Nurses' decision on seclusion: patient characteristics, contextual factors and reflexivity in teams

Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses' perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma-informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use.

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“…Researcher‐devised items based on literature review (Boumans et al . ; Mann‐Poll et al . ) and our own previous research (e.g.…”

Section: Methodsmentioning

confidence: 99%

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

Gerace

Muir‐Cochrane

2018

Int J Mental Health Nurs

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“…Confidence within the team has been found to be a very important factor in the decision‐making of nurses on seclusion (Boumans et al . ; Lendemeijer ; Wynaden et al . ).…”

Section: Introductionmentioning

confidence: 99%

“…Well-defined plans also give the nursing team guidance in their work with the patients and will strengthen the confidence in one's self and in each other. Confidence within the team has been found to be a very important factor in the decision-making of nurses on seclusion (Boumans et al 2012;Lendemeijer 1997;Wynaden et al 2002). Critical reflection on the working process is considered the most essential feature of the methodical work approach (Coussens 2010; Tiemens Winkelaar 2001).…”

Section: Introductionmentioning

confidence: 99%

Reduction in the use of seclusion by the methodical work approach

Boumans

Egger

Souren

et al. 2013

Int J Mental Health Nurs

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Patient care in a psychiatric setting can benefit from a more systematic, transparent, and goal-driven way of working. The methodical work approach, with its cyclic five phases, provides such an approach: (i) translation of problems into goals; (ii) search for means to realize the goals; (iii) formulation of an individualized plan; (iv) implementation of the plan; and (v) evaluation and readjustment. We examined the effect of the methodical work approach on the use of seclusion at a ward for the intensive treatment of inpatients with psychoses and substance-use disorders. The team of this ward implemented the methodical work approach. Special attention was paid to the involvement of the patient and his/her family in the treatment process and to the role of the coordinating nurse. Compared to control wards within the same hospital, at the ward where the methodical work approach was implemented, a more pronounced reduction was achieved in the number of incidents and in the total hours of seclusion. Implementation of the methodical work approach can contribute to a reduction in the use of seclusion.

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“…Some studies have shown a decrease in seclusion to be associated with a slight increase in use of enforced medication (Georgieva et al 2013;Verlinde et al 2017). Between 2007 and 2012, seclusion-reduction programmes focussed on changes in ward culture and nursing approaches (Bouwmans et al 2012(Bouwmans et al , 2015Voskes et al 2013), whereas recent initiatives are increasingly aimed at implementing evidence-based practice in seclusion reduction in mental health care (Verlinde et al 2017). Dutch practice is becoming more in line with international practice (Lepping et al 2016).…”

Section: Dutch Contextmentioning

confidence: 99%

“…Between 2007 and 2012, seclusion‐reduction programmes focussed on changes in ward culture and nursing approaches (Bouwmans et al . , ; Voskes et al . ), whereas recent initiatives are increasingly aimed at implementing evidence‐based practice in seclusion reduction in mental health care (Verlinde et al .…”

Section: Introductionmentioning

confidence: 95%

Associations between psychiatric symptoms and seclusion use: Clinical implications for care planning

Sande

Noorthoorn

Nijman

et al. 2017

Int J Mental Health Nurs

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Findings from an increasing number of studies suggest that incorporating systematic short-term risk assessments in treatment planning could lead to safer practice on psychiatric admissions wards. The aim of the present study was to investigate the associations between the scores of three structured observation tools - the Kennedy Axis V (K-Axis-V), the Brief Psychiatric Rating Scale (BPRS), and the Social Dysfunction and Aggression Scale (SDAS) - and seclusion. In total, 1840 weekly risk assessments with these observation scales were collected over 2342 admission weeks. These assessment scores related to 370 acutely-admitted psychiatric patients and were subjected to a multilevel analysis. It was found that several dynamic and static factors were related to seclusion. Dynamic factors included violent behaviour, current substance abuse, suspiciousness, and negativism. Static factors included ethnicity and having been diagnosed with a substance abuse disorder. The findings suggest that the incorporation of the Kennedy-Axis V, the BPRS, and the SDAS into standard practice might be helpful in identifying patients at high risk of seclusion, and could be supportive to treatment planning and clinical decision-making in the prevention of seclusion use in acute psychiatric settings.

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Nurses' decision on seclusion: patient characteristics, contextual factors and reflexivity in teams

Cited by 28 publications

References 38 publications

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey

Reduction in the use of seclusion by the methodical work approach

Associations between psychiatric symptoms and seclusion use: Clinical implications for care planning

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