Many institutions including medical institutions exhibit challenges with ineffective systems, poor strategies or selection of the right staff. These organizations or institutions do not see the satisfaction of employees, valuation of leaders, among other things that lead to the profitability of the organizations. Systemic challenges are prudent over many medical institutions and still remain a modern problem. These challenges are a result of the issues that are inherent in the entire system instead of a specific factor. Changes to the structure of the institution, the organization itself or a shift of the policies without factoring in the systemic problems could lead to alleviation of the entire challenge. One of the systemic challenges in medical institutions, as well as those institutions that I have seen and worked, is mental health and the use of restraints. As a nurse leader, I ought to make sure that my organization is able to deliver safe, high-quality patient care to avoid such challenges. This can be initially done through gap analysis.
The use of restraints in mental health setups leads to various ethical challenges despite protecting highly agitated and violent patients from possible physical harm. One of the steps towards avoiding resulting systemic challenges is the use of least restrictive restraint. It is imperative that I understand and follow the proper protocols and procedures in the performance of my duties. I understand that failure to follow these protocols could lead to legal ramifications to the patient and health authorities. Of the various chemical, physical, and environmental restraints being used by the organization, I could select the physical restraint as it is the most suitable and applicable for most patients. Many countries use physical restraining where more than 20% of their psychiatric patients are suffering from the condition (Hendryx, Trusevich, Coyle, Short, & Roll, 2009). This is especially applicable if the patient's behaviour is a result of a harmful organic source. Application of physical restraint is important if one needs to prevent injury of a patient and reduce aggression and agitation. Application of these interventions can be the last resort to preventing injury to patients while maintaining their safety. For such a source, it is more preferable to treat the condition instead of restraining the patient. I can also discuss with other workmates to come up with the best judgment regarding the safety of addressing the condition in that way and also the best ways of ruling out various life-threatening causes. Many organizations also do not consider verbal de-escalation strategies, which are important in making a good decision. I would ensure that this is considered even before using any form of restraint on the patient. Some other measures may include laying out policies, maintenance of justice, and maintaining the concept of beneficence and non-maleficence
Laying out policies
The institution also does not have specific laid out policies for the use of physical restraints. These may include devices such as limb holders, bandages and safety vests. As a nurse leader, I ought to make sure that the staff examine different literature and hence, come up with good policy guidelines as generated from an international platform. One of the policies that I would put in place is an initial discussion of the usage of physical restraints along with chemical and environmental restraints. In doing so, I would not only target patients but the entire medical population. An additional guideline could be that which specifically targets the mental health patients. This guideline could most importantly concentrate on the use of universal restraints. Both would be effective in realizing better procedures of assessment, consent, application, discontinuation, and documentation. Even though there has been extensive research regarding the negative effects of employing a physical restraint, it could as well serve as a permanent solution to a mental health patient's behaviours regardless of their ecology (Peplau, 1986).
Maintenance of justice
Justice for all is applicable to global citizens and patients are no exclusion. My organization does not see justice and equality for every patient regardless of the condition identified with. Patients should not be treated with prejudice in any way as they still have the right to equality and survival. Mental patients ought to be shown humane care as well as building strong human-human relationships. Since these patients have to be shown justice, they should be provided with emotional support. Physical restraints have been seen as important in controlling an individual's emotions and behaviours. Through empathy, these restrained patients can get relieved of their negative emotions including stress anxiety (Bowers, Alexander, Simpson, Ryan, & Carr-Walker, 2004). Additionally, the patients should be issued with a good post-restraint care to relieve their subjective thinking regarding the quality of life. One instance of this care is giving the patients attention especially when the restraint is not sufficient. Giving restrained patients this physiological counselling and support is important in making sure that they are not affected by the restraints.
Maintaining the concept of beneficence and non-maleficence
Presently, my organization does not maximize any benefits arising as well as minimize the detriment of physical restraints. This is important for a nurse leader I ought to demonstrate explicitly the principles and requirements underpinning any physical restraints. As a way of making sure that the same protocol is followed even by other nurses and also make it lawful, it should be written in the nursing code. Writing the code and following it can let one reach to the goal of restraints while minimizing any side effects. My organization always sees the abuse of physical restraints as there is no such a code. The institution complains of the lack of professional trainers but I believe that trainers are available and training nurses of the use of these restraints can let them be able to face violence and hence, regulate their works. I would prefer that this law is applied only after a patient completes their assessment on time. Time is an important factor that is not considered in the organization that can lead to the minimization of the negative impacts of physical restraints. A good schedule with time set for medical reviews is as well important as long as nursing practitioners want to reach their objectives.
Mentally ill patients and patients in psychiatric wards need to be attended by the use of physical restraints along with other nursing interventions. A patient's violence may affect the safety of other people in the same organization and hence, such coercive tools are important (Kaltiala-Heino, Tuohimaki, Korkeila, & Lehtinen, 2003). One of the safest skills for nurses in dealing with violent patients is learning to identify when the physical restraint is applicable (Moylan, 2009). Implementing these changes can also help foster a culture of quality and safety. Maintaining beneficence and non-maleficence as well as justice as steps to making sure that mental health patients are well attended to and receive the quality care they need. Adopting this culture would lead to various behavioural norms and values that are a representation of the expression of the institution's organizational culture (Hatch & Cunliffe, 2013).
Bowers, L., Alexander, J., Simpson, A., Ryan, C., & Carr-Walker, P. (2004). Cultures of psychiatry and the professional socialization process: The case of containment methods for disturbed patients. Nurse Education Today, 24(6), 435-442. doi:10.1016/j.nedt.2004.04.008
Care Psychiatry. Journal of Psychosocial Nursing and Mental Health Services, 47(3), 41-47. doi:10.3928/02793695-20090301-10
Hatch, M. J., & Cunliffe, A. L. (2013). Organization theory: Modern, symbolic, and postmodern perspectives. Oxford, United Kingdom: Oxford University Press.
Hendryx, M., Trusevich, Y., Coyle, F., Short, R., & Roll, J. (2009). The Distribution and Frequency of Seclusion and/or Restraint Research, 37(2), 272-281. doi:10.1007/s11414-009-9191-1
Kaltiala-Heino, R., Tuohimaki, C., Korkeila, J., & Lehtinen, V. (2003). Reasons for using seclusion and restraint in psychiatric inpatient care. International Journal of Law and Psychiatry, 26(2), 139-149. doi:10.1016/s0160-2527(02)00210-8
Moylan, L. B. (2009). Physical Restraint in Acute among Psychiatric Inpatients. The Journal of Behavioral Health Services &
Peplau, H. E. (1986). Toward healthy ageing: Human needs and nursing response. Geriatric Nursing, 7(4), 175. doi:10.1016/s0197-4572(86)80083-0
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