Introduction
People with challenging behavior can be hard to deal with especially for those who interact with them on a daily basis, be it family members, colleagues, the society, or health caregivers. Challenging behavior results in distress and danger to the persons who handle the person who is exhibiting it. It includes outbursts of aggression, physical and verbal threats of harm, and other such acts of aggressive behavior. Several methods have been adopted to effectively interact with people who exhibit this kind of behavior so as to accord them effective healthcare. The most common methods involve the use of physical or chemical restraints to inhibit behavior. Even though these methods are effective, they have an array of side/negative effects on the person they are been administered to. This essay seeks to discuss the use of restraints, their negative effects on patients, patient rights, and what better alternatives are available for this situation.
Implications of restraints on both patient and staff safety.
Challenging behavior is any act by an individual, physical or verbal, which are likely to cause physical or psychological harm to themselves or the person caring for them or to property around them. For a healthcare provider to effectively deal with challenging behavior, they have to understand the factors that trigger it which can be intrinsic or extrinsic.
- Intrinsic factors – These are borne out of personal feelings, emotions and the physical and mental health status of the patient. For instance, the patient may get agitated because they are feeling pain due to a sickness or because they feel out of place.
- Extrinsic factors – These are derived from the surroundings and people around the patient who can trigger a behavioral response. An uncomfortable hospital facility or a rude or overtly aggressive nurse can trigger a violent or agitated rection from the patient.
In order to minimize incidents of patients exhibiting challenging behavior, healthcare providers should ensure that the environment around the patient provides a calming effect and does not lead to trigger of such behavior. In extreme cases where the patient’s behavior is overly aggressive and threatens their safety and the safety of people around them, physical and chemical restraints are usually applied to restrict the patient’s mobility and prevent them from harming themselves and others. Physical restraints involve applying a mechanism, gadget or barrier which prevents the patient’s movement and include limb ties, straps and belts, vests, wheel chair bars and brakes etc. Chemical restraints involve the use of any drug on a patient to manage or avert dangerous and uncontrollable behavior in an agitated patient.
The use of restraints on patients with challenging behavior is a sensitive issue which should be handled carefully and professionally to avoid backlash from the patient and family members. Here are some guidelines that a health care provider should follow while applying them: –
– They should be applied only when all other means of calming down the patient have been tried without effect.
– The patient’s family or representatives are involved in the decision to use the restraints or in an emergency situation where a serious threat to the patient’s safety or others is evident; nurses can apply them (Rainier, 2014).
– They should be used in the shortest period possible. Once the challenging behavior subsides, their use should be withdrawn forthwith. Continuous assessment should be done on the patient to determine if the use of restraints should be continued (Dewa, Murray, Thibaut, Ramtale, & Adam, 2018).
– After discontinuation, the patient and his/or family should be de-briefed and discussions about alternatives to restraints should be held (Freeman, Hallett, & McHugh, 2016).
Alternatives to Restraints related to RN standards.
The use of restraints provides for a short-term solution to control the challenging behavior of the , and prevent harm/injury to them, people around them and to property. However, their continued use is known to cause many negative effects. They should therefore only be used as a stop-gap measure while the healthcare provider works out a long-term solution to handle the patient. Alternative solutions to the use of restraints involves three stages; Diagnosing what triggers the challenging behavior, working out how to care for the patient in a manner that does not trigger the behavior and infusing a care-routine that will result in gradual withdrawal of use of restraints on the patient. Here are some alternatives which can be used together with restraints or separately depending on the nature of the challenging behavior: –
- Individualizing the patient’s care – It involves making the care routine person-centered by regulating care activities and minimizing abrupt changes in the patient’s schedule. This makes it easy for the patient to follow a familiar routine hence less likely to resort to agitation.
- Restraint fading alternative – This is applied mostly to people with developmental disabilities and involves the introduction of a mechanism that will make the patient stop the challenging behavior. For instance, advocating for the wearing of arm sleeves helps in managing hand mouthing habits (Freeman, Hallett, & McHugh, 2016).
- Improving the skills and behavioral competencies of the health-care staff – Healthcare givers involved at all levels of the patient’s care should be adequately trained on how to accord optimal care and handle patients who are likely to exhibit challenging behavior (Dewa, Murray, Thibaut, Ramtale, & Adam, 2018). Training should include how to observe patients and find out what triggers the challenging behavior.
- Involve and engage the patient as much as possible – Engaging and talking with the patient and keeping them occupied with activities such as games, story-telling etc. will make them feel at ease and less likely to be aggressive. Involve the patient on treatment decisions like dosage, ward conditions and medication will make them feel included hence reduce the need for exhibiting challenging behavior (Dewa, Murray, Thibaut, Ramtale, & Adam, 2018).
Legal and ethical implications to use of Restraints on patients with challenging behavior.
In applying physical and chemical restraints to patients, the healthcare provider should ensure that their use is not against set legal and ethical guidelines.
Legal.
Chapter 16 of the Australian Mental Health Act provides for healthcare providers to use restrains on a patient under the following conditions: –
- When the safety of the patient, healthcare provider and property is threatened.
- Only when all other means of calming down the patient have failed.
- Unless in an emergency, involve family members.
- Use a method that is relevant to the type of agitation and for the shortest possible period.
The human rights commission framework on use of restraints states that restraints should not be used to torture, humiliate, distress or degrade someone. It further states use of an inherently inhuman method of restraint, excessive physical force or a restraint that results in humiliation of the patient is tantamount to torture.
Ethical.
The use of restraints should also be guided by the ethical principles of justice and Autonomy which requires a healthcare provider to get the consent and will of the patient or their dependents before administering any form of treatment. In this case, the care-giver should explain to the patient or their dependents on why restraints are necessary and work out on a restraint method that is acceptable to all parties.
Beneficence and non-maleficence – these two principles basically state that healthcare providers are required to apply a treatment regime that will not only benefit the patient but also one that does not result in physical and emotional pain, harm, suffering or eventual death to the patient. This therefore requires the healthcare provider to apply a restraint method that balances providing safety to the patient, care-giver and property and having the least negative effects on the patient.
Conclusion.
Restraints have been used on patients exhibiting challenging for a long time. Their use is guided by legal and ethical principles which protect the rights of the patient and sets the grounds on which restraints can be used. The type of restraint mechanism used should be dependent on the type of aggression been exhibited by the patient and should be used proportionally.
Restraints should provide only a temporary measure for patient and alternative, long-term measures should be sought in order to ensure that the patient’s trigger points are minimized. These include providing personalized care of patients, training healthcare givers on detection and prevention of trigger points and engaging the patient in the care routine as much as possible. A combination of these factors will result in a reduction and eventual withdrawal of restraints as a control measure on patients with challenging behavior.
References
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