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Nurses’ ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study

Medicine, Health Care and Philosophy volume 16, pages 983–991 (2013)Cite this article

Abstract

In their practice, nurses make daily decisions that are ethically informed. An ethical decision is the result of a complex reasoning process based on knowledge and experience and driven by ethical values. Especially in acute elderly care and more specifically decisions concerning the use of physical restraint require a thoughtful deliberation of the different values at stake. Qualitative evidence concerning nurses’ decision-making in cases of physical restraint provided important insights in the complexity of decision-making as a trajectory. However a nuanced and refined understanding of the reasoning process in terms of ethical values is still lacking. A qualitative interview design, inspired by the Grounded Theory approach, was carried out to explore nurses’ reasoning process in terms of ethical values. We interviewed 21 acute geriatric nurses from 12 hospitals in different regions in Flanders, Belgium in the period October 2009–April 2011. The Qualitative Analysis Guide of Leuven was used to analyse interview data. Nurses’ decision-making is characterized as an ethical deliberation process where different values are identified and where the process of balancing these values forms the essence of ethical deliberation. Ethical decision-making in cases of physical restraint implies that nurses have to choose which values receive priority in the process, which entails that not all values can be respected to the same degree. As a result, decision making can be experienced as difficult, even as a dilemma. Driven by the overwhelming goal of protecting physical integrity, nurses took into account the values of dignity and justice more implicitly and less dominantly.

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Author information

Affiliations

  1. KAHO St-Lieven, Sint-Niklaas, Belgium

    Sabine Goethals

  2. Centre for Health Services and Nursing Research, Catholic University of Leuven, Sint-Niklaas, Belgium

    Bernadette Dierckx de Casterlé

  3. Centre for Biomedical Ethics and Law, Catholic University of Leuven, Sint-Niklaas, Belgium

    Chris Gastmans

Authors
  1. Sabine Goethals
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  2. Bernadette Dierckx de Casterlé
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  3. Chris Gastmans
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Correspondence to Sabine Goethals.

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Goethals, S., Dierckx de Casterlé, B. & Gastmans, C. Nurses’ ethical reasoning in cases of physical restraint in acute elderly care: a qualitative study. Med Health Care and Philos 16, 983–991 (2013). https://doi.org/10.1007/s11019-012-9455-z

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  • DOI: https://doi.org/10.1007/s11019-012-9455-z

Keywords

  • Ethical decision making
  • Grounded theory
  • Nurses
  • Physical restraint
  • Qualitative research