The excessive use of chemical and physical restraints in intermediate care facilities has been a subject of study since the early eighties, and has produced several explanations for why restraint use continues to be practiced. One of the primary reasons often cited is that restraints are used to control "problematic behavior" commonly exhibited by a person suffering from dementia. The focus of the proposed project is to analyze whether restraint practices for residents with moderate to severe dementia differ between Special Care Units and integrated units within long term care facilities. The main objective of the study is to demonstrate whether seniors with dementia residing in Special Care Units will be less likely to encounter physical and chemical restraints than demented residents living within an integrated facility. This objective explores the assumption that Special Care Units were designed to meet the needs of residents with dementia, and therefore, care providers should be more accepting of deviant behaviours. The findings revealed that the more severe the level of memory impairment the more likely a resident would be placed in a Special Care Unit. Once located in these Special Care Units, residents were more likely to experience physical and chemical restraints than their counterparts in integrated care units.

This thesis investigates the implementation of the ‘Team-Teach’ behaviour support training programme in New Zealand. This school-wide training package develops generalised skills in behaviour management and de-escalation for students who are exhibiting extreme and violent behaviour. The Team-Teach framework also provides training in physical interventions that are designed for use in schools, and with children. The legal issues associated with the use of physical intervention are also addressed during the training in addition to recommended best practice for the development of policies and procedures. Prior evidence suggests that behaviour support training with a physical intervention overlay can result in increased confidence and safety for staff members and a reduction in the levels of physical intervention and incidents. The purpose of this study was to investigate participant opinion of Team-Teach training immediately after course delivery and further into implementation in addition to an investigation into the barriers and facilitating factors affecting the impact of Team-Teach within two New Zealand special schools. The research employs a mixed method pragmatic paradigm utilising document analysis, questionnaire and interview survey to ascertain the impact and implementation issues related to Team-Teach training. Quantitative analysis of course feedback ratings and attitudinal scales were combined with the qualitative thematic analysis of written comments and interview transcripts to inform the discussion. The results present a positive endorsement of Team-Teach training both immediately after the training course and further into implementation and compare favourably with the findings of previous international studies. Research participants reported a significant increase in personal confidence and a perceived reduction in incidences of extreme behaviour and physical intervention. The perceptions of research participants to initial training in New Zealand varied considerably between training providers and there were also notable differences between groups in different work roles and with different levels of experience. Research participants expressed concern over the lack of adaptation of the Team-Teach syllabus to embrace the New Zealand context. Research participants endorsed use of the ‘positive handling plan’ (PHP) as a way to legitimatise and standardise practice in difficult situations. It was however clear that neither school had developed genuine parental partnerships in either the creation or effective communication of these plans. There was a general agreement that parents should be able to access Team-Teach training but significant concerns were highlighted over how this could be achieved in practice. Research participants endorsed the Team-Teach model of training ‘in-house’ tutors to provide contextual and responsive internal capacity. There was a general agreement that the physical interventions taught were effective and appropriate for use with children. Participants clearly expressed concerns related to the teaching of too many physical interventions that were not required and recommended that training in physical interventions should be in class teams and specific to actual need. There was a clear indication that research participants believed this training should receive official recognition at the highest level as an acknowledgement that physical intervention is sometimes necessary in schools and that there is a legitimate way to achieve this.

Bakgrund: Fasthållning av barn används vid ett flertal kliniska procedurer. Barns samt vårdnadshavares upplevelse av situationen är ofta negativ. Etiska principer samt lagar och riktlinjer utgör en teoretisk grund i en fasthållningssituation. Barnets autonomi samt sjuksköterskans omvårdnadsplikt är två utgångspunkter i fasthållning som fenomen. Syfte: Att beskriva sjuksköterskors erfarenhet av fasthållning av barn vid kliniska procedurer inom somatisk vård. Metod: Litteraturstudien är baserad på tio vetenskapliga artiklar med både kvalitativ och kvantitativ ansats. En textanalys, inspirerad av kvalitativ innehållsanalys, har gjorts i resultatet. Resultat: Fem kategorier framkom: Användandet skiljer sig åt, Fasthållning möjliggör kliniska procedurer, Optimera situationen för barnet, Kommunikation underlättar fasthållningen samt Fasthållning är en svårighet. Sjuksköterskornas syn på fasthållning skiljdes åt beroende på den specifika situationen samt på sjuksköterskornas egna kunskaper och förutsättningar. Sjuksköterskorna upplevde en känslomässig konflikt i användandet av fasthållning men ansåg också att fasthållning är en nödvändighet vid många kliniska procedurer på barn, särskilt i akuta sammanhang. Slutsats: Erfarenheten av fasthållning av barn vid kliniska procedurer är mångfacetterad. Sjuksköterskor bör ha god kunskap om barns rättigheter och om etiska principer för att kunna optimera de kliniska procedurerna. Klinisk betydelse: Studien kan ge ett ökat etiskt medvetande som stärker sjuksköterskans professionella roll samt ha betydelse för vårdrelationen. / Background: Restraint of children is used in multiple clinical procedures. The experience of the situation is usually negative on children and legal guardians. Ethical principles, laws and guide lines represents the theoretical foundation in a restraint situation. The autonomy of the child as well as the caring duty of the nurse make up two basis for the phenomena of restraint. Aim: To describe nurses' experiences of restraint of children during clinical procedures in somatic health care. Method: This literature review is based on ten scientific papers with both qualitative and quantitative approach. A textual analysis, inspired by qualitative content analysis, represents the result. Result: Five categories emerged in the result: The usage differs, Restraint enables clinical procedures, Optimizing the situation for the child, Communication facilitates the use of restraint and Restraint is a difficulty. The nurses' view on restraint differed depending on the specific situation as well as the skills and abilities of the nurse. The nurses experienced an emotional conflict in the use of restraint but considered it to be necessary in multiple clinical procedures, especially during emergency contexts. Conclusion: The experience of restricting children during clinical procedures is multifaceted. Nurses need to have good knowledge about children's rights and ethical principles to optimize the clinical procedures. Clinical significance: The study can provide a greater ethical awareness that strengthens the professional role of the nurse and also have significance for the nurse-patient relationship.

Syfte: Syftet med föreliggande litteraturstudie var att beskriva sjuksköterskors erfarenheter av att utföra tvångsvårdsåtgärder av patienter med psykisk ohälsa samt att granska de valdaartiklarnas urvalsmetod. Metod: Föreliggande litteraturstudie har en deskriptiv design som inkluderar artiklar av bådekvalitativ och kvantitativ ansats, litteraturstudien innefattar totalt tolv artiklar. Resultat: Resultatet visade att sjuksköterskors erfarenheter av utförande av tvångsvårdsåtgärder inkluderar ett brett spektrum av känslor som engagerar bland annat enmotstridighet av känslor då patientens autonomi fråntogs. Resultatet visade skilda erfarenheter hos sjuksköterskor gällande uppfattning om tvångsvårdsåtgärder gynnade patienten i fråga eller inte. Majoriteten av sjuksköterskorna upplevde att utförandet av tvångsåtgärder används för lättvindigt samt att de äventyrar den terapeutiska alliansen med patienten. Sjuksköterskor gemensamma åsikt var att det fanns behov för att få möjlighet att ventilera åtgärdsförfarandet. Slutsats: Resultatet visade att majoriteten av sjuksköterskor ansåg att tvångsvårdsåtgärder medförde negativa erfarenheter. Ett återkommande utslag i samband med tvångsvårdsåtgärder var motstridighet av känslor hos sjuksköterskorna till följd av det etiska dilemmat som uppstod. Gemensamma erfarenheter identifierades, att tvångsvårdsåtgärder användes för lättvindigt. Alternativa åtgärder bör få mer utrymme att implementeras i den kliniska praktiken. Det bör även utvecklas ett ventilationsforum för sjusköterskor som kommer i kontakt med tvångsåtgärder för möjlighet till diskussion samt en förbättring av förfarandet. / Aim: The aim of the present study was to describe nurses' experiences of performing compulsory measures of patients with mental illness and review the selected articles sample method.                                                                                                                           Method: The present literature study has a descriptive design that includes articles of both qualitative and quantitative approach; the literature review includes a total of twelve articles.   Result: The results showed that nurses' experiences of performing compulsory treatment measures include a wide range of emotions that involve, among other things, a conflict of emotions in conjunction with the exclusion of the patient's autonomy. Results showed differing experiences of nurses existing idea of ​​compulsory measures favored the patient in question or not. The majority of nurses felt that the execution of coercive measures was used too casually as well as to undermine the therapeutic alliance with the patient. Nurses’ common view was that there was need for the opportunity to vent action procedure.   Conclusion: The results showed that the majority of nurses felt that compulsory measures implied negative experiences. A recurring verdict associated with compulsory measures was a contradiction of emotions in nurses due to the ethical dilemma that arose. Common experiences were identified, that compulsory measures was used too lightly. Alternative measures should have more room to be implemented in clinical practice. It should also develop a forum for ventilation for the nurses that are in contact with the coercion, an opportunity for discussion and improvement of the procedure.

Paul Ramsey's medical ethics is built from a philosophical antinomy: Premise, the human being is a creature of will; Proposition, the human will is a free will; Contrary Proposition, the human will is a not-free will. General, exceptionless rules of conduct function in Ramsey's thought as moral restraint to human freedom. The moral agent ought always to act in accord with the demands of agape; and not only once but as often as the same features of a decision/action arise. General rules guide and restrain human free will in a necessary way to assure an ordered and moral society. This antinomy-interpretation helps locate Ramsey in the theatre of ethical debate; it also is the key to criticism of Ramsey's rigid rules in medical ethics.

Universiẗat, Diss., 2006--Augsburg.

Zugl.: Tübingen, Univ., Diss., 2006

Zugl.: St. Gallen, University, Diss., 2008. / Includes bibliographical references and bibliography (p. 219-231).

Univ., Diss.--Köln, 2003. / Literaturverz. S. 329 - 339.

Univ., Diss.-2003--Frankfurt am Main, 2002.