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Ethical Considerations in Balancing Use of Seclusion and Restraint With Risk of COVID-19 Exposure: Recommendations
Alysha D Thompson1, Emily R Berkman1, Shannon W Simmons1
1Seattle Children's Hospital, Washington; University of Washington, Seattle.
Insights
The COVID-19 pandemic created challenges for child and adolescent inpatient psychiatry units (IPUs). IPUs must balance infection control with patient care, facing ethical dilemmas regarding seclusion and restraint use to enforce COVID-19 guidelines.
Area of Science:
- Psychiatry
- Infectious Disease Control
- Healthcare Management
Background:
- The COVID-19 pandemic significantly impacted inpatient psychiatry units (IPUs), particularly those serving children and adolescents.
- IPUs traditionally depend on milieu group programming for patient care and supervision.
- Adapting unit policies to balance therapeutic milieu maintenance with COVID-19 transmission prevention posed unique challenges.
Discussion:
- IPUs faced the dual challenge of providing psychiatric care while preventing COVID-19 spread.
- Treating pediatric patients exposed to or infected with COVID-19 added complexity.
- Mandatory quarantine and isolation protocols, if refused, could necessitate restraint, creating an ethical conflict.
Key Insights:
- Maintaining a therapeutic milieu amidst COVID-19 required significant policy and procedural adaptations in IPUs.
- The risk of COVID-19 transmission necessitated infection control measures, including quarantine and isolation.
- Enforcing infection prevention policies in IPUs can conflict with best practices aimed at reducing seclusion and restraint.
Outlook:
- Future pandemic preparedness plans for IPUs should address the ethical considerations of infection control.
- Further research is needed on effective strategies for managing infectious diseases in psychiatric settings.
- Developing guidelines that harmonize infection prevention with patient rights and therapeutic care is crucial for IPUs.
Abstract:
The onset of the COVID-19 pandemic has presented unique challenges for inpatient psychiatry units (IPUs). IPUs, especially those caring for children and adolescents, rely heavily on milieu group programming to provide care and supervision for patients, and have had to adapt unit policies and procedures to maintain a therapeutic milieu while minimizing COVID-19 transmission.1 Simultaneously providing care while preventing transmission of COVID-19 within IPUs is a formidable task, and many IPUs face the additional challenge of treating youth who have been exposed to, or are actively infected with, COVID-19. In addition, given the need to prevent transmission of COVID-19, recommendations include "mandatory quarantine and isolation when patients refuse to adhere to guidelines,"2 potentially leading to the use of restraint when patients attempt to leave isolation; thus a conflict between the potential risks of enforcing infection prevention policies in order to reduce virus transmission and best practices of eliminating seclusion and restraint (S/R) creates an ethical dilemma for IPUs.
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