Restraints in daily care for people with moderate intellectual disabilities

Research output: Contribution to journalArticleScientificpeer-review

Abstract

Background:
Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings.

Research question:
What do support staff consider as restraints on freedom and how do they justify these restraints?

Research design:
In this study, data were collected by semi-structured interviews.

Participants and research context:
Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands.

Ethical considerations:
The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee.

Findings:
Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger.

Discussion:
In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence.

Conclusion:
Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.
Original languageEnglish
Pages (from-to)54-68
JournalNursing Ethics: An International Journal for Health Care Professionals
Volume25
Issue number1
DOIs
Publication statusPublished - 2018

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Personal Autonomy
Disabled Persons
Coercion
Ethics
Netherlands
Mental Competency
Drinking
Organizations
Interviews

Keywords

  • Adult
  • Attitude of Health Personnel
  • Ethics, Nursing
  • Female
  • Humans
  • Intellectual Disability/nursing
  • Male
  • Middle Aged
  • Nursing Staff/psychology
  • Personal Autonomy
  • Psychological Theory
  • Young Adult

Cite this

@article{c1b9bccdc632491e994f20f9b95dd44c,
title = "Restraints in daily care for people with moderate intellectual disabilities",
abstract = "Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings.Research question: What do support staff consider as restraints on freedom and how do they justify these restraints?Research design: In this study, data were collected by semi-structured interviews.Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands.Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee.Findings: Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger.Discussion: In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence.Conclusion: Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.",
keywords = "Adult, Attitude of Health Personnel, Ethics, Nursing, Female, Humans, Intellectual Disability/nursing, Male, Middle Aged, Nursing Staff/psychology, Personal Autonomy, Psychological Theory, Young Adult",
author = "{van der Meulen}, A.P.S. and Maaike Hermsen and P.J.C.M. Embregts",
year = "2018",
doi = "10.1177/0969733016638141",
language = "English",
volume = "25",
pages = "54--68",
journal = "Nursing Ethics: An International Journal for Health Care Professionals",
issn = "1477-0989",
publisher = "Sage Publications Ltd",
number = "1",

}

Restraints in daily care for people with moderate intellectual disabilities. / van der Meulen, A.P.S.; Hermsen, Maaike; Embregts, P.J.C.M.

In: Nursing Ethics: An International Journal for Health Care Professionals, Vol. 25, No. 1, 2018, p. 54-68.

Research output: Contribution to journalArticleScientificpeer-review

TY - JOUR

T1 - Restraints in daily care for people with moderate intellectual disabilities

AU - van der Meulen, A.P.S.

AU - Hermsen, Maaike

AU - Embregts, P.J.C.M.

PY - 2018

Y1 - 2018

N2 - Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings.Research question: What do support staff consider as restraints on freedom and how do they justify these restraints?Research design: In this study, data were collected by semi-structured interviews.Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands.Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee.Findings: Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger.Discussion: In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence.Conclusion: Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.

AB - Background: Self-determination is an important factor in improving the quality of life of people with moderate intellectual disabilities. A focus on self-determination implies that restraints on the freedom of people with intellectual disabilities should be decreased. In addition, according to the Dutch Care and Coercion bill, regular restraints of freedom, such as restrictions on choice of food or whom to visit, should be discouraged. Such restraints are only allowed if there is the threat of serious harm for the clients or their surroundings.Research question: What do support staff consider as restraints on freedom and how do they justify these restraints?Research design: In this study, data were collected by semi-structured interviews.Participants and research context: Fifteen support staff working with clients with moderate intellectual disabilities were interviewed. All participants work within the same organisation for people with intellectual disabilities in the Eastern part of the Netherlands.Ethical considerations: The study was conducted according to good scientific inquiry guidelines and ethical approval was obtained from a university ethics committee.Findings: Most restraints of freedom were found to be centred around the basic elements in the life of the client, such as eating, drinking and sleeping. In justifying these restraints, support staff said that it was necessary to give clarity in what clients are supposed to do, to structure their life and to keep them from danger.Discussion: In the justification of restraints of freedom two ethical viewpoints, a principle-guided approach and an ethics of care approach, are opposing one other. Here, the self-determination theory can be helpful, while it combines the autonomy of the client, relatedness to others and the client’s competence.Conclusion: Despite the reasonable grounds support staff gave for restraining, it raises the question whether restraints of freedom are always in the interest of the client.

KW - Adult

KW - Attitude of Health Personnel

KW - Ethics, Nursing

KW - Female

KW - Humans

KW - Intellectual Disability/nursing

KW - Male

KW - Middle Aged

KW - Nursing Staff/psychology

KW - Personal Autonomy

KW - Psychological Theory

KW - Young Adult

U2 - 10.1177/0969733016638141

DO - 10.1177/0969733016638141

M3 - Article

VL - 25

SP - 54

EP - 68

JO - Nursing Ethics: An International Journal for Health Care Professionals

JF - Nursing Ethics: An International Journal for Health Care Professionals

SN - 1477-0989

IS - 1

ER -