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.
  
  
  OBJECTIVE
  What do support staff consider as restraints on freedom and how do they justify these restraints?
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Tilburg University, The Netherlands.
authors.forename: Anne Pier S
authors.initials: APS
authors.lastname: Van der Meulen
authors.affiliation: Tilburg University, The Netherlands.
authors.forename: Maaike A
authors.initials: MA
authors.lastname: Hermsen
authors.affiliation: Tilburg University, The Netherlands.
authors.forename: Petri Jcm
authors.initials: PJ
authors.lastname: Embregts
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D004993:Ethics, Nursing; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000451:nursing*; D008297:Male; D008875:Middle Aged; D009740:Nursing Staff / Q000523:psychology* / Q000706:statistics & numerical data; D026684:Personal Autonomy; D011582:Psychological Theory; D055815:Young Adult
keywords: Ethics; intellectual disabilities; morality; restraints on freedom; support staff