Redefining Care: Ethics and Portugal's Journey to Restraint-Free Healthcare
DOI:
https://doi.org/10.24950/rspmi.2658Palavras-chave:
Ethics, Medical, Informed Consent, Patient Safety, Patient Rights, Personal AutonomyResumo
The ethical use of physical restraints in medical wards is a critical issue that requires careful consideration of patient autonomy, dignity, and safety. This article explores the complex ethical landscape surrounding the application of physical restraints, focusing on core principles such as respect for autonomy, beneficence, non-maleficence, and justice. Restraints should be justified through thorough assessment and documentation, emphasizing minimizing harm and involving patients or their representatives in decision-making. Ethical guidelines recommend regularly monitoring and reviewing restraint practices, prioritizing patient comfort and dignity, and exploring alternative strategies for managing challenging behaviors. Additionally, this article examines Portugal’s regulatory framework and legal standards, which emphasize restraint as a last-resort measure, highlighting the importance of necessity, proportionality, informed consent, and ongoing monitoring. By fostering a culture of empathy, transparency, and continuous improvement, Portuguese healthcare practices illustrate a model for ethically responsible restraint use that aligns with national and international standards.
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Spennato U, Lerjen N, Siegwart J, Mueller B, Schuetz P, Koch D, et al. Prevalence, risk factors and outcomes associated with physical restraint in acute medical inpatients over 4 years: a retrospective cohort study. Geriatrics. 2023; 8:15. doi: 10.3390/geriatrics8010015
Eskandari F, Abdullah KL, Zainal NZ, Wong LP. Incidence rate and patterns of physical restraint use among adult patients in Malaysia. Clin Nurs Res. 2018; 27:278-95. doi: 10.1177/1054773816677807
Zhou J, Qin Q, Chen S, Zhang H. Moral Dilemmas Regarding Physical Restraints in Intensive Care Units: Understanding Autonomy, Beneficence, Non-Maleficence, and Justice in the Use of Physical Restraints. J Multidiscip Healthc. 2024; 12:1619-27. doi: 10.2147/JMDH.S455910
Ye J, Xiao A, Yu L, Wei H, Wang C, Luo T. Physical restraints: An ethical dilemma in mental health services in China. Int J Nurs Sci. 2017; 5:68-71. doi: 10.1016/j.ijnss.2017.12.001
Convention on the Rights of Persons with Disabilities - Articles 2008. [Accessed: 18/11/2024] Available at: https://social.desa.un.org/issues/disability/crpd/convention-on-the-rights-of-persons-with-disabilities-articles.
Direção Geral da Saúde. Avaliação da Cultura de Segurança do Doente nos Hospitais 2020. [Accessed: 18/11/2024] Available at: https://www.dgs.pt/directrizes-da-dgs/normas-e-circulares-normativas/norma-n-0052018-de-20022018-pdf.aspx.
Eswaran V, Molina MF, Hwong AR, Dillon DG, Alvarez L, Allen IE, et al. Racial Disparities in Emergency Department Physical Restraint Use: A Systematic Review and Meta-Analysis. JAMA Intern Med. 2023; 183:1229-37. doi: 10.1001/jamainternmed.2023.4832
Richmond JS, Berlin JS, Fishkind AB, Holloman Jr GH, Zeller SL, Wilson MP, et al. Verbal De-escalation of the Agitated Patient: Consensus Statement of the American Association for Emergency Psychiatry Project BETA De-escalation Workgroup. West J Emerg Med. 2012; 13:17-25. doi: 10.5811/westjem.2011.9.6864
Fariña-López E, Estévez-Guerra GJ. Historical aspects of the use of physical restraint: from antiquity to the era of moral treatment. Rev Enferm. 2011; 34:14-21.
Ferrão SA, Bleijlevens MH, Nogueira PJ, Henriques MA. A cross-sectional study on nurses' attitudes towards physical restraints use in nursing homes in Portugal. Nurs Open. 2021; 8:1571-7. doi: 10.1002/nop2.769
Varkey B. Principles of Clinical Ethics and Their Application to Practice. Med Princ Pract. 2021; 30:17-28. doi: 10.1159/000509119
Sedig L. What’s the Role of Autonomy in Patient- and Family-Centered Care When Patients and Family Members Don’t Agree?. AMA J Ethics. 2016; 18:12-7. doi: 10.1001/journalofethics.2017.18.1.ecas2-1601
Fry M. Autonomy and its limits: a discussion of the shortcomings of informed consent. Voices Bioethics. 2024;10. doi: 10.52214/vib.v10i.12507
Mehrok S, Belsiyal CX, Kamboj P, Mery A. The use of physical restraints- knowledge and attitude of nurses of a tertiary care institute, Uttarakhand, India. J Educ Health Promot. 2020; 31:77. doi: 10.4103/jehp.jehp_451_19
Stephen J, Wu J. “First, Do No Harm”? Non-Maleficence, Population Health, and the Ethics of Risk. Social Theory Pract. 2022; 48:525-51. doi: 10.5840/soctheorpract2022218152
de Bruijn W, Daams JG, van Hunnik FJ, Arends AJ, Boelens AM, Bosnak EM, et al. Physical and pharmacological restraints in hospital care: protocol for a systematic review. Front Psychiatry. 2020; 28:921. doi: 10.3389/fpsyt.2019.00921
Minguell C, Gassó AM, Martin-Fumadó C, Gómez-Durán EL, Arimany-Manso J. Physical restraints in nursing homes: A qualitative study with multiple stakeholders. Nurs Open. 2024; 11:e2078. doi: 10.1002/nop2.2078
Cortinhal VS, Correia AS, Fernandes SJ. Nursing Ethical Decision Making on Adult Physical Restraint: A Scoping Review. Int J Environ Res Public Health. 2024; 21:75. doi: 10.3390/ijerph21010075
Raveesh BN, Gowda GS, Gowda M. Alternatives to use of restraint: A path toward humanistic care. Indian J Psychiatry. 2019; 61: S693-S697. doi: 10.4103/psychiatry.IndianJPsychiatry_104_19
Dentice S, Chiappinotto S, Moreale, Pitacco G, Bicego L, Palese A. What are the alternatives to restraints in clinical practice? Results of a multicentre study. Assist Inferm Ric. 2023; 42:208-15. doi: 10.1702/4178.41685
Abraham J, Hirt J, Kamm F, Mohler P. Interventions to reduce physical restraints in general hospital settings: A scoping review of components and characteristics. J Clin Nurs. 2020; 29:3183-200. doi: 10.1111/jocn.15381
Mulkey MA, Munro CL. Calming the Agitated Patient: Providing Strategies to Support Clinicians. Medsurg Nurs. 2021; 30:9-13. PMID: 34092999
Tucker J, Whitehead L, Palamara P, Rosman JX, Seaman K. Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions. BMC Nurs. 2020; 19:106. doi: 10.1186/s12912-020-00495-x
Monnat ML. Incorporating occupational therapy to decrease agitation in nursing home residents with dementia. J Am Geriatr Soc. 2011; 59:556-7. doi: 10.1111/j.1532-5415.2010.03297.x
Thomas JM, Sezgin D. Effectiveness of reminiscence therapy in reducing agitation and depression and improving quality of life and cognition in long-term care residents with dementia: A systematic review and meta-analysis. Geriatr Nurs. 2021; 42:1497-506. doi: 10.1016/j.gerinurse.2021.10.014
Fraker J, Kales HC, Blazek M, Kavanagh J, Gitlin LN. The role of the occupational therapist in the management of neuropsychiatric symptoms of dementia in clinical settings. Occup Ther Health Care. 2014; 28:4-20. doi: 10.3109/07380577.2013.867468
Muir-Cochrane E, Grimmer K, Gerace A, Bastiampillai T, Oster C. Prevalence of the use of chemical restraint in the management of challenging behaviours associated with adult mental health conditions: A meta-synthesis. J Psychiatr Ment Health Nurs. 2020; 27:425-45. doi: 10.1111/jpm.12585
Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract. 2020; 26:927-56. doi: 10.1111/jep.13232
Wong B, Ismail Z, Watt J, Holroyd-Leduc J, Goodarzi Z. Barriers and facilitators to care for agitation and/or aggression among persons living with dementia in long-term care. BMC Geriatr. 2024; 24:330. doi: 10.1186/s12877-024-04919-0
Carrier SL, Ponsford J, McKay A. Family experiences of supporting a relative with agitation during early recovery after traumatic brain injury. Neuropsychological Rehabilitation. 2023; 34:510-34. doi: 10.1080/09602011.2023.2219064
Zwijsen SA, Depla MF, Niemeijer AR, Francke AN, Hertogh CE. Surveillance technology: an alternative to physical restraints? A qualitative study among professionals working in nursing homes for people with dementia. Int J Nurs Stud. 2012; 49:212-9. doi: 10.1016/j.ijnurstu.2011.09.002
Favez L, Simon M, Bleijlevens MH, Serdaly C, Zúniga F. Association of surveillance technology and staff opinions with physical restraint use in nursing homes: Cross-sectional study. J Am Geriatr Soc. 2022; 70:2298-309. doi: 10.1111/jgs.17798
Raguan B, Wolfovitz E, Gil E. Use of Physical Restraints in a General Hospital: a Cross-Sectional Observational Study. Isr Med Assoc J. 2015; 17:633-8. PMID: 26665319.
Ye J, Wang C, Xiao A, Xia Z, Yu L, et al. Physical restraint in mental health nursing: A concept analysis. Int J Nurs Sci. 2019; 6:343-8. doi: 10.1016/j.ijnss.2019.04.002
Roseira MB: The new Healthcare Basic Law. e-Pública. 2019;6:62-74.
Cunha M, André S, Bica I, Ribeiro O: Chemical and physical restraint of patients. Procedia. 2016;217:389-99. doi: 10.1016/j.sbspro.2016.02.109
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