Nursing Practices Recorded in Reports of Episodes of Seclusion

Abstract

The purpose of this study is to describe the nursing practices recorded in reports of patient episodes of seclusion, with or without restraints, in a specialized psychiatric facility in Quebec. The reports for all adult patients secluded (n = 4863) in a psychiatric unit between April 1, 2007 and March 31, 2009, were examined. Descriptive analyses were performed. The main reasons for seclusion were agitation, disorganization, and aggressive behaviour. The alternative methods that were attempted included stimulus reduction, extra medication, and working with the patient to find a solution. Few families were notified about their relation's seclusion. More hours of seclusion were reported in the evening and at night. Our results are comparable to those obtained by other investigators. Some of the variables have not been the subject of much research: for example, health conditions during seclusion with or without restraint and partnerships with family members. Our findings also suggest that, in their analyses, studies should differentiate between cognitive-impairment and adult-psychiatry units as well as long-term seclusion and short-term seclusion. The information reported by the nurse makes no distinction between short-stay and long-stay adult psychiatric units. Only one psychiatric facility was investigated in this study, precluding generalization.

De‐escalation techniques used, and reasons for seclusion and restraint, in a forensic psychiatric hospital

“…An even greater number of patients have been reported to be agitated or disorientated while secluded (92.6%, with or without restraint). In contrast, 77.5% of secluded patients behaved aggressively (Larue et al 2010).…”

“…Internationally, the use of restrictive measures and the types of measures vary (Noorthoorn et al 2015;Steinert & Lepping 2009;Steinert et al 2010), despite the fact that studies have reported quite similar reasons for seclusion and restraint. These reasons include threats or use of violence against other people or oneself, aggression towards property, attempts to escape from care, inability to care for oneself (Paavola & Tiihonen 2010;Raboch et al 2010), and agitation/disorientation (Kaltiala-Heino et al 2003;Keski-Valkama et al 2009;Larue et al 2010).…”

“…In addition to threatening and inciting violence Noda et al 2013;Paavola & Tiihonen 2010;Raboch et al 2010), agitation/disorientation has been found to be a main reason for seclusion and restraint in some studies (Kaltiala-Heino et al 2003;Keski-Valkama et al 2009;Larue et al 2010). The reported rate of threatening or inciting actual violence has varied between approximately one-third and twothirds of incidents Paavola & Tiihonen 2010).…”

Comparing Attitudes to Containment Measures of Patients, Health Care Professionals and Next of Kin

“…Coercive measures are usually applied to avert destructive actions against oneself, other patients, or staff. Aggression, especially assault of third persons, disorganization, and agitation, are common catalysts for coercive measures ( 4 – 7 ). Moreover, HCP often see the therapeutic effects of coercive measures ( 2 , 8 ).…”

Patient Experience of Coercive Measures

“…After seclusion or restraint is over, ventilation and discussion are needed to process all the feelings experienced, to provide psychological and emotional support, to accept the reasons for seclusion and to discuss treatment plans for the future (Mann et al 1993;Kennedy et al 1994;Meehan et al 2000;El-Badri and Mellsop 2008;Ryan and Happell 2009;Keski-Valkama et al 2010a;Larue et al 2010;Needham and Sands 2010;Kontio et al 2012). The importance of being respected as a unique fellow human being cannot be emphasised enough (Välimäki 1998;Chien et al 2005).…”