False Imprisonment
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False imprisonment is confining an individual against his or her will by either physical (restrain- ing) or verbal (detaining) means. The following are examples:
■ Using restraints on individuals without the appropriate written consent
■ Restraining mentally challenged individuals who do not represent a threat to themselves or others
■ Detaining unwilling clients in an institution when they desire to leave
■ Keeping persons who are medically cleared for discharge for an unreasonable amount of time
■ Removing clients’ clothing to prevent them from leaving the institution
■ Threatening clients with some form of physical, emotional, or legal action if they insist on leaving
Sometimes clients are a danger to themselves and to others. Nurses need to decide on the appropri- ateness of restraints as a protective measure. Nurses should try to obtain the cooperation of the client before applying any type of restraint. The first step is to attempt to identify a reason for the risky or threatening behavior and resolve the problem. If this fails, document the need for restraints, consult with the physician, and carefully follow the institu- tion’s policies and standards of practice. Systematic documentation and continual assessment are of highest importance when caring for clients who have restraints. Any changes in client status must be reported and documented. Failure to follow these guidelines may result in greater harm to the client and possibly a lawsuit for the staff. Consider the following:
Mr. Harrison, who is 87 years old, was admitted to the hospital through the emergency department with severe lower abdominal pain of 3 days’ duration. Physical assessment revealed severe dehydration and acute distress. A surgeon was called, and an abdomi- nal laparotomy was performed, revealing a rup- tured appendix. Surgery was successful, and the client was sent to the intensive care unit for 24 hours. On transfer to the surgical floor the next day, Mr. Harrison was in stable condition. Later that night, he became confused, irritable, and anxious.
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chapter 3 ■ Nursing Practice and the Law 33 He attempted to climb out of bed and pulled out his indwelling urinary catheter. The nurse restrained him. The next day, his irritability and confusion continued. Mr. Harrison’s nurse placed him in a chair, tying him in and restraining his hands. Three hours later he was found in cardiopulmonary arrest. A lawsuit of wrongful death and false imprison- ment was brought against the nurse manager, the nurses caring for Mr. Harrison, and the institution. During discovery, it was determined that the primary cause of Mr. Harrison’s behavior was hypoxemia. A violation of law occurred with the failure of the nursing staff to notify the physician of the client’s condition and to follow the institution’s standard of practice on the use of restraints.
To protect themselves against charges of negligence or false imprisonment in such cases, nurses should discuss safety needs with clients, their families, or other members of the health-care team. Careful assessment and documentation of client status are imperative and also components of good nursing practice. Confusion, irritability, and anxiety often have metabolic causes that need correction, not restraint.
There are statutes and case laws specific to the admission of clients to psychiatric institutions. Most states have guidelines for emergency involun- tary hospitalization for a specific period of time. Involuntary admission is considered necessary when clients demonstrate a danger to themselves or others. Specific procedures and legal guidelines must be followed. A determination by a judge or administrative agency and/or certification by a specified number of health-care providers that a person’s mental health justifies his or her detention and treatment may be required. Once admitted, these clients may not be restrained unless the guide- lines established by state law and the institution’s policies provide for this possibility. Clients who voluntarily admit themselves to psychiatric institu- tions are also protected against false imprisonment. Nurses working in areas such as emergency depart- ments, mental health facilities, and so forth need to be cognizant of these issues and find out the policies of their state and employing institution.
Assault and Battery Assault is threatening to do harm. Battery is touch- ing another person without his or her consent. The significance of an assault lies in the threat:
“If you don’t stop pushing that call bell, I’ll give you this injection with the biggest needle I can find” is considered an assaultive statement. Bat- tery would occur if the injection were given when it was refused, even if medical personnel deemed it was for the “client’s good.” With few exceptions, clients have a right to refuse treatment. Holding down a violent client against his or her will and injecting a sedative is battery. Most medical treat- ments, particularly surgery, would be considered battery if clients failed to provide informed consent.