Placing a loved one in a nursing home may be the most difficult and heartbreaking decision one will have to make. The reasons for admitting someone into a nursing home is usually because they cannot provide care for themselves, their caregiver is no longer capable, or they require full-time medical attention. Peace is typically found when one realizes it is the best option for the individual and there will be a quality health care team to support and comfort them.
Susan was admitting into a long-term care centre because she could no longer wash or feed herself, and would consistently get lost and forget things. She was sad to be admitted because she felt like it was the end of the line for her. After a few weeks, she was diagnosed with dementia and depression, and her mobility decreased. One night she felt very sad and agitated, but due to her cognitive deterioration, she did not know how to express herself. She then began to yell and continuously ring her call bell. The nurse working the night shift had a total of twelve residents to monitor and she became overwhelmed. She saw on the resident’s care plan that she had an antipsychotic ordered “as needed”. The nurse told Susan she had a candy for her and gave her the highest dose of medication in order to sedate her. Chemical restraints are a form of medical restraint in which a drug is used to restrict the freedom and movement in a patient (Paul & Paul, 2016). Healthcare consists of many ethical controversies and debates; improper use of chemical restraints is on the rise. By 2030, one in every four persons will be senior which means that nursing homes and long-term care facilities will be overpopulated; leading to an increased chance of improper care (Government of Canada, 2014). This paper will incorporate ethical considerations that are violated by chemical restraints such as respect for humans, beneficence, autonomy and justice. The historical evolution and present day laws and regulations will be covered; along with the roles of individuals facing this dilemma. The main classes of medications used as chemical restraints are antipsychotics and benzodiazepines (Mattingly, 2014). However, Health Canada does not approve of antipsychotic use for elderly and pharmaceutical companies have issued a “black box warning” on their labelling; which is the strictest warning put on products by the Food and Drug Administration (FDA) when there is evidence of a potentially serious hazard upon taking the drug (Bruser, 2014). Even though they are contraindicated in the elderly population, the medication goes “off-label”-meaning the drug is being used for an age group or condition is it not approved for. Antipsychotic drugs are too often given to residents who are not psychotic; but are suffering from anxiety, depression, dementia, or feeling impatient and confined. Long-term care centers struggle with staffing shortages and …show more content…
The primary ethical principles that are violated are respect for human dignity, autonomy, and non-maleficence. Human dignity cannot be relinquished during illness, disability or approaching death; everyone is entitled to all their rights and freedoms despite their health status. The side effects of the medication can actually cause the symptoms they are supposed to be eradicating. Chemical restraints often leave the individual feeling confused, agitated, and physically sedentary. Robert Harris was described as energetic and lively before entering a nursing home in California (Bisnar, 2011). During the transition he acted like a “regular grumpy old man”, the doctors then categorized him as psychotic and needed to be chemical restrained. The medication made him very confused and drowsy; he stopped eating and drinking as much and lost 10% of his body mass within a month. This example demonstrates the harmful repercussions of improper use of antipsychotics. Respect for autonomy is also violated when using chemical restraints, the resident should be able to make choices for themselves. Everyone is entitled to the right of self-determination; and if they are not cognitively able to do so, then the family’s opinion should be considered and they should always be informed. The non-maleficence principle “to do no harm” is violated as chemical restraints cause physical harm to the residents. Chemical restraints have been proven to increase risk of falls, muscle weakness, incontinence, malnutrition, and increase dependence in activities of daily living (Gastmans & Milisen,
Susan was admitting into a long-term care centre because she could no longer wash or feed herself, and would consistently get lost and forget things. She was sad to be admitted because she felt like it was the end of the line for her. After a few weeks, she was diagnosed with dementia and depression, and her mobility decreased. One night she felt very sad and agitated, but due to her cognitive deterioration, she did not know how to express herself. She then began to yell and continuously ring her call bell. The nurse working the night shift had a total of twelve residents to monitor and she became overwhelmed. She saw on the resident’s care plan that she had an antipsychotic ordered “as needed”. The nurse told Susan she had a candy for her and gave her the highest dose of medication in order to sedate her. Chemical restraints are a form of medical restraint in which a drug is used to restrict the freedom and movement in a patient (Paul & Paul, 2016). Healthcare consists of many ethical controversies and debates; improper use of chemical restraints is on the rise. By 2030, one in every four persons will be senior which means that nursing homes and long-term care facilities will be overpopulated; leading to an increased chance of improper care (Government of Canada, 2014). This paper will incorporate ethical considerations that are violated by chemical restraints such as respect for humans, beneficence, autonomy and justice. The historical evolution and present day laws and regulations will be covered; along with the roles of individuals facing this dilemma. The main classes of medications used as chemical restraints are antipsychotics and benzodiazepines (Mattingly, 2014). However, Health Canada does not approve of antipsychotic use for elderly and pharmaceutical companies have issued a “black box warning” on their labelling; which is the strictest warning put on products by the Food and Drug Administration (FDA) when there is evidence of a potentially serious hazard upon taking the drug (Bruser, 2014). Even though they are contraindicated in the elderly population, the medication goes “off-label”-meaning the drug is being used for an age group or condition is it not approved for. Antipsychotic drugs are too often given to residents who are not psychotic; but are suffering from anxiety, depression, dementia, or feeling impatient and confined. Long-term care centers struggle with staffing shortages and …show more content…
The primary ethical principles that are violated are respect for human dignity, autonomy, and non-maleficence. Human dignity cannot be relinquished during illness, disability or approaching death; everyone is entitled to all their rights and freedoms despite their health status. The side effects of the medication can actually cause the symptoms they are supposed to be eradicating. Chemical restraints often leave the individual feeling confused, agitated, and physically sedentary. Robert Harris was described as energetic and lively before entering a nursing home in California (Bisnar, 2011). During the transition he acted like a “regular grumpy old man”, the doctors then categorized him as psychotic and needed to be chemical restrained. The medication made him very confused and drowsy; he stopped eating and drinking as much and lost 10% of his body mass within a month. This example demonstrates the harmful repercussions of improper use of antipsychotics. Respect for autonomy is also violated when using chemical restraints, the resident should be able to make choices for themselves. Everyone is entitled to the right of self-determination; and if they are not cognitively able to do so, then the family’s opinion should be considered and they should always be informed. The non-maleficence principle “to do no harm” is violated as chemical restraints cause physical harm to the residents. Chemical restraints have been proven to increase risk of falls, muscle weakness, incontinence, malnutrition, and increase dependence in activities of daily living (Gastmans & Milisen,