노인요양시설 내 신체억제 경험에 대한 의미 분화와 윤리적 갈등

초록

"This study explored the experience of physical restraint among nursing home staff and the essential structure of the ethical conflicts arising in that process. Although physical restraints are used to ensure residents’ safety, they raise ongoing ethical concerns due to infringement of autonomy and dignity. In nursing homes, unlike medical institutions, there are no clear guidelines regarding physical restraint, leading practitioners to face ethical dilemmas between safety and human rights. To achieve the research goal, in-depth interviews were conducted with 13 staff members from seven nursing homes in Seoul, and the data were analyzed using Colaizzi’s phenomenological method. The analysis identified 3 categories, 6 theme clusters, and 18 themes. First, participants perceived physical restraint not merely as a physical act, but as a multi-layered form of control embedded in spatial confinement, routinized daily life, and organizational management systems. Second, staff members experienced persistent ethical conflicts between respecting human rights and fulfilling responsibilities for safety, which was intensified by organizational practices and guardian-centered decision-making. Third, physical restraint was understood not as an individual choice, but as an outcome of structural interactions between the care environment and institutional responsibility. The study suggests that addressing physical restraint requires restructuring care environments and institutional responsibility systems, rather than focusing solely on individual practices. These findings lay the groundwork for developing guidelines and policies for human rights-oriented care in nursing homes."

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