Cultivating moral sensitivity and restraint-free practice in nurses and midwives.

Abstract

Nursing and midwifery students are frequently exposed to physical restraint during clinical training, often presented as necessary for patient safety. However, growing evidence challenges this assumption, highlighting the risks associated with restraint and the limited implementation of effective alternatives in practice. Studies show that alternatives are considered in only a minority of cases, while organisational and educational factors contribute to the persistence and normalisation of restraint. Although professional codes define restraint as an exceptional, last-resort measure, this principle is not consistently reflected in practice or education. Students may experience moral distress and cognitive dissonance when witnessing practices that conflict with core values such as patient autonomy and dignity. At the same time, hierarchical dynamics, obedience to authority, and the influence of the hidden curriculum and professional socialisation may inhibit critical reflection, foster passive compliance, and contribute to the normalisation of ethically problematic care. Despite these implications, nursing and midwifery curricula often provide limited opportunities to explicitly address restraint, its ethical complexity, and the development of moral sensitivity. This discussion paper explores how educational strategies can support students to critically engage with restraint practices encountered during clinical placements and to develop both moral sensitivity and ethical agency. It highlights the importance of cultivating moral sensitivity through reflection, simulation, and experiential and digital learning, enabling students to recognise ethical dilemmas, question routine practices, and advocate for patients. Educational approaches should also promote the application of evidence-based alternatives to restraint, including person-centred interventions such as pain management, environmental adaptations, de-escalation strategies, and the involvement of family members or volunteers. Ultimately, nursing and midwifery education should prepare future professionals to recognise when routine clinical practices have been normalised despite being ethically problematic, to question their legitimacy critically, and to advocate for humane, dignified, restraint-free care.