Use of restraints on dementia patients: an ethical dilemma of a nursing staff in Israel.

UNLABELLED: This quality improvement project investigates the ethical dilemmas faced by nursing staff (ie, registered nurses, practical nurses, and nurse aids) using restraints for dementia patients in "realistic" and "idealistic" situations. RATIONALE: There is a need to offer adequate care for a growing number of patients suffering from dementia and to ensure their safety. Restraints are a common practice for this purpose; however, they may inflict harm and contradict patient rights of freedom, autonomy, and respect. The issue becomes more complex in view of the multiple studies showing that the various justifications for using restraints are often based on caregiver interests and institutional considerations rather than on the patient's benefit. DESIGN: The project was conducted on a sample of 200 Israeli nursing staff members, half from internal medicine wards of 3 hospitals and the other half from 3 psychogeriatric nursing homes, all treating dementia patients. The project used a questionnaire composed of demographic data and an ethical preference questionnaire built on 18 situations concerning restraints. Situations were categorized into 3 purposes: (a) patient's benefit, (b) other patients' benefit, and (c) institutional benefit. These situations referred to realistic (ie, expressing views of daily practice) and idealistic (ie, expressing personal and professional beliefs and values) situations. RESULTS: The project exposes a discrepancy between the manner in which the nursing staff perceive use of restraints in an idealistic situation and in a realistic situation and the greater tendency to use restraints in the realistic situation than in the idealistic situation. The main contribution of the project is in revealing the conflict between the personal beliefs of the nursing staff and the nurses' perceptions of their institutional obligations. CONCLUSIONS: The project uncovered a discrepancy among the beliefs, the personal and professional values of the nursing staff, and their perception regarding the actual use of restraints in the daily work routine.

The use of physical restraints for patients suffering from dementia.

This study reviews the ethical dilemmas of nursing staff about using restraints on patients suffering from dementia in two types of health care settings in Israel: internal medicine wards of three general hospitals; and psychogeriatric wards of three nursing homes. The nurses' level of knowledge about the Patient's Rights Law, the Israeli Code of Ethics, and the guidelines on restraints was analysed. The purposes of restraints were defined as beneficial to: (1) the patient; (2) other patients; or (3) the institution. The concept was evaluated in a realistic situation (expressing views of daily practice) and in an idealistic situation (expressing personal and professional beliefs and values). It was shown that nurses in internal medicine wards of general hospitals agreed more with the use of restraints than those in psychogeriatric wards in nursing homes. Differences were more pronounced when restraints were beneficial to the institution. In addition, nurses working in psychogeriatric wards of nursing homes had more knowledge about the guidelines on restraints and were less inclined than their counterparts to agree with the use of restraints for the benefit of other patients or the institution.

Interventions used by nursing staff members with psychogeriatric patients resisting care.

Although resistance to care can have a major impact on the provision of care, relatively limited research has been reported on the topic. This research examined differences in the use of interventions by nurses in different care settings to manage resistance to care with eating and dressing. A convenience sample of 50 nurses (34 working in psychiatric hospitals and 16 in nursing homes) participated in the study. Nurses in both settings reported using similar interventions for both problems. Non-nursing interventions were consistently mentioned to be more common when resistance was accompanied by physical aggression than by verbal aggression.