RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES.

Running head: RESTRAINT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
Restraint of individuals with a mental health issues
Name of the Student:
Name of the University:
Author Note:

1RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
There are two aspects in ethical issues, which is either right or wrong. The ethical
dilemma is a situation that occurs when a person is encountered with single or numerous
options however, the outcome is uncertain in nature because it is either ethical or lacks it. On
a regular basis, patients, their family members and even healthcare staffs encounter ethical or
legal issues and it requires immediate attention. Patient privacy and confidentially, the
transmission of disease, end of life issues are an example of the ethical issues related to the
health care system (Kalula and Petros 2016). The usage of physical restraint is found to be
common in clinical practice especially in case of mental healthcare as well as in intensive
care units. However, it can be noted that the form of physical constraints is different in
different scenario. In case of the mental healthcare setting, medical nurses or other staffs are
found to adopt physical constraint on the patient in case, they exhibit any kind of life-
threatening, violent or unmanageable action or behaviour. Sometimes this physical restraint
causes various unexpected effects, which is very much unethical. The aim of the essay is to
discuss an ethical or moral dilemma related to physical constraint with a mental health issue
or disability.
Individual right to health and health care is one of the rights in the International
human rights standards (Who.int, 2020). Therefore, the right is stated to be inseparable from
other kinds of rights. According to the provision of this right, every individual can appreciate
the most achievable level of health in the case of health protection. It can be stated that lack
of consideration to human rights could have serious implication in the healthcare setting. In
recent time, mental health is given untimely and inappropriate attention in public health.
Violence and social abuse that contributes to inappropriate mental health outcomes for
general people with a mental disorder or disability (Jiang, Gu and He 2015). Human-right
based approach to the health system offers a set of proposition for estimating the health
policy and service delivery, focusing on discriminatory practices. It is important to execute

2RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
the health programs, policies and strategies in an explicit manner thus, improving and
development of the patient’s health and well-being. In the last two centuries or even more,
the application of restraint in the healthcare sector was assessed that gave rise to ethical and
clinical controversies that focused the misuse of the aspect in several cases. According to
Hughes and Lane (2016), physical restraint can be stated as an intimidating action or measure
that are being employed by the staff as the last in any situation for addressing the issue and
ensuring the safety of both patients and healthcare professionals. This can be done by
adopting a basic framework that allows in addressing the issue associated with it. According
to the recent report, the incidence of physical restraint is found to be rising at a fast rate. The
high rate of this phenomena has been responsible for causing various serious implications
resulting in the rise of ethical and legal issues. As per Ye et al. (2018), western media have
been found to blame the government and other related authorities for negotiating the rights of
psychiatric patients. There are good and bad impacts of physical restraint in the healthcare
setting. In a few cases, some patients being physically abused for giving back memories of
previous trauma and thus, re-traumatised to a serious extent (Whitton, Treadway and
Pizzagalli 2015). On the contrary to this, it is an anti-recovery approach that helps in treating
patients that are disobedient or unmanageable in nature. From the perspective of the staffs, by
administering the strict behaviour, it supports in offering strict handling of the situation and
do not allow to become emotionally attached to the patient. As per the opinion of Hofmann
and Hahn (2014), dehumanisation is defined as a condition of an individual following
restraint, which created a feeling of being a lower being due to it. There is evidence that
states that nurses are being penalised because of applying power over the patient, resulting in
feelings such as helplessness, powerlessness and abused causing low self-esteem. According
to Gunn, Taylor and Hutcheon (2014), being restraint can be stated to be a feeling of distress
at the time of the incident as well as after that. There is certain evidence stating that physical

3RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
restraint is necessary for the creation of a healthy environment. Nurses might use chuckling,
creating words to the reduction of stress during physical restraint without any emotional
response. In certain cases, nurse is found to be afraid of patients thus, it involve administrate
of such harsh action (Möhler and Meyer 2014). Sometimes the patient thinks that nurse
ignores their distress prior to physical restraint. Physical restraint is used for mentally ill
people. Physical restraint has both good and bad impacts on the patient and nurse. A patient is
suffering from mental illness and he is treated by physical restraint due to her disturbing
behaviour. This patient is 50 years old and she is suffering from schizophrenia, which is a
psychotic disorder. Schizophrenia can change how a person thinks, feel and act. The types of
hallucinations in schizophrenia include auditory, visual, olfactory, gustatory and tactile.
Confused thoughts and disorganized speech also observed in a schizophrenic patient.
Every psychiatric practitioner has to face an ethical dilemma in her/his daily
professional work (Yönt et al. 2014). The moral issue arises in the case of treatment and care
of a person afflicted with some mental issues, and it rises because the patient’s view of and
choice regarding his/her condition and the view and opinion of the professional differ and are
contrasting. The conflict starts from the difference of opinion between the service user and
experiencer of suffering on the one hand and the clinician as knowledge-power holder
(Smethurst 2016). Mental illness often leads to autonomy, including forced treatment, and
disregard of legal capacity to make their own decisions. An ethical dilemma arises from
many reasons such as confidentiality, moral beliefs, self-determination, obligations and dual
relationship (Gunn, Taylor and Hutcheon 2014). Real case ethics can help to identify,
understand and resolve the ethical issues related to physical restraint. Real cases are very
helpful in resolving ethical problems. A nurse can get help through studying the real cases
that elaborated the ethical dilemmas and easily recognize their problem. The understanding of
the consequences of various cases is very important for resolving the ethical matter.

4RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
Autonomy can be defined as the capability of an individual to make an appropriate and aware
decision as per the value, belief and moral obligation within the nursing practices. This can
be done by attaining informed consent which is a basic procedure of showing respect to the
autonomy of the patient (Oshana 2016). The usage of physical constraint can be found to
violate the principle of autonomy as it negatively affects the freedom of patient and family
member. Moreover, the use of such actions limits the intervention of the authority as it is
always done without the authorisation of patients making it an unlawful act. With respect to
equity, patients ought to be tended to as human instead of being marked insane under any
conditions (Bromley 2015). The major privileges of patients with dysfunctional behaviour
ought not to be denied. In addition, the mental patients are not in such an extraordinary
condition constantly; in this way, they are legitimate to carry on as ordinary individuals. In
particular, aimlessly actualizing physical restraint toward forceful patients brings about the
inability to comprehend the patient in a basic human relationship. Beneficence is defined as
the adoption of a certain measure that will ultimately help the patient (Kelher 2014). In the
case of physical restraint in beneficence can be stated as a protective action that has been
designed in order to promote the well-being of patients from any kind of physical damage. By
considering this principle, the use of physical restraint can be stated to a measure to limit the
movement of patients in controlling of emergency. The principle of non-maleficence can be
referred to as no harm, which involves care providers to balance therapeutic goals and side
effects of the actions (Price and Walker 2018). Individual right to health and health care is
one of the sets of international human rights standards. This is inseparable from other rights.
According to Sasso et al. (2016), the core competencies of the right to health can be realised
as progressive in nature that can be attained by maximising the use of resources and
techniques. The concept of progressive realisation is stated to need government intervention
that will promote the well-being of patients by fulfilling the basic requirement of healthcare

5RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
among the population. The basic element of the right to health includes proper availability of
the resources, acceptability, quality and accessibility.
Ethical issues can be effectively resolved by applying a clear framework and
assessing the situation before making any decision (Slade 2017). The use of theories is taken
into account that allows in addressing the issue faced by the patient either suffering from
mental illness or is disabled. The Kantian theory is stated to be an ethical obligation that
differentiates right and wrong. Therefore, it states that there is an absolute duty that is
accountable for the action undertaken by the individual. As discussed in the above case, the
staffs are accountable for causing physical abuse upon the patient (Simpson et al. 2014). The
focus of the theory is directed toward doing good and not harming people that practiced by
accessing information and respecting the freedom of patients (Price and Walker 2018). In this
case, the mental status of people is not stable in nature thus, consent from the family member
is critical in nature. The standards, policies and ethical laws need to be undertaken while
delivering care by the nurses and physicians. Another ethical approach that needs to be
addressed in order to mitigate the issue of physical restraint on the patient suffering from
schizophrenia is the virtue approach that assumes that there are certain cases that individual
need to strive for the development of humanity. The ideals are found to be developed from
the thoughtful approach in reflecting upon the situation as well as considering various kinds
of people that are potentially involved in the case. Millan et al. (2014) opined that virtues are
considered to be characters or attitudes that help in acting in a definite manner that allow in
development of the highest potentiality. This allows in pursuing the ideals that are adopted
(Eren, 2014). The characters that are being used as virtue include courage, generosity,
honesty, self-control, compassion, fidelity, prudence and fairness. The nurses need to make
the virtue as their habits that are slowly being acquired by the healthcare professionals. The

6RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
person that has developed the virtue on a natural process have the ability to dispose of in a
consistent manner with the integration of moral principles (Fusar-Poli et al. 2014).
As a nurse, I can help that patient by providing proper care. This specific patient is
suffering from major anxiety and anger problem. Anger is a big problem with schizophrenia.
Anxiety, apathy, feeling detached from self, general discontent, loss of interest or pleasure in
activities, elevated mood, or inappropriate emotional response, all are the symptoms of the
schizophrenia. Sometimes physical restraint would be used for schizophrenia patient. That
specific middle-aged female patient has faced some anger and anxiety issues. Anger problem
has increased extremely. And she cannot control the temper. So, other care professionals and
I are decided to use physical restraint. Motion disorders also present in schizophrenia. Some
patient with schizophrenia can seem jumpy. Sometimes the patient will make the same
movements repeatedly. However, sometimes they might be perfectly still for hours, which
experts call being catatonic. Contrary to popular belief, people with the disease usually are
not violent. Flattening, the person with schizophrenia might seem like they have a terrible
case of the blahs. Voice sound of a patient would be flat. They may not smile normally or
show usual facial emotions in response to conversations or things happening around them.
Physical restraint is a little bit of pain for her. Ethical issues related to physical restraint also
arises with it. Regarding all these ethical issues and dilemmas, physical restraint has applied
to the female patient for her betterment. Through this step, we think we can help the patient
and treat her well. After using physical restraint, the patient is started to come down. Now we
can be counselling her with patience. Patient’s family also get relief from her angry
behaviour. On the base of obligation, a nurse needs to take care of the patient irrespective of
any condition in order to promote high health status. According to Cusack et al. (2018), it is
important to understand that there is a safety aspect that allows in ensuring effective nursing
practices in case the person is suffering from mental or physical distress (Boyle 2014). In

7RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
some instances, some of the patients suffering from schizophrenia demonstrate aggressive
behaviour, suicidal tendency or may injure themselves. The principle of ethics needs to be
implemented that allow in balancing of the clinical practices and ethical implications in an
effective manner.
This study can conclude that physical restraint is sometimes required for mental
illness cases. Physical restraint can stable a psychiatric patient. Few ethical issues and
dilemmas, which can affect the health-care centre and professionals. Sometimes psychiatric
patients are suffered many problems due to the physical restraint. In a few cases, patients are
severely injured by physical restraint. Some patients have beaten by the family, which
unethical and due to those problems, nurses are faced with many ethical issues.
Schizophrenia patients get angry and dangerous sometimes, so physical restraint could be
applied for the patient. Different types of ethical issues are related to physical restraint which
cannot be fully removable. Principle of autonomy, beneficence and principle of justice can
help the patient and nurse from problems related to ethical issues and dilemmas. The case
study related to a patient suffering from schizophrenia stated that people suffering from this
disorder generally demonstrate violent behaviour; thus, hurting herself or others. This needs
to be managed or controlled in one way or the other as a result of which, healthcare staff need
be aware of the standards and policy. A reflective section has been added in the essay that
critical reflects on the nurse’s perception to handle the situation as well as understand the
right and wrong during the clinical practices. Moreover, it is important to know the extent of
knowledge the nursing team possess to evaluate the understanding level of the ethical issues
and dilemmas occurring in the mental setting. This in turn, allow in having a perspective of
whether the implication is positive or negative based on the scenario. As stated earlier that
there is a provision of assessing the situation from two perspective, therefore, it is important
to understand the perception of both patient and nurse while judging the ethical dilemma.

8RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES

9RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
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10RESTRAIT OF INDIVIDUALS WITH A MENTAL HEALTH ISSUES
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