Question

The medical practitioner providing the patient's care is ultimately responsible for the decision to restrain a patient. However, the decision to use restraints should not occur in isolation. It involves a process of request, assessment, team involvement and consent within an ethical and legal framework. A restraint is a device or medication that is administered for the purpose of restricting the movement and/or behaviour of a person.
Determine the limitations and legal ramifications of the following forms of restraint (in 40-60 words each):

11.1)   Physical

Answer 1

Medical restraints are physical restraints used during certain medical procedures to restrain patients with the minimum of discomfort and pain and to prevent them from injuring themselves or others.

Examples of physical restraint include vests, straps/belts, limb ties, wheelchair bars and brakes, chairs that tip backwards, tucking in sheets too tightly, and bedside rails.

Limitations of physical restraint-

Physical risks

Over the last few years, a consensus has been building up about the physical risks associated with the application of physical restraint to older people, the physical consequences of which are:

1. Bruises

2. Decubitus ulcers

3. Respiratory complications

4. Urinary incontinence and constipation

5. Undernutrition

6. Increased dependence in activities of daily living

7. Impaired muscle strength and balance

8. Decreased cardiovascular endurance

9. Increased agitation

10. Increased risk for mortality caused by strangulation or as a consequence of serious injuries—for example, fracture, head trauma.

Psychological risk- physical restraint also causes the mental trauma to the individual who was restraint.

Legal ramifications of the physical restraint-

Section 69 – theory and practice
Section 69(1) of the Mental Health Act 2001 provides that a person shall not place a patient in seclusion or apply mechanical means of bodily restraint to the patient unless such seclusion or restraint is determined, in accordance with the rules made under section 69(2), to be necessary for the purposes of treatment or to prevent the patient from injuring himself or herself or others and unless seclusion or restraint complies with such rules.

Current United States law requires that most involuntary medical restraints may only be used when ordered by a physician. Such a physician's order, which is subject to renewal upon expiration if necessary, is valid only for a maximum of 24 hours.

Japanese law states that psychiatric hospitals may use restraints on patients only if there is a danger that the patients will harm themselves or others. The law also states that a designated psychiatrist must approve the use of restraints and examine the patient at least every 12 hours to determine whether the situation has changed and the patient should be removed from restraints.