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Restraints ethical and legal considerations in children/ adolescent and adults

     Restraints can only be used only if absolutely necessary when harm to self, others, or staff is preventative and cannot be used for the convenience of

staff in any case and is considered a physical device that restricts movements and can be chemical (Medcom, 2008). Restraints must be ordered by a

physician or independent practitioners and cannot exceed 4 hours for adults, 2 hours for 9-17 years of age, and 2 hours for ages 8 or less with the ability to

be renewed up to 24 hours until a face to face examination is done and a new order in place (APA, 2008). In a recent study on adolescents being restrained

the risk factor for the restrained adolescents were found to be primarily female gender with low psychosocial functioning with more and longer admissions

and concomitant use of pharmacological restraints (Furre et al, 2017). Restraints in the elderly are three times greater related to the higher hospitalization

rate secondary to their affliction by different chronic conditions, along with their higher risk for fall or injury to self or others (Sharifi et al, 2020). Legal and

ethical consideration for all age groups is of high importance when using restraints of any kind and can have implications to the practitioner if not used with

high considerations and constant supervision with reevaluation ongoing. Three considerations legally and ethically when using restraint in a setting is the

staff and admitted patients adequately supported and supervised at this time, the numbers of staff working should adequately reflect the number of

admissions at any given time, and thirdly during the admission process police and psychiatric staff should cooperate to ensure that the admission proceeds

safely for staff and patient, and stay until it is established that the referral was appropriate. 

References

Cole, C., Vandamme, A., Bermpohl, F., Czernin, K., Wullschleger, A., & Mahler, L. (2020). Correlates of seclusion and restraint of patients admitted to

     psychiatric inpatient treatment via a German emergency room. Journal of Psychiatric Research130, 201–206. https://doi-

     org.ezp.waldenulibrary.org/10.1016/j.jpsychires.2020.07.033

Furre, A., Falk, R. S., Sandvik, L., Friis, S., Knutzen, M., & Hanssen-Bauer, K. (2017). Characteristics of adolescents frequently restrained in acute psychiatric

     units in Norway: a nationwide study. Child & Adolescent Psychiatry & Mental Health, 11, 1–9. https://doi-org.ezp.waldenulibrary.org/10.1186/s13034-016-

     0136-1

Legal Considerations and Patient Rights: Orders and Evaluation. Anonymous Medcom, 2008. https://video.alexanderstreet.com/watch/legal-considerations-

     and-patient-rights-orders-and-evaluation.

Sharifi, A., Arsalani, N., Fallahi-Khoshknab, M., Mohammadi-Shahbolaghi, F., & Ebadi, A. (2020). Iranian nurses’ perceptions about using physical restraint for

     hospitalized elderly people: a cross-sectional descriptive-correlational study. BMC Geriatrics, 20(1), 233. https://doi-

     org.ezp.waldenulibrary.org/10.1186/s12877-020-01636-2

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