Use of seclusion: finding the voice of the patient to influence practice

Seclusion for escalating behavior in psychiatric patients has been a controversial intervention over the past 3 decades. The current study investigated the experience of seclusion from the perspective of inpatient psychiatric patients in the mid-western United States. Twelve patients were interviewed about their experiences; the interviews were transcribed into a written text. A phenomenological method was used to analyze the text, and themes were generated. Three themes emerged: (a) Patient Hope for Respect and Open Communication described patients' desires for discussion about their individual problems before their behavior escalated; (b) Patient Emotional Response to the Seclusion Process described accelerating emotions such as anxiety and anger. Patients perceived disrespect from staff prior to and during seclusion; and (c) Patient Insight into Behavior and the Importance of Positive Coping Skills described the importance of debriefing with staff and learning positive coping skills. Further improved education for nurses is needed to help manage psychiatric patients, for it is the goal of the mental health profession to understand the reasons these seclusion episodes occur and to directly take the steps to eliminate the need for the seclusion process entirely.