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0 Running Head: Assignment 2: What Is Evidence? 1 Assignment 2: What Is Evidence? The essay highlights restraints and causes of restraints relevant to challenging behaviors. It is also aimed at emphasizing ethical considerations, laws, policies, and rights relevant to caring for challenging behaviors and restraining them for their safety. Restraints are defined as "interventions that may infringe [on] a person's human rights and freedom of movement, including observation, seclusion, manual restraint, mechanical restraint, and rapid tranquillization" (Thomann et al.). In general, restraints are used to regulate behavior when patients are disoriented or may injure themselves (e.g., suicide, falls) or others. (Pozgar, 2019, p. 62). All other options must be explored before restraint is considered a viable option in the given situation. (The Joint Commission, 2016). By safely reducing the patient's movement, physical restraint allows for the administration of necessary treatment. The use of physical restraint must be the last resort. (Ye et al.,). Physical restraint is an intervention that must be conducted as the last resort. Similarly, Chemical restraint, also known as rapid tranquilization, is the use of prescribed drugs for sedation in situations where people with mental health disorders present with severe agitation, aggression, or violent behaviors that pose a danger to themselves or others. This serves as the ultimate resort for patients being difficult to be controlled through lesser impacting restraints. (Muir‐Cochrane et al.).Physical causes of challenging behavior tend to be vast and can be sub-categorized as self-injurious, directly aggressive, and non-person-directed. The most common examples of physical harm are injury and aggression, pressure sores and loss of muscle tone, contractures, asphyxiation, and strangulation death. (Gunawardena & Smithard, 2019). Some of the significant physical causes of challenging behavior involve physical pain along with medical side effects or issues and discomfort imparted. It can further entail reason in the form of hunger or thirst, poor nutrition, dehydration, fatigue, inadequate workouts. Furthermore, internal challenges in the matter of urinary tract infections, sensory impairments, and reduced ability of communication foster increased scope of challenging behavior by the sufferers. (Stokes,2017). Psychosocial effects of restraints can include anger, frustration, aggression, fear, reduced engagement, include social isolation, loneliness, betrayal or pain, some forms of loss, and negativity followed by communal exclusion (Stokes, 2017). Concerning staff safety in clinical settings, challenging behaviors of clients or patients have a significant impact. Hazelhof et al. (2016) contended that nursing staff stress and burnout appear due to challenging behavior in terms of excess demands, unresponsiveness, and aggression. The Registered Nurse Standard of Practice states that practice standard 2 includes engaging in therapeutic and professional relationships. While standard 4 states that nurses are responsible for Allowing the person the chance to talk, discuss what they consider to be their most important life concerns. (National and Midwifery Board of Australia, 2016). Working with the consumers must identify their stressors, triggers, and why they become aggressive, they have all that information coordinated back to assessing the cause of their presenting behavior. Nurses' communication is respectful, comforting, and calming. Understanding empathy means listening to patients, believing in them, allowing them to express their emotions, and acknowledging that delusional people may also have valid motives for their behavior. (Tölli et al.) Understanding common triggers can assist nurses in identifying timely and appropriate interventions, as well as supporting the consumer to mitigate aggression. The more information about someone, the better decision is made about them. Registered nurses are responsible for talking to patients and asking what their point of view is? Nurses should try to identify the reasons for the escalating behavior. Standard 6 of Registered Nurse's Practice specifies that nurses provide safe, appropriate, and responsive nursing care for consumers. (National and Midwifery Board of Australia, 2016). They should focus on the consumers' strengths and support, not their risks, and encourage them to self-manage their behavior so that they will experience respect and regard for their civil rights. Sometimes, what the person needs is a few minutes of your attention and encouragement. De-escalation can often be accomplished on its own. Consumers were given feedback on their strengths, positive aspects, useful aspects, and successes and triumphs in de-escalation through the use of effective communication. (Lim et al.) By using these techniques, these patients may seek help earlier in the future, or avoid further episodes of agitation. Richmond and colleagues (2012) claim that when de-escalating verbally, staff should demonstrate empathy and a positive attitude, understanding that the patient's actions are not intentional, but rather a symptom of his/her mental health disorder. Similarly, Kuivalainen et al. (2017) reported de-escalation techniques are more effective at calming agitated patients than seclusion. Registered Nurses have the responsibility to analyze and think critically about nursing according to the Registered Nurse's standard of practice standard 1. A Registered Nurse should also be aware that they do not provoke further the patient or other patients. (Richmond et al.).Regular conversations with the nursing staff and the round-the-clock presence of the staff will make the patients feel engaged and decrease aggression. Furthermore, the ratio of staff to consumers increases interaction between them and decreases seclusion or restraint. A change in the environment of the ward or unit, such as lowering ambient distress levels and altering how nurses and consumers interact, might also be helpful. Debrief the patient and staff to reduce coercive experiences and to restore the therapeutic relationship. (Raveesh, et al.).These entail distracting, redirecting, and giving personal space to the patients. (challenging behavior foundation, 2021). Increasing the staff ratio also increases interaction between consumers and staff, resulting in a decline in seclusion or restraint. It can also be helpful to change the environment of the wards and units, such as reducing the ambient distress levels and changing the communication style between the consumers and nursing staff. It involves distracting, redirecting, and giving personal space to the patients to reduce coercive experiences and to restore the therapeutic relationship. (Raveesh, et al.). (challenging behavior foundation, 2021). Restraints should only be used with consent, which is an ethical consideration. When it comes to patient care, autonomy means respecting the patients' choices and interpreting their values by their preferences. A patient's autonomy is overridden for their safety. (CAI et al.). The need for appropriate care is also an ethical factor associated with beneficence The concept of selective beneficence regarding the implementation of restraints advocates designing interventions to protect patients from physical injury. (CAI et al.). Ye et al. (2018) mentioned that the principle of nonmaleficence accounts for ethical components as it desires to cause no harm to patients during the application of restraints. Care providers must weigh therapeutic goals with side effects when applying bodily restraints. The principle of autonomy may conflict with the principle of malfeasance (maleficence) if a patient causes physical harm to himself or herself or others. Lastly, the ethical principle of justice mentions that everyone should be treated equally. As a matter of justice, patients should never be labeled as "insane" under any circumstances. Patients with mental illness should not be denied their fundamental rights. (Ye et al., ). In addition to providing adequate healthcare, compliance with the Australian health and human rights includes providing patient safety as well as the safety of other staff, patients, and visitors (ACSQHC, 2021). Compliance with the "Australia Charter of Health Care Rights" assists in highlighting patient-centered care and empowering patients to become active participants in healthcare. In this way, specific needs of the patients can be identified, which in turn, leads to an appropriate selection of treatments and restraints for behavioral challenges based on ethical considerations. According to ACT's Policy (Restraint of a Person), Staff must document all restraints on the Mechanical or Physical Restraint Form at Attachment 2, in the patient's clinical records, and Riskman. Under the Rules for Persons Being Treated Mental Health Act 2015, The person able to use restraint, or their delegate, must record the forceful administration of medication in the Forcible Giving of Medication Register. Restraint is not allowed unless the person consents, or if the person cannot consent, a substitute decision-maker has statutory authority to give consent. (ACT HEALTH). Furthermore, section 8 states that in an emergency restraint of a person without their consent, where treatment is expected to be administered immediately and a concern for their safety exists, it is lawful under the defense of 'necessity. The Senior Nurse on duty must obtain a restraint order from the Senior Medical Officer responsible for the person. Under the Mental Health Act 2015, a mental health expert or care coordinator as well as a person in charge of the facility or an emergency medicine specialist within the emergency department can give /prescribe restraint orders. This defense can only succeed if restraint is the last resort after all other alternatives have failed. Documentation of restraints must be done on Riskman by all staff members. Whenever a person is restrained under the Mental Health Act 2015, the Public Advocate must be notified within 12 hours. (Policy Restraint of a Person – Adults Only, 2016). Additionally, the nursing practices must comply with the "Australian Capital Territory Law". There is a concern regarding privacy regarding restraints and restrictions applied for challenging behaviors and the imparted care (ACT GOVERNMENT, 2021). It can also contribute to the satisfaction of patients through effective care handling. (Canberra Hospital and Health Services, 2015) . Psychiatric treatment orders, community care orders, emergency hospital interventions, and emergency detentions should be able to be applied under the Mental Health Act 2015 with minimal restrictions. The doctor who conducted the assessment authorized involuntary detention, treatment care, and support at a mental facility for not more than three days (ACT Mental Health Act, 2015). Whenever restraints are used without the consent of the individual (adult) or the consumer does not have the decision-making capacity, the guardian or legal advocate keeps the consumer safe and presents a defense during the restrictive period (Canberra and Health Services, 2018). It can thereby be concluded through the desired evidence that exerting necessary care for patients with challenging behavior is a significant right. Reference List ACSQHC (2021). Australian Charter of Healthcare Rights. https://www.safetyandquality.gov.au/consumers/working-your-healthcare-provider/australian-charter-healthcare-rights ACT GOVERNMENT (2021). About Our Health System. https://health.act.gov.au/ Bowring, D. L., Painter, J., & Hastings, R. P. (2019). Prevalence of challenging behaviour in adults with intellectual disabilities, correlates, and association with mental health. Current Developmental Disorders Reports, 6(4), 173-181. https://link.springer.com/article/10.1007/s40474-019-00175-9 CHALLENGING BEHAVIOUR FOUNDATION (2021). Physical Interventions. https://www.challengingbehaviour.org.uk/information-and-guidance/when-things-go-wrong/physical-interventions/ Hallett,