Ethical and Legal Implications of Nursing in Mental Health Care

This essay delves into the ethical and legal considerations within mental health nursing, specifically addressing the challenges of seclusion and restraint practices. It examines the historical development of these practices, the impact on both patients and healthcare professionals, and the role of nurses in advocating for consumer rights and reducing restrictive interventions. The essay analyzes the perspectives of various stakeholders, including patients, nurses, and regulatory bodies, highlighting the importance of ethical guidelines and the implementation of strategies to minimize the use of seclusion and restraint. It further discusses the initiatives of organizations like the NMHC and ACMHN in promoting safer and more humane mental healthcare practices, emphasizing the need for a balance between patient safety and the protection of human rights. The conclusion underscores the complexities of mental health nursing, the challenges nurses face in balancing patient needs with legal and ethical obligations, and the importance of adhering to established guidelines to ensure patient dignity and effective treatment.

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Introduction
The objective of this essay is to discuss development of ethical consideration and people
involvement in mental health treatment sector to manage the dignity and legal practice of the
treatment. Issue selected for the discussion in this research essay is practices increasing in
Australia to reduce the seclusion and restraint practice in nursing care for mental health
treatment (Goldacre, 2012). This essay will analyse historical development of seclusion and
restraint practice under mental healthcare and role of nurses who manage to perform these
practices. Research aim of this essay is divided in two sections, first section will discuss the
impacts of the seclusion to patient and nursing professionals, and another section will discuss
the role of nurses actively supporting to the consumers to reduce the practices of the
seclusion and restraint practices to manage effective healthcare treatment to the consumers.
This essay will analyse the secondary resources available on analysis and understanding of
the issue and nursing behaviour to get detailed overview of the entire situation in mental
treatment (Evans, Nizette, & O'Brien, 2016).
Implication of seclusion and restraints in the psychological sector of care for a psychiatric
patient has been a matter of moral argument, and controversy for the ethical values of
nursing, since the establishment of psychiatric medication. The establishment of psychiatric
caution, is said to be founded by the Quakers, introducing the of mechanical and chemical
based restraint practices (Dudgeon & Ugle, 2014). Some psychiatrist opposed this, and some
supports it. The formal placing of a patient in a specially designated room for the short-term
management of disturbed/violent behaviour is seclusion. This practice includes reducing the
stimulation the patient takes, preclude looming damage to the patient if supplementary means
are unsuitable or unsuccessful or at the patient's request.

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Restraint is controlling the physical movement of the patients, including tying to beds by the
hands and legs for many hours, days, and even longer periods of time. Traditionally these
techniques were aimed to prevent the activities of human who had aggressive and disturbed
behaviour possible to cause harm and issues to others including the nursing staff.
Nurses represent that seclusion or restraint is their last option because they had to make
patient in restraint to treat his aggressive behaviour as part of their mental health challenges
solution (Miller & Rollnick, 2012).
Based on this traditional concept of the seclusion and restraint many practitioners and
consumer found it improper and cruel to behave with a suffering person. These practices
represent to them as controversial, but with good reason to prevent others from risk (Colaizzi,
2005).
The impact of seclusion to consumers and healthcare professional alike
According to the statics available in limits from data of the Victorian Office of the Senior
Practitioner, consensuses on the base of global investigation that an assessed 10–15% of
patients having ill health or mental disability possible to represent ‘activities of concern.’
Among 44–80% of these targeted patients will be controlled a method of biochemical
restraint in reaction to the comportment (Australian, Government; , 2014).
In this investigation, the Office of the Senior Practitioner represent that most popularly used
restraint practice is the chemical restraint, managed to control the aggressive behaviour.
Restraint and seclusion have similarity and related to the behavioural mismanagement that is
put on the last stage of treatment. These are needed to be placed in last to control and manage
a behavioural emergency. These emergencies are frequently the outcome of unmet wellbeing,

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serviceable, or psychosocial requirements, and nurses practitioners are supposed to decrease,
remove, or cope such crises by speaking over identified circumstances that formed them.
Seclusion and Restraint are not healing care treatments. In fact, these can encourage
additional health or psychosocial disturbance. Importantly Seclusion and Restraint techniques
carriage a protection hazard to the sensitive and physical comfort of the individual and ensure
no recognized long-standing advantage in dropping manners.
Many participants or stakeholders including government, nurses, and communities raised
general questions through numerous sectors, which result in unsuitable or misuse of
restrictive practices. A significant enlightenment for the practice of restraining applies may
be the absence of means for affirmative performance managing and multi-disciplinary
interferences to ‘perplexing behaviours’. Such behaviours may be better understood as a
‘reasonable reaction to problematic situations and states’ or ‘adaptive behaviours to
maladaptive environments’.
In divergence, Caxton Legal Centre defined situation in a dementia division as a pure
illustration of restraining practices. Presented a case of ‘Mrs H’, a lady in her mid-70s and
of a customarily and linguistically different contextual, who baptised the centre to carp that
she had been misdiagnosed with Alzheimer’s syndrome and forced to spent 10 months in
‘prison’ that as seclusion.
Many people facing the issues of the restrictive practices found the situation challenging for
the patients as they already face difficulties with their health and making them to live in
seclusion may affect their illness and behaviour negatively. According to Kinner and all,
appeals to reduce, and exclude, the practice of seclusion and restraint in mental health
settings are growing since many decades, but the outlooks and opinions of consumers,
protectors and mental health professionals in the direction of these applies are not clearly

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implicit and presented. This research aimed to identify the health professionals, consumers
and their perceptions for these practices in a survey of 1150 participants. The outcome of the
survey represented that this is a growing concern for everyone. Majority of the participants
accept this practice as imperfect and breach human rights as well. However, particularly
professionals also identified some benefits. Contributors had mixed views apropos the
practicability and attractiveness of eradicating these applies (Muir‐Cochrane, O'Kane, &
Oster, 2018).
The role of the registered nurse in collaborating with consumers to work towards
State/Territory and National initiative in reducing seclusion and restraint
The NMHC argued that there is solid arrangement that isolation and restraint is an issue
related to breach of human rights, because its application has no therapeutic significance, in
additional it also result in emotional and physical harm for patients and nurses. This is a
signal of a system under stress. The NMHC found no supportive evidence that represent the
restraint and seclusion as therapeutic treatment or beneficial for the stress and behavioural
management.
The National Mental Health Commission (NMHC) involved the Australian College of
Mental Health Nurses (ACMHN) to commence exertion intended at dropping restrictive
practices and confirming safety in care and safety for staff in Australian mental health
services. (ACMHN) and (NMHC) introduced a package for staff in Australian mental health
services containing an inspection toolkit for service area, the Six Core Strategies checklist of
Australian health care service amendments and a checklist of superintendent booklets to
decrease seclusion and restraint. The Mental Health Act 2009 in its section 7 encompasses a
regular pack of Guiding Principles for its management, which ought to notify the judgment
making and activities of health experts (Kinner, et al., 2016).

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Muir-Cochrane and others conducted a research with 44 mental health nurses across
Australia, collected data were analysed on thematic scale. Overall study to discover views of
the mental health nurses’ about the prospective removal of these practices, the nurses voiced
substantial dread around the reduction of these restrictive practices. their fear represented
that they feel critical to saw themselves as being responsible for the entire situation as like to
practice these restrictive activities and to present support of the potential elimination
(Maxham, Hazelton, Muir-Cochrane, & Heffeman, 2018).
The Royal Australian and New Zealand College of Psychiatrists (RANZCP) is dedicated to
the supply of superiority mental health services that pursue to progress safe repetition and
endorse optimum results to those accepting care. The RANZCP present its commitment to
support good medical practice and offers safe and better quality care for clients.it manage to
support diminish of seclusion and restraint in practice, to meet these outcomes it provides
education and development programs with the help of registered nurses. The RANZCP fully
supports systems-oriented activities In the interests of consumer and staff safety for example
Trauma-Informed Care (Oster, Gerace, Thomson, & Muir-Cochrane, 2016).
Nurses find these practices sometimes essential for the patients, because seclusion provide
relax to their mind and give time to comfort their behaviour, chemical restraint is also
profitable to treat patient, as it provide relax to the body and mind and nurses can practices
their treatment. (NMHC) understand that complete restriction of seclusion and restraint is
impossible because it is a part of treatment and is essential to manage but in effective and
prescribed guidelines.
Nurses face many challenges as these practises are related to cure a patient and they need to
apply these in effective manner, this put a great question to their image. As they can not be
accepted to play double faced character hence these are very challenging but after (ACMHN)

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and (NMHC) contribution in this sector there is some relief for the nurse. Many organisations
are raising voices to reduce restraint and seclusion take guidance from the nurses to
understand level of these practices application. After the development of assessment tool and
guidelines to manage these services, application of restraint and seclusion has become proper
is operated in manner that it not violate the human rights of the consumers and don’t raise
other health issues to the consumers.
Conclusion
This essay concludes that nursing practice with ethical and legal implication and management
is very challenging, especially in mental health care treatment. Sometimes behaviour
management of a consumer become challenging for the nurses and it is possible to lead harm
to either any staff or to the staff. In these circumstances nurses use seclusion and restraint
practices to control behavioural challenges of a consumer, as these restraint and seclusion
practices include use of mechanical and chemical substance to tie consumer or to keep him in
a separate room for a period. This practice is being criticised by many stakeholders infect
nurses assume this as violation of human rights hence a guidelines issued by the (ACMHN)
and (NMHC) for the nurses to apply and practices these with management of consumer
dignity and legal rights. It is effective because it guide nurses to practice restraint on base of
specific crucial challenges and under the issued guidelines.

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