Ethical Issues in Nursing: A Case Study of Restraints on a Dementia Patient

1Running head: NURSING
Nursing
Name of student:
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Brief overview
The paper discuses about Arthur and Nancy, who had been happily married for 45
years before Nancy developed Alzheimer disease. Nancy has got habits of wandering and is
doubly incontinent and has got the habit of daubing faeces on the wall. Nancy had to be tied
in to the bed as Arthur had to go out for doing shopping or banking or to spend an hour with
the friends at the bowling club. Unfortunately Nancy cannot be taken to the Bowling club due
to her inappropriate health condition and if she is left alone in the house, she is incontinent
and makes a terrible mess throughout the house. Thus, Arthur often ties Nancy to the toilet to
prevent the wandering and incontinence. This essay will discuss about the different ethical
issue that has been withheld in this case study. The ethical principles that are relevant to the
case, the ethical principle related to this case and rationale behind choosing the following
ethical issue. Furthermore, the paper had also provided information about the nursing
standards of practice, relevant to this case, the rationale behind choosing the principals.
Furthermore, the essay would also provide information about the recommendations that are
required in part of a registered nurse.
Ethical issues
Ethical can be defined as sets of values or morals that contribute to the betterment of
one’s life. The main components of ethics that should be present in a human being are-
honesty, trustworthiness, respect , responsibility and being a person of integrity (Nursing and
Midwifery Board of Australia., 2018). Is the morality and the ethical beliefs of a person that
guides whether one person treats there other person with integrity and dignity. Some of the
ethical underpinnings that a person should follow while providing care to someone are
beneficence, truthfulness and confidentiality, autonomy, informed consent, beneficence, non-
maleficence and justice.

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The ethical issue that can be found in this case is that Arthur put restraints on Nancy
due to her habit of wandering around and incontinence. Nancy is also not appropriate for
being accompanied in a bowling club. Furthermore, Arthur also needs few hours of sleep and
the freeing Nancy might disturb his sleep. Use of restraints on a dementia patient can be an
ethical dilemma.
Looking at the case scenario, one can definitely understand the commitment that
Arthur has made to his wife, with whom he had spent almost the whole of his lifetime.
Despite of the incontinent problem of Nancy, Arthur never thought to transfer Nancy into any
sort of rehabilitation centres Nancy never wanted to visit a nursing home and wants to stay
with her husband. In spite of all these it can be seen that Nancy had to be tied on her bed or
had to be tied in a toilet sometimes under some circumstances. Whatever, might be the
reason, providing restraints to person displays direct breach of the autonomy of person, which
is one of the ethical parameters while upholding the interest of a human being. Hence the
chosen ethical principle relevant to this case is “autonomy”. Autonomy refers to the right of
every individual’s right of self-determination, independence and freedom to make their own
choices. In the concept of health care, the concept of autonomy is mainly concerned with the
ethical obligation of a practitioners to provide respect to the rights of their clients for making
decisions about their own health. Again as per the Universal declaration of the human rights,
everyone has got the right to experience freedom and autonomy. In this context, restraining
Nancy has led to the breaching of the autonomy of the patient. Hence, the ethical principle of
autonomy is appropriate in this case.
Various criticisms are prevalent retarding the principle of respect for the autonomy.
The idea that patient should be given with the choices for making voluntary choices about the

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health care interventions, discouraging the so called paternalistic attitude of the conventional
nurses and the other health care professionals has turned to be good for some of the patients
(Parahoo, 2014). The concept that patients should be allowed to make informed decisions and
also encouraged attention to the patients’ understanding about the different health care
interventions and assist the development of the autonomy enhancing patient decision aids.
Now, the ethical dilemma that can be used in this context is that Nancy suffers from a
degenerative disease and leaving her free might bring about harm for Nancy itself.
Furthermore, it has to be noted that Arthur has also turned old and must be suffering from
some frailty due to his old age and hence it can be difficult for Arthur to look after Nancy
every now and then. He also needs some amount of peaceful sleep at night and letting Nancy
free at night can cause sleep disturbances that can become the precursors of several diseases
at old age. Human rights are common on to all the people irrespective of the age, race of
religion and are divided in to rights to live, safety, freedom, equality and dignity (Gastmans,
2013). From an ethical perspective it is important to protect certain rights of the human
beings. Due to this reason ethical dilemmas are common in managing patient with
neurodegenerative disorders (Yamamoto, Mizuno & Aota, 2012). It is the duty of the person
taking care of the patient to address the physiological and the psychological needs of the
patients, hence putting restraints on a patient with dementia might affect the psychological
wellbeing of Nancy, on the other hand putting restraints on Nancy might serve to be
beneficial for Nancy itself as that would probably help to prevent harm due to falls and
injury.
Ethical issues from the perspective of the registered nurse
Restraints in dementia like conditions are common in clinical practice. Although that
can inflict harm and largely contradicts the rights of freedom, respect and autonomy of the