A significant percentage of the population

Running head:NURSING
Use of Sedative medications in Mental Health Settings
Name of the Student
Name of the University
Author Note

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Introduction
In psychiatric settings, sometimes it is essential to control the patient’s activities in
order to prevent any sort of harm to the patient himself or the people around them. The
procedures that are used are usually seclusion, restraint, and sedative medications. Sedatives,
also referred to as chemical restraints, has been used to safely deescalate the patients for a
long time (Muir‐Cochrane et al., 2019). However, this has been under controversy since it has
been described to be a very coercive way to treat the patients (Muir-Cochrane & Gerace,
2017). The potential and harms and side effects have been investigated many times, and
strongly opposed against frequently. However, some do think this to be a necessity in order to
maintain a safe environment in the psychiatric ward. The objective of this essay is to focus on
the ethical and moral aspects of using sedatives in mental healthcare settings by conducting a
critical analysis of the available literature on the topic. This highlights the issues with this
form of chemical restraint in mental healthcare settings and also provide an insight as to why
this may be required.
Discussion
Issues with Psychotropic Medication as Chemical Restraint
As mentioned before, the use of sedation on people with a mental health condition has
been opposed to for a long time. A significant percentage of the population believes it to be
ethically wrong. Much of the research done in recent times back this up. This is due to
accounts of ill-effects of sedation on the patients. In history, it has been accounted that
sedative medications were used to correct cognitive behaviour in patients, which sometimes
did not end very well. There has been more than one case study relating to the adverse effects
of the use of sedatives (Holmes & Jacob, 2016). Thankfully, the medication administration in
current times is much more cautious, and the side effects are monitored more carefully than

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before. So while the adverse effects are much less than before, they continue to pose a
problem both physically for the patients and from a moral standpoint.
This process is known as conscious sedation, where an agitated patient is often
administered sedatives, orally, or more commonly intravenously to deescalate the patient,
resulting in a calmer state. However, this calmer state entails that the patient becomes
dissociated with the surroundings and thus becomes ‘indifferent.’ This can be considered
manipulative and thus coercive in nature. This still remains a part of the routine in most
psychiatric facilities. The medications that are commonly used in such cases are
benzodiazepines or some sort of antipsychotics. It has been seen that benzodiazepines have
clear adverse effects (Korczak, Kirby & Gunja, 2016). In fact, most medications that are used
as chemical restraints have certain side effects. Commonly used medications are olanzapine
and clonazepam (Hu et al., 2019). This may include long-lasting psychological effects,
cardiac arrest as well as respiratory depression. It has also been seen that patients who have
been administered benzodiazepines have a higher intubation rate than those who were
administered other medications such as ketamine (Parsch et al., 2017). These side effects also
include physical effects such as oral infections. The patients were reported to have
Xerostomia and other dental infections. Increased salivation is also a side effect that has been
noticed in patients who were administered psychotropic medications (Cockburn et al., 2017).
These sort of side effects are usually noticed in the older sedative medications rather than the
newer alternatives. Some medications may also cause the patient to have withdrawal
symptoms like that experienced in substance abuse patients. Cognitive dysfunction has also
been reported in patients who have undergone chemical restraint. Hence, in the case of
patients who already suffer from cognitive impairment, this sort of coercive and restraining
measures pose a significant risk of causing damage. Sometimes, sedatives can cause memory
impairment, as well.

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The major argument in regards to chemical restraint is that it is a form of coercion that
is non-consenting and inhumane in some aspects. Like any other human, the patients
suffering from mental illness have basic rights like consenting to the medication to be used
on them (Rose et al., 2017). On a similar context, it is also under debate whether any sort of
nursing intervention should be administered to a non-consenting patient at all. Relating to this
topic, it is still a dilemma if any sort of compulsion should be used on the patient at all. Many
consider the use of chemical restraint to be degrading and a violation of human rights. It may
also be possible that some nursing professionals may use force on the patients and abuse
them in the healthcare facilities (McSherry, 2017). Abuse of sedative medications has also
been reported in many healthcare facilities throughout the last three decades (Simmons et al.,
2018).
Physically, sedatives can be very harmful. This includes respiratory depression as
well as other issues like cardiac arrhythmia. The side effects of the psychotropic drugs may
be due to long-term administration in chronic mental issues such as dementia. Tranquilization
poses serious risks. To reduce the risks to the patients, it is legally required to assess the
patients and make sure that the medications do not have a significant negative impact on the
physical aspects of the patients. This includes possible comorbidities that may be
contradictions to the medications being used. In a study conducted, around 95.5% of
healthcare professionals said that sedatives should only be used after the thorough physical
assessment of the patient. However, in most cases, such physical assessments are not possible
before the administration of the medication. The vital signs during the administration of the
medications are of utmost importance. Most nurses lacked knowledge regarding the effects of
sedative medication in the patients as well (Cunha et al., 2016). The aim of chemical restraint
is to safely sedate a patient in a psychiatric setting. The dose of the medication depends on
the height, weight, body function, and medical history (MacDonald & Albulushi, 2017).

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However, as pointed out before, there is often no prior assessment before the medications are
used, and often, it is not practical either.
Another aspect of this issue is the mental trauma to the family and the caregivers.
Some family members or closed ones may feel uncomfortable with the patient being forced
like this. It is particularly discouraged in the presence of parents when the patient is a child.
There have been reports of the closed ones feeling uncomfortable when chemical restraints
were being used on the patient. The family is more likely to allow the use of chemical
restraints when they are assured that the use of medication is being done for the betterment of
the patient, and not those around them (Edwards et al., 2017). However, in a study conducted,
the family and caregivers reported to understand the need for using coercion methods and
acknowledged the need for using them in acute psychiatric settings (Gowda et al., 2019)
Finally, the aspect of the perceived coercion by the patient may leave them disturbed
and traumatized. Many patients feel aggression, fear, anger, and apathy (Gunawardena &
Smithard, 2019).
Overall, throughout the literature, there have been clear discrepancies which suggest a
lack of understanding regarding the use of chemical restraint, their psychological effects, and
preserving the dignity of the patient while administering sedatives (Muir‐Cochrane, Oster &
Grimmer, 2019).
Challenges faced by RNs regarding Chemical Restraints
Apart from the ongoing controversy regarding the use of sedatives in psychiatric
settings, there are many conflicting opinions regarding the role of the nurses. This procedure,
however, still is largely in use. The nurses and the physicians also agree with the immoral and
degrading factor in the use of sedative medication; however, they also feel that this method
cannot be completely eliminated. The nurses highlight the situations they face with

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psychiatric patients and the challenges with it, including conditions that force them to use
sedatives.
According to the Mental Health Act 2013, the use of restraint is only considered when
there is a significant risk to the patient themselves or the surroundings (Dhhs.tas.gov.au.,
2020) and the healthcare professionals agree with it. The use of sedatives is not the first
course of action by the nurses, and they do not inject patients at the first sign of agitation.
They strictly try less restrictive methods to deescalate the patients and all possible
interventions, such as trying to talk to the patient and calming them down. The sedatives are
only used when the patients threaten either themselves or the people surrounding them. In
such cases, the use of restrictive medications poses less threat to patients than if they are not
given. The nurses usually offer medications by mouth first, but if they are unable to make the
patient take the medication, they use the intravenous injection as a last resort. The majority of
the nurses report never using sedatives unless they are forced to do so. They are usually
administered when the patient is experiencing a sort of manic episode and may be dangerous
to themselves or others. The patients are sedated to ensure that they do not cause any harm,
and the nurses can take care of them. In a study conducted, the psychiatrists felt that this is a
necessary measure in acute care settings. However, they did also acknowledge the potential
side effects of the method (Gowda et al., 2019).
While the nurses do use these methods on patients as a last resort, they also
acknowledge the fact that there is simply no ethical way to sedate a patient once all the non-
restrictive methods have been exhausted. Physical restraint and seclusion are the only viable
options that may be considered as alternatives to sedatives. Most nurses agree that the use of
psychotropic medicines is simply more ethical than restraining the patient physically.
Sedative medications also tend to pose less harm than that of a physical restraint (Chieze et

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al., 2019) and usually have lower cognitive side effects than that of physical restraints or
seclusion.
Another challenge the nurses often face is the fear of being misunderstood. Many
healthcare professionals reported feeling fear that they might be portrayed in the wrong way
for using chemical restraints on the patient. They fear getting blamed by the family and
getting antagonised by them for it. On the other hand, they understand the need for sedative
use and thus fear the results of not using such methods on the patients (Muir‐Cochrane,
O’Kane & Oster, 2018). Since they are aware of the consequences, they do administer the
medication but feel apprehensive while doing it.
Sometimes, when the patient has to be moved from one centre to another centre, or
moved from home to a medical setting, the use of sedatives may be essential in some cases
(Nambiar et al., 2019). This is because it is hard to control patients during transport. So it is
possible that the nurses may administer sedatives to patients who suffer from manic
disorders. While this is coercive and ethically questionable, it is really the only way to ensure
the safety of the patients as well as the people around them.
Conclusion
From this essay, we can conclude that the use of psychotropic medications in
psychiatric settings, while maybe necessary, is highly controversial and under a lot of debate.
The use of chemical restraint is by no means safe and may cause significant damage to the
patient both psychologically and physically. The issues regarding the use of sedatives relate
to the aspects of morality and ethics, and a high percentage of the population feels like it is
degrading and inhumane in nature. The issues also include the fact that it cannot be assessed
if it is safe to administer the medication to the patient or not. The use of such restrictive
methods may also be the cause of significant discomfort to the family and caregivers of the

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patient. So, there has been significant arguments for the elimination of this practice.
However, nurses acknowledge the risks of not using such methods. There are simply no
alternatives to using chemical restraints, other than physical restraints or seclusion, which are
considered to be even more inhumane. So it can be understood that while chemical restraints
are coercive, they may be a necessary evil in acute psychiatric settings.

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