Exploring the ethics of physical restraints: Students’ questioning

Abstract

Background: Physical restraints are routinely employed to ensure patient safety in Japanese acute care. Little is known about nursing students' perspectives and how they begin to question their value and knowledge in the face of restraint experiences in clinical practice. Objective: To investigate nursing students’ questions about patient restraints and how they understand the ethics of the use of restraints in nursing. Research design: Qualitative descriptive research using narrative analysis. Participants and research context: Experiential data were generated and thematically analyzed from semi-structured interviews with 16 nursing students who had completed their bachelor’s degree program requirements. Ethical considerations: The study was approved by academic and clinical ethics agencies. Participants provided written informed consent. Results: Physical restraints were encountered in 16 incidents, 3 with children and 13 with older patients with dementia. Students struggled to comprehend the policies and protocols of restraint use and worried their use was primarily for security rather than therapeutic purposes. Five themes were identified: (1). Questioning the tension between person-centered care, patient autonomy, and restraints, (2). Questioning the nature of restraints in which participants analyzed the policies and protocols around restraint use, (3). Questioning the professional nursing self whereby students reflected on how restraint use challenged their nursing values, and (4). Questioning professional nursing practice, in which students explored how restraints fit within a nursing perspective and positioned themselves as patient advocates. Students encountering physical restraints should ask questions based on values of patient-centeredness, autonomy, and advocacy. There is a need for education that facilitates reflection and questioning so that it informs students’ ethical thinking which may enhance nurse advocacy to reduce restraint use. Conclusions: Restraints provide contexts in which students must face tensions between nursing values and clinical reality. Further research on nursing education strategies within non-psychiatric settings is needed to reduce physical restraints.