Ethical Issues in Health and Social Care: Restraint Practices in Mental Health Patient Care

This report explores the ethical and moral principles in context to the ethical dilemma of restraint practices in mental health patient care. It discusses the key issues of ethics such as confidentiality, fairness, and more. The report evaluates the importance and regulations of restraints and ethical social care principles. It concludes that ethical issues in health and social care are a huge problem, which creates ethical dilemmas for healthcare professionals to make the right choice of care and patient control practices in mental health care provision.

Ethical Issues in Health and
Social

Table of Contents
INTRODUCTION ..........................................................................................................................1
MAIN BODY ..................................................................................................................................1
CONCLUSION................................................................................................................................6
REFERENCES ..............................................................................................................................7

INTRODUCTION
Ethics is the sets of moral principles which pay important role in the individuals
behaviour and decision making. The situation at which this become difficult to make choice
between two moral principle for single factor or solution, is consider as moral dilemma. Control
and management of Individuals with a Mental Health Issue or Disability is the main area of
ethical consideration. Because in mental health care there are the different situation at which
health care professionals have to make right choice of restraint. There are the three types of
restraint use in the mental health patient care and control, such as physical. Chemical and
environment restraint (Brenner, and et. al., 2021). Restraint is the important practice in metal
health care but in context to the nurses it create various ethical issues and dilemma, because this
effects their ethical values along with human rights and dignity, This can also causes harm to the
service users ( (Reid, 2017)). In this report ethical and moral principles in context to the ethical
dilemma of selected topic, in health and social care environment is explored. There is also the
discussion of key issues of ethics such as confidentiality, fairness etc.
MAIN BODY
Restraint in the mental health care organisation and system use at the situation of patient
abnormal behaviour , when they can harm themselves or others. There are the three different
method's of restraint, such as physical, chemical and environmental. Physical restraint is done
by the aid of body movement preventing tools such as prescribed devices for restricting patient at
bad and char. This is done to control the body movement of aggressive patient for preventing self
and others harm. Ethical issues of physical restrain is difficulty is the management non-
maleficence principles (Chaudhuri, and Basu, 2018). According to the human right health care
organisation have to follow the Article 3, 8 and 14, but at the situation of mental health care
procedure some time this become difficult meet all theses principles. These principles create the
ethical dilemma of chasing right decision for patient control at abnormal condition. The five
principles of social justice is equity, participation, diversity and human right, at the process of
restraint social justice issues arise related to the participation and human right principles.
Because this become impossible to make participation of patient at care procedure when they are
behaving abnormally and crating the chances of harm (). Chemical Restraint use in some
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situation for restricting the movement of patient through drugs such as antipsychotics. In
context to the mentally ill patient safety from self harm environment restraint use. This involves
the limiting the resident to specific environment by assuring the removal of risk factors, such as
sharps, glass etc. patient restricted at the room and not allow to come outside. Both of these
restraint method's are also associated with the ethical and social injustice because there is not any
participation of patient and it create the issues of nursing code of conduct. Because some
restraint drugs can harm the patient, and according to the nursing code of conduct, human right
and social justice principles that is important to make participation of patient, not cause any
harm. Restraint is posing the possibility's of bad impact on patient health and social care
practices, because this causes the helplessness, tension anger, fear and trauma. In the health care
practices this can cause complications like dehydration, urinary incontinence and injuries.
Along with the patient, staff member's also face distress and ethical issues. In social care
restraint is posing came impact of physical and mental health issues, but in other hand that is
helpful for providing best care to the patient and treatment according to their mental health
condition. The major impact of this practice is one staff ethical values and empathy due to which
they face huge issues, while providing care to the patient (Scheepmans, and et. al., 2017).
Mental Capacity Act 2005 illustrating the rules and regulation regarding the patient decision
making support when they not able to make their own decision. According to this act Adult
mental health patient have to be supported for making their own decision regarding health care
practices. But is the person is harmful for others and themselves them they can resist (Duffy, and
Kelly, 2019).
From the above discussion it has been critically evaluated that restraint is use to manage
the abnormal behaviour of mental health patient, in order to provide the care which they don't
want to take but necessary for them. There are the different type restraint with several ethical
issues and social injustice issues but this become important at the situation when patient
behaviour force to use Restraint for their and other safety, and this practice supported by the
Mental Capacity Act.
Ethical and moral dilemma develop due to the classing of health professionals personal
and moral principles. Ethical dilemma is the problem in the decision making process between
the two principles and options related to the one situation. The major issues in ethics and moral
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decision making is lack of the possibility's to cover or justify all ethical norms related in context
to the specific problem solution, and in this way it create ethical dilemma. There are some
approaches to solve the ethical dilemma such as Refute paradox, value theory approach and
finding of the alternative solutions.
In context to the mental health patient Restraint practices there are the various clashing
with personal and moral ethics which crate the ethical dilemma (Yusuf, and et. al., 2019). The
side effects of physical and chemical restraints is the factor which prevents the meeting of non-
maleficence principles of health care and create the ethical dilemma of balancing therapeutic
goals and side effects. The bodily restraints causing injury and mental issue to patient such as
nerve system damage, functional disability, nerve damage and its mental health impact is fear,
anger and loss of dignity. In this way physical restraint impact staff and causes patient distress,
decrease social function and it opposed to the ethical principles of beneficence and that's why
the ethical dilemma is how to balance beneficence and non-maleficence. Principle of
beneficence is involving the measures of patient benefits and providing the safe and effective
care is important part of the nursing. But at the situation when patient mental health condition is
dangerous for themselves and other patients, then one of the beneficence interventions for every
one will be the physical restraints. But this can cause the physical and mental health to the
restricted patient, which again do not meet the beneficence principles and in this way, create
ethical dilemma. principles of justice illustrate the regulations according to which patient should
addressed as the Human rather then any levelled insane. On the basis of this fundamental rights
of the patient with mental illness should not be compromised. But at the situation of aggressive
patient behaviour that become essential to implement physical restraints, and that not meet the
principle of understanding patient as human. So that way physical restraints consider as
injustice, hence it create ethical dilemma. In order to manage all these ethical dilemma health
care professionals can balance the beneficence and non-maleficence by using the Mental
Capacity Act 2005 and Mental health commission of Ireland, according to which health care
professionals can implement restraints at abnormal and aggressive behaviour of patient. By
assuring the professionals for restraints, with all safety measures, provide best familiar and
trained nurses , follow all the guidelines of the physical restraints. Through accomplishment of
comprehensive assessments and minimizing of restraints side effects.
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From the above discussion of the restraints ethical dilemma it has been evaluated that,
this is not possible to meet all ethical and moral principles but this can be legal or justifiable with
the application of guidelines and prevention of side effects.
Utilitarianism ethics this is the ethical theory according to which ethical choice is can be
achieved by assuring the effective and good outcomes for greatest number of the members. This
theory is supporting the restraints in mental health care practices because, that is use to prevent
the harm of abnormal patient and other in the health care unit. This causes the side effect to
restricted patient but save from harming themselves and others (Bevan, and Penuel, 2017).
Deontological ethics (duty based) this is the ethical theory and according to this action should be
based on clear sets of the rules and duty, it can be good or bad. So the restraints practices should
be ethical by following the rules and regulation of mental health Act. Ethical equity is the
implementation of equitable policy's , legislation, practices and procedure in order to manage
equality in the resources and care services allocation to all patients. In context to the polarized
health care system of mental health care, the equity issues are related to the equality Act
regulations, which has to be followed in health care practices. But due to the abnormal and
vulnerable behaviour patient care procedure have to be different from other, with the application
of restraints. Another then that health care professional are following equity all other treatments
and medication, according to the patient condition. Professional issues related to the restraints is
develop due to complexity of managing both health care professional code of conducts and
ethics. Such as according to the section 33 of Mental Health Act 2001 the use of physical
restraints is approved which should be use with the regular reviews. But opposite to that the
health care such as nurses personal ethics, empathy and kindness prevent them to make decision.
This complication impact the nursing staff and causes distress, anxiety. On the basis of principles
of underpinning the use of physical restraints, this method should be use In rare situation and
circumstance, before this alternative intervention should be use, serious harm should be
prevented, this should be based on ethical and legal framework. The equity should be managed in
the physical restraints settings along with the assurance of service users, staff and visitors safety.
There should be proper risk assessment before restraints (Mackinnon, 2021). Health care
professionals face issues to meet all code of conduct due to their ethical and moral values, such
as they face problem in restraints of patient and cannot see their pain. But that is important to
have patients and follow all code of conduct. Justice is involving the ethical principles of treating
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patient as human and be kind with them but at the situation of professional needs for the
restraints due to self harming behaviour of the patient. But in other hand by securing the patient
from self harm and providing the equal care professionals are meeting the principle of justice.
Autonomy this is involving the principles of individuals own decision making, which should be
supported by the health care professionals. But in context to the abnormal behaviour of the
mental health patient this become ethical issue, because that is not possible to make patient
participation. Non- maleficence is the ethical principle of the health care according to which
health care professionals should prevent the harm of patient. But this principle can not be met at
the stage of patient in abnormal behaviour, when they got treated with the restraints. Although
professional try their best to prevent side effects but there is the possibility of some side effects,
such as distress and injury. Beneficence is the fundamental ethics, according to which healthcare
professionals have to be kind with patient and professional do that with they best efforts, but in
the case of physical restraints kindness is not follow effectively. Because doctors can not let
them go and harm themselves (Andersen, and et. al., 2017).
From the above consideration of ethical principles it has been evaluated that, restraints is
in some principles is relevant for the patient and other safety. But most of the ethical principles
create personal and professional ethical dilemma. Which can be effectively manage with legal
guidelines and frameworks.
From the above study of the importance and regulations of restraints and ethical, social
care principles, it has been evaluated that I should use and follow all the ethical and legal
standards of mental health patient care as much as possible. I have developed my moral values
regarding patient care with fairness and empathy. Fairness is can be my morals to manage all
mental health patient and in context to the restraints I will be fair, with the application of all
possible measures and guidelines. Along with this I will make sure that Confidentiality of the
patient should be managed at every are and stage of care. Kindness is important in mental health
care which I sill use to provide the emotional support but at the situation of patient abnormal
behaviour I will follow the Mental health Act guidelines and balance between beneficence and
non-maleficence (Holm, and Mors, 2021). Competence will be my main skills or moral in
order to achieve success in the effective patient care. Proper understanding of the individual
needs in health and social care practices will be effectively managed. Integrity will be my best
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moral tool to provide effective care to the patient, by following the principles of professionalism
and honesty. Privacy is the important part of the health care related to the principle of dignity,
use to respect patient privacy. In the mental health care practices I will make sure that patient are
gating their personal space. Fidelity will use be the best moral and ethical tool which will use for
the faithfulness and continuous demonstration of the healthcare practices in order to assure the
application of best care practices for mental health patient. Such as in context to the patient
restraints, development of the effective safety measures and guidelines will accomplish (Rainer,
2018).
CONCLUSION
From the above study it has been concluded that ethical issues in health and social care
huge problem, which create the ethical dilemma for health care professionals to make right
choice of care and patient control practices in mental health care provision. Restrain is one of
the major factor or practice which is use to manage mental health patient at the situation of
abnormal behaviour. But due to the multiple range of personal and professional ethical principles
and approaches health care professional face huge ethical issues and ethical dilemma. Such as
ethical dilemma of balancing between beneficence and non-maleficence, meeting of justice and
medical code of conduct. Personal moral values of the nursing staff prevent them to make this
practice, because this can cause injury and mental harm to the patient. Mental Capacity Act
2005 is the legal regulation which influence the application of restraints with proper assessment,
pre application of alternative intervention and well trained staff along with safe setting.
Utilitarianism ethics and deontological ethics are ethical approaches which support the
restraints, because this safe the patient and others in mental health care setting. Privacy ,
competence, fidelity, confidentiality are some personal moral and ethical principles which has to
be followed by the health care professional for effective and ethical care of the patient.
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REFERENCES
Books and Journals
Brenner, J.M., and et. al., 2021. Ethical issues in the access to emergency care for undocumented
immigrants. Journal of the American College of Emergency Physicians Open, 2(3),
p.e12461.
Reid, L., 2017, November. Ethical issues in health philanthropy. In Healthcare management
forum (Vol. 30, No. 6, pp. 298-301). Sage CA: Los Angeles, CA: SAGE Publications.
Chaudhuri, S. and Basu, A., 2018. Ethical issues in sharing patients' information on social
media. Indian journal of public health, 62(4), pp.319-320.
Scheepmans, K., and et. al., 2017. Restraint use in older adults receiving home care. Journal of
the American Geriatrics Society, 65(8), pp.1769-1776.
Duffy, R.M. and Kelly, B.D., 2019. India's Mental Healthcare Act, 2017: content, context,
controversy. International Journal of Law and Psychiatry, 62, pp.169-178.
Yusuf, A., and et. al., 2019. Assessment of the Kempe Family Stress Inventory in self-care post-
restrain schizophrenia. International Journal of Public Health Science (IJPHS), 8(2),
pp.55-59.
Bevan, B. and Penuel, W.R., 2017. Connecting research and practice for educational
improvement: Ethical and equitable approaches. Routledge.
McClure, J.S., 2021. Ethical Approaches to Preaching: Choosing the Best Way to Preach About
Difficult Issues. Wipf and Stock Publishers.
Mackinnon, K., 2021. Ethical Approaches to Youth Data in Historical Web Archives (Dispatch).
Studies in Social Justice, 15(3), pp.442-449.
Andersen, C., and et. al., 2017. Applying sensory modulation to mental health inpatient care to
reduce seclusion and restraint: a case control study. Nordic journal of psychiatry, 71(7),
pp.525-528.
Holm, T. and Mors, O., 2021. Psychological adjustment following mechanical restraint in
individuals with schizophrenia. Nordic Journal of Psychiatry, pp.1-10.
Rainer, J., Schneider, J.K. and Lorenz, R.A., 2018. Ethical dilemmas in nursing: An integrative
review. Journal of Clinical Nursing, 27(19-20), pp.3446-3461.
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