course material

1. [From 10$/Pg] Anyone Ages 9 –
[From 10$/Pg] Anyone Ages 9 – The use of any form of restraints, whether in minors or
adults, should always remain as the last measure implemented in patient care, as there are
legal and ethical implications that must be considered. In fact, the ethical and legal basis for
using restraint interventions as a last resort is founded on eight crucially important
overarching principles, which include the fact that such interventions shall never be used as
a means for punishment or humiliation, and that a real possibility of harm to the person or
others is imminent if no action is undertaken and that the chosen form of restraint being
used is proportionate to the risk of harm while remaining as the seriousness of that harm.
Any action taken to restrict a client’s freedom of movement must always be the least
restrictive option for meeting that need, among others (Ridley et al., 2019).When used in
children, the most important aspects pertaining to the moral and ethical implications
resulting as the aftermath. Aspects that are highly significant to consider are the possible
resulting physical and psychological harm that may result from their use. One meta-analysis
found that a potential relationship between physical restraints being used for more than 15
minutes in children or adolescents resulted in increased risk for physical injury while
demonstrating a lack of therapeutic effect which potentially resulted in worsening
behaviors(Nielson et al., 2020). This worsening behavior can only be interpreted as a
worsening emotional state being experienced by the minor and may cause traumatic
memories. Based on this information, PMHNPs must be completely aware of the minor’s
condition and what led to the event requiring restraints, as well as all pertinent client health
information, to ensure that restraints are only used as a last resort when all other options to
deescalate the client have been exhausted. Furthermore, Florida practicing providers must
also take into account that legalities on physical restraint use limitations exist by client age;
for example, anyone ages 9 – 17 may only remain restrained for a maximum of two hours,
whereas in adults 18 and over the limit is four hours (Disability Rights Florida.org, 2022).
Just as with adults, provider orders for the restraint must be obtained within 15 minutes
(preferably prior to their application), but in the case of a minor, their parent/guardian
must also be notified.In terms of ethical and legal considerations regarding adults 18 years
and older, providers must also follow the same rules of implications for their use and
application, with the best ethical justification behind the notion that such restraint use will
result in self-harm (Crutchfield et al., 2019). However, when dealing with adults,
particularly seniors, providers must first consider their mental state, and any prior existing
medical conditions which may exacerbate under the use of restraints, and which then may

2. result in physical harm, or even death, to the client (Ye et al., 2018). In Florida, PMHNPs
must remain aware of the requirements of meeting the client’s needs while in restraints,
including that of physically monitoring and documenting on the client every 15 minutes,
while offering fluids and comfort measures as stipulated (Disability Rights Florida.org,
2022).ReferencesCrutchfield, P., Gibb, T. S., Redinger, M. J., Ferman, D., & Livingstone, J.
(2019). The conditions for ethical application of restraints. Chest, 155(3), 617–625.
https://doi.org/10.1016/j.chest.2018.12.005Disability Rights Florida.org. (2022). Rights in
a statewide inpatient psychiatric program (sipp) for children under 21 – disability rights
florida. https://disabilityrightsflorida.org/disability-
topics/disability_topic_info/rights_in_a_statewide_inpatient_psychiatric_program_sipp_for_c
hildren_underNielson, S., Bray, L., Carter, B., & Kiernan, J. (2020). Physical restraint of
children and adolescents in mental health inpatient services: A systematic review and
narrative synthesis. Journal of Child Health Care, 25(3), 342–367.
https://doi.org/10.1177/1367493520937152Ridley, J., Leitch, S., & Restraint Reduction
Network (RRN) Training Standards 2019. (2019). Ethical training standards to protect
human rights and minimise restrictive practices. (1st Edition). Birmingham: BILD
Publications.Ye, J., Xiao, A., Yu, L., Wei, H., Wang, C., & Luo, T. (2018). Physical restraints: An
ethical dilemma in mental health services in china. International Journal of Nursing
Sciences, 5(1), 68–71.
https://doi.org/10.1016/j.ijnss.2017.12.001WEEK2PDF1.pdfWEEK2PDF2.pdf