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Keywords:

  • restraint;
  • chemical;
  • physical;
  • Foucault;
  • case study;
  • discourse;
  • governance;
  • marginalization;
  • older people;
  • power;
  • physiotherapy;
  • nursing

Background.  The purpose of this article is to provide an interpretation of how restraint use is maintained and legitimized despite negative reports on its efficacy and questions about its ethicality. My research examined the use of restraint on a patient requiring care in an acute teaching hospital in Australia. This article examines one case study that was part of a PhD research project. The literature reveals evidence of the harm that restraints cause, as well as their ineffectiveness as a safety measure. In addition, it indicates that the prevalence of restraint use is high.

Methods.  The study is framed by a Foucauldian approach to discourse analysis. This report is an in-depth case study including observations of the patient, interviews with members of the multidisciplinary team and analysis of medical, physiotherapy and nursing notation.

Findings.  Discourses from the health care team are identified by which restraint use is justified, and legitimized by staff. An important discursive practice is ‘constituting the patient's inability to self govern' and their resulting marginalization from the services provided by the team.

Limitations.  There are certain philosophical limitations including classical arguments about the position of postmodernism and specifically the ideas of Michel Foucault as opposed to other philosophy's ability to make sense of a phenomenon. The study was carried out in Australia and thus the discursive practices may be dissimilar in other countries.

Conclusions.  Through these discursive practices we can understand how staff maintain a monopoly over the truth and perpetuate claims about the inevitability of restraint use.