest to prevent immediate harm and only after less restrictive remedies have been considered and proven not to be successful. It requires that restraints are applied only on the order of a physician, except in emergencies, in which case the nurse may apply them but is to do so only after ordering a physician. The policy requires that restraints be used, documented meticulously, for a rational reason, using a specific kind of restraint for a determined period of time.

Possible Causes That Led to It

The following are some of the reasons why the nurse had to apply the physical restraints without the physician's order. First, there was overcrowding of patients with traction to the number of nursing personnel available during the shift, stressing the nurses and, therefore propensity to develop poor judgment. Also, the nurse may have had the feeling because there was danger from the patient and everyone was in close range to be attacked. The lack of well-defined standard procedures for behavioral crises' quick response might have also contributed to this, as the nurse felt alone in looking for a physician's quick intervention. (Thomann et al. 2021).

The outcome of the Incident

The short-term effect of the particular event was that the patient was restricted, and the tension was brought under control within a few minutes. Despite this, such action had significant risks, such as the patient suffering psychological harm, the nurse-patient relationship being compromised, and the patient's rights being violated. This could have been followed by physical harm or any other psychological problems by the use of restraints in case proper surveillance was not conducted. Also, the hospital was open for a legal battle for false imprisonment because the restraints were put on the patient without adequate permission.

Measures to Take in Order to Avoid Future Disasters

Being a future RN, I understand the significance of observing Ethics and Institutional Policies that are surrounding the problem of physical restraints. In the same regard, measures that would be recommended in order to avoid such mishaps in future are as follows. The first step, therefore, is to make sure all nursing staff are properly educated on the policies of physical restraint use, other interventions, the law on the use of physical restraint on patients, and what happens when they go ahead and restrain a patient without following the right procedures. (Linton & Koonmen 2020).

Second, the adoption of more rigorous communication practices would enable reaching physicians more rapidly during an emergency so that nurses could ask for orders regarding restraints without compromising the patient's security. Third, facility restraint policies should be reviewed on a regular basis in order to assess its current practices against the best standards and to get input from the nursing staff as to the difficulties experienced in practice.

Conclusion

In the case of using physical restraint without a physician's order, there exist very important ethical and legal aspects in the nursing practice. This way, nurses can maintain the patient rights adopted by The Joint Commission NPSGs and the safety of the latter from false imprisonment. This means education to be continuous, communication to be enhanced, and the paramount importance of reverting back to patient-centered solutions to prevent such mishaps from being repeated in future, to come up with a safer healthcare setting for all patients.

References

Al-Worafi, Y. (2023). Patient safety in developing countries: Education, research, case studies. CRC Press.

Linton, M., & Koonmen, J. (2020). Self-care is an ethical obligation for nurses. Nursing ethics, 27(8), 1694-1702.

Thomann, S., Zwakhalen, S., Richter, D., Bauer, S., & Hahn, S. (2021). Restraint use in the acute-care hospital setting: A cross-sectional multi-centre study. International journal of nursing studies, 114, 103807.