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Seclusion. The nursing challenge.

F H Outlaw1, B J Lowery

  • 1University of Pennsylvania, School of Nursing, Philadelphia 19104-6096.

Journal of Psychosocial Nursing and Mental Health Services
|April 1, 1992
PubMed
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Limited data guides nursing decisions on patient seclusion. Seclusion is often used for escalating agitation, not just violence, raising concerns about potential patient injustice and reinforcing behaviors.

Area of Science:

  • Psychiatric Nursing
  • Patient Safety
  • Clinical Decision-Making

Background:

  • Current research lacks sufficient data to guide nursing decisions regarding patient seclusion.
  • The justification for using seclusion is often unclear, with patients secluded for reasons beyond active violence.

Purpose of the Study:

  • To analyze the current state of research on patient seclusion and its implications for nursing practice.
  • To identify the justifications and potential negative consequences associated with patient seclusion.

Main Methods:

  • Review of existing research and data on patient seclusion practices.
  • Analysis of reasons for seclusion, including violence, escalating agitation, and non-compliance.

Main Results:

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  • Many patients are secluded for escalating agitation without overt violence, indicating potential staff prediction of behavior.
  • Seclusion may reinforce the behaviors it aims to prevent and lacks justification for non-violent reasons like noise or medication refusal.
  • Potential for injustice exists due to arbitrary selection, prolonged seclusion, and unit/staff-specific decision-making.

Conclusions:

  • Patient seclusion practices require clearer guidelines and further research to ensure patient safety and prevent potential injustice.
  • The use of seclusion, especially for non-violent behaviors, warrants critical re-evaluation in psychiatric nursing.
  • Seclusion is a distressing event for staff and elicits varied, often negative, responses from patients.