Page 435 - Encyclopedia of Nursing Research

402 n PHYSICAl ReSTRAINTS

3. ethical inquiry. This category of philo- rails, some types of furniture, and audible
sophical inquiry research focuses on an alarm systems are also considered restraints
P analysis of the moral life and on an analy- when used to limit movement. Although this
sis of ethical problems; its primary meth- entry focuses mainly on physical restraints,
ods of inquiry are critique and debate it is important to keep in mind that these
based on ethical theories, principles, and devices are often used in conjunction with
virtue ethics. Two examples of ethical psychopharmacological drugs. When given
inquiry research include Begley’s (2008) for the purposes of discipline or convenience
Guilty but Good: Defending Voluntary Active and not required to treat specific medical or
Euthanasia from a Virtue Perspective and psychiatric conditions, such drugs are con-
Holland’s (2010) Scepticism about the Virtue sidered chemical restraints.
Ethics Approach to Nursing Ethics. The prevalence of physical restraints in
nonpsychiatric settings, estimated in 1989 to
In sum, foundational inquiry, philosoph- affect 500,000 elderly persons daily in hospi-
ical analysis inquiry, and ethical inquiry, tals and nursing homes (evans & Strumpf,
when focused on nursing philosophical phe- 1989), led many to conclude that a restraint
nomena, constitute the three categories of crisis existed. High prevalence in the United
nursing philosophical inquiry research in States sharply contrasted with reported
qualitative nursing research. Philosophical lesser use in Western europe. The historical
nursing knowledge is often derived from antecedents for these differences appeared
the research method of nursing philosoph- related to American beliefs that were embed-
ical inquiry. Future directions for nursing ded by the end of the nineteenth century:
philosophical inquiry and for philosophy of that restraint use was therapeutically sound,
nursing include (a) increased commitment necessary to control troublesome behavior,
by nurses to conduct nursing philosophi- and protective against tragic accidents and
cal inquiry research, (b) clarification of the injuries.
multiple processes of inquiry that constitute For nearly 100 years, those beliefs were
philosophical inquiry in nursing, (c) analy- largely unchallenged; debate concerning the
sis and synthesis of the existing literature on efficacy of physical restraint was limited, and
nursing philosophical inquiry and on phi- interventions for preventing and responding
losophy of nursing with the goal of building to “unsafe” or “troublesome” behaviors were
a cohesive body of philosophy of nursing rarely considered. Over a 20-year period,
knowledge, and (d) application of the out- the efforts of advocacy groups and com-
comes of nursing philosophical inquiry to mitted clinicians, changes in nursing home
nursing practice. regulations and standards for accreditation
of hospitals, warnings from the Food and
Mary Cipriano Silva Drug Administration, media exposés, and
research demonstrating successful restraint
reduction have forced a complete reexamina-
tion of their use (Castle & Mor, 1998; evans &
PhysiCal restraints Strumpf, 2010). Although average prevalence
has now declined in U.S. nursing homes to
approximately 3% and acute-care medical
A physical restraint is any device or object units are often restraint free, restraint use
attached to or adjacent to a person’s body that and the problems associated with it remain
cannot be removed easily and restricts free- a global concern. Witness the upsurge since
dom of movement. Bilateral full-length side 2000 of published research on prevalence,