Reducing Seclusion

Central Themes Around The Practice Of Seclusion

Seclusion is defined as the forced confinement of an individual alone in a locked room or in an area where the individual is physically stopped from leaving (APNA, 2014). Seclusion is used as an intervention in mental health settings to manage violent and self-destructive behavior. However, its implementation is controversial. Its implementation is conflicting with the international guidelines and recommendations, government reports, mental health service policies, and a literature support that seclusion as a policy to handle with disturbed behavior must be used in the least to absolutely no amount. It is seen as a human rights issue and believed that it has no therapeutic value and has only caused emotional and physical harm. This research is conducted to evaluate the role of nurses in reduction of the practice of seclusion.

The usage of seclusion is controversial as it is also regraded as a forced activity with negative outcomes for the clients as well as the staff. Yet this strategy is used regularly as an intervention in mental health settings globally. Nurses are widely involved in beginning and managing the practice of seclusion due to their direct care role, nurses are commonly involved in the initiation or management of seclusion. Several databases were searched using the key words “role”, “nurses”, “seclusion” and “reduction”. After careful evaluation, 12 articles were found relevant. Comprehensive evaluation of these articles identified few central themes around the practice of seclusion which are discussed below. An outline of the literature is also presented as per the central themes.

ORDER A PLAGIARISM-FREE PAPER HERE

One of the research indicated that majority of nurses supported the continued use of seclusion as a practice for management of violence and aggression. Therefore, it becomes vital to gain deep understanding of the factors that affect attitudes to effectively reduce seclusion (Happell & Harrow, 2010). Further, numerous recommendations for reduction of the practice of seclusion by nurses are also identified.

The practice of seclusion practice is a special form of restraint in which the client is put in a locked room or area from which they cannot exit at their will. Seclusion in most of the metal health settings involved two forms, containment and isolation and reduction. The most common form is containment is the practice in which an individual is placed within a locked room and the patient can only be freed on staff’s decision. Isolation involves putting the patient alone in a room. Reduction involves decreasing the sensory input so that the the room is reasonably bare.

The Lack Of Accessible Alternatives To Seclusion

Nurses who support the practice give safe working environment the top priority and believe that seclusion is one of the tools which is used to achieve this goal. They believe having a safe environment is primary to central to understanding of their practice. On the contrary, nurses who oppose the practice of seclusion believe that this practice has negative influence on patient and staff safety. As it can enhance the likelihood for physical injury to patients as well as staff. Further the opponents also argue that usage of seclusion may have adverse physical and psychological effect on the patient, staff and other patients (Purcell, McGlinsey, Beckett, Rudd, & Arbour, 2015).

One of the most commonly occurring factor which frequently came up in the literature was lack of accessible alternatives to seclusion. It was reported that the lack of alternatives approaches negatively influenced the will of the nurses to use the practice of seclusion as it lowers the options for nurses to address aggression. Nurses want to separate the aggressive patients from other patients but there’s no other place to send them.

It was also noticed that a significant consideration was the quality of interpersonal environment and relationships between the patients and nurses (Yang, Hargreaves, & Bostrom, 2014). In most of the settings patient aggression is regarded as the chief cause of the practice of seclusion as the nurses may believe that if there are aggressive and violent individuals, there is a need for seclusion. Nurses, other staff and patients considered at risk from aggression and, require protection from danger through seclusion of the potential harm-causing patient. Nurses in support of the concept of seclusion believe that it prevents patients from hurting other people. However, it must be considered that inadequate or poor nurse-patient interpersonal relationships may be a source or contributor in development of patient aggression. For example, patients may make use of the aggression when the nurses fail to listen to or fulfill patients’ requirements.  They could adopt an aggressive behavior to be heard. Therefore, it is essential that the mental health nurses must find out the reason of a patient’s anger by listening to them instead of secluding them. when patient’s aggressive behaviour is responded with staff’s inappropriate or insensitive behaviour, it may lead to escalation of patient’s aggression. Therefore, it is essential that nurses develop communication skills to handle such situations.

Another important factor which lead to a poor interpersonal relationship is the cultural differences and insensitivity which may cause misinterpretation of patients’ behavior as aggressive. For example, if the patient is Italian, he might use his hands to explain his issues which the non-Italian nurse might perceive as violence. So, it is essential that the nurses familiarize themselves from the culture of the service-user. Apart from the poor nurse-patient interpersonal relationship, other factor which was identified was unfavorable physical environment. The adverse physical conditions may lead to development of aggression between patient and therefore their subsequent seclusion (Cochrane, McCann, Baird, & McCann, 2010).

The Importance Of Interpersonal Relationships And Practice Environment

For the lack of accessible alternatives to restraint and seclusion, it was found that having space where patients could go, either of their own will, or being put there for a short time by the nurse, like in a low stimulation area (LSA) or high dependency unit can be an effective alternative to seclusion.

Further, it is also identified through the literature that the practice environment affect the decision of the staff to implement of the practice of seclusion. Some of the factors which contribute are the organizational policies about use of seclusion, low staff-to-patient percentage, degree of care requirement by the patient, gender mix, focus on offering a safe environment to patients and staff and adhering that seclusion is implanted rarely and as a last resort, as per the government policies. Nurses must ensure that they are using the measure of seclusion appropriately and their practice does not require any changes. Nurse at their level must also view seclusion as the last resort and should only make this decision after careful evaluation. However, it is not completely dependent on the nurses as the competency to handle mental health patients by using seclusion as last resort depends on nurse-to-patient ratio, nurse education and nurse clinical experience. Nurse may make use of the measure of seclusion due to pressure they are experiencing due to shortage of staff and increased number of patients with challenging and aggressive behaviour. Therefore, the reduction in usage of seclusion practice can be achieved through integrated efforts of organization and the nurses by having adequate, educated and experienced staff (Gerace & Muir?Cochrane, 2018).

Further, the level of care needed by the patient also affects the usage of seclusion on them. Apart from that, seclusion practice also depend on the age and diagnosis of the patient. For example, staff refrain from using seclusion on weak elderly or those suffering from dementia.

The literature demonstrated consensus over the recommendations that can be implemented to reduce the practice of seclusion. The recommendations are required at various level but this research only holds the scope for the role of nurses in reducing seclusion. A strong nursing leadership which will evaluate these cases and take the most suitable decision is vital. Role Of Nurses In Mental Health Settings Discussion Paper The nurse leader should make consultation available to nurses, including ethical consultation about decisions regarding seclusion. Nurse leaders can lead the nursing workforce in right direction in using the measure of seclusion. Further nurses must focus on bringing the change in organizational culture in promoting minimization or eradication of seclusion. Further, the nurses should focus on engagement and participation with the patients so that an interpersonal relationship based on trust and empathy can be developed (O’Hagan, Divis, & Long, 2008).

ORDER NOW HERE

Recommendations For Reduction Of The Practice Of Seclusion By Nurses

Nurses should be educated along with other members of the interdisciplinary team so that they are capable to take appropriate decision regarding the practice of seclusion. The education must include suitable use of seclusion, and on the alternate options of the intervention. Nurses should ensure that care of the patient is monitored and individualized with the aim of using seclusion only when no other feasible option is available. Nurses should support the working environment to offer viable substitutive options to seclusion and shift increasingly toward a seclusion-free environment while giving a therapeutic safety for the patients. Nurses should focus on documentation so they must be aware regarding what should be documented. Nurses should familiarize themselves and understand the ethical outcomes of secluding patients. They should learn about government policies and organizational guidelines regarding the practice of seclusion that clarifies when, where, and how clients are to be secluded and monitored while secluded. Overall, it is essential that nurses must understand all the implications of allowing the implementation of seclusion in health care facilities (Center for Ethics and Human Rights, 2012).

Conclusion

The usage of seclusion is prevalent in mental health care settings as a therapeutic intervention however, its usage is debatable as it can result in exacerbation of the patient’s condition and harm the patient as well as the staff by causing physical and emotional trauma to the patient. The research provided clarification regarding the practice of seclusion. Several factors which contribute towards provision of deep exploration of contextual influences sustaining resistance to decreasing or eradicating the practice of seclusion. Some of the factors identified are lack of alternative option of seclusion, the poor quality of interpersonal environment and relationships between the patients and nurses, the cultural differences and insensitivity, use of seclusion, low staff-to-patient percentage and degree of care requirement by the patient. Such contextual and situational factors must be addressed to reduce the practice of seclusion meaningfully and sustainably. Certain recommendations for minimizing the measure of seclusion are based on education, consultation, support and collaboration. The ethical and workplace cultural issues regarding the measure of seclusion must be considered. Comprehensive initiatives involving interdisciplinary team must be developed and implemented to address violence and aggression among patients. Further research is required to assess the efficiency of alternative options to the practice of seclusion.

References

APNA. (2014, April). Seclusion & Restraint Standards of Practice. Retrieved from APNA: https://www.apna.org/i4a/pages/index.cfm?pageid=3730

Center for Ethics and Human Rights. (2012). Reduction of Patient Restraint and Seclusion in Health Care Settings.

Cochrane, E. M., McCann, T. V., Baird, J., & McCann, F. (2010). Nurses’ experiences of seclusion and restraint use in acute old age psychiatry inpatient units. Melbourne.

Gerace, A., & Muir?Cochrane, E. (2018). Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey. International Journal of Mental Health Nursing.

Happell, B., & Harrow, A. (2010). Nurses’ attitudes to the use of seclusion: A review of the literature. International journal of mental health nursing, 19(3), 162-8.

O’Hagan, Divis, & Long. (2008). Best practice in the reduction and elimination of seclusion and restraint; Seclusion: time for change. National Centre of Mental Health Research, Information and Workforce Development. Auckland: Te Pou Te Whakaaro Nui.

Purcell, A., McGlinsey, Beckett, Rudd, & Arbour. (2015). Restraint Reduction, Restraint Elimination, and Best Practice: Role of the Clinical Nurse Specialist in Patient Safety. The International Journal of Advanced Nursing Practice, 29(6).  Role Of Nurses In Mental Health Settings Discussion Paper