THE MENTALLY ILL AND SOCIAL EXCLUSION: A CRITICAL EXAMINATION OF THE USE OF SECLUSION FROM THE PATIENT'S PERSPECTIVE

Nurses in psychiatric settings have an important role to play in the application of seclusion, a measure that continues to be a frequently used intervention for the management of disturbing patient behaviours. Albeit a controversial measure, isolating patients remains a common institutional practice...

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Bibliographic Details
Published in:	Issues in mental health nursing Vol. 25; no. 6; pp. 559 - 578
Main Authors:	Holmes, Dave, Kennedy, Suzanne L., Perron, Amélie
Format:	Journal Article
Language:	English
Published:	England Informa UK Ltd 01-09-2004 Taylor & Francis
Subjects:	Adaptation, Psychological Attitude of Health Personnel Attitude to Health Canada Dangerous Behavior Female Hospitals, Psychiatric Humans Inpatients - psychology Male Mental Disorders - nursing Mental Disorders - psychology Mentally Ill Persons - psychology Motivation Narration Needs Assessment Nurse's Role Nurse-Patient Relations Nursing Nursing Methodology Research Organizational Culture Patient Isolation - methods Patient Isolation - psychology Psychiatric Nursing - methods Punishment - psychology Qualitative Research Restraint, Physical - methods Restraint, Physical - psychology Social Isolation Surveys and Questionnaires Canada
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Summary:	Nurses in psychiatric settings have an important role to play in the application of seclusion, a measure that continues to be a frequently used intervention for the management of disturbing patient behaviours. Albeit a controversial measure, isolating patients remains a common institutional practice that has received widespread attention from a political, ethical, legal, and clinical standpoint. Although there is an abundance of scientific work on the subject, few studies have examined the experience of patients being confined. In order to improve the quality of nursing care surrounding this measure it appeared essential to obtain data on patients' perspectives, information deemed valuable in orienting nursing interventions. This qualitative study, guided by a phenomenological research design, aimed at describing and gaining a better understanding of patients with a severe and persistent psychiatric disorder who were placed in a seclusion room while hospitalized on a closed psychiatric unit. Using a semi-structured, non-directive interview format, a total of six patients participated in this study. Content analysis of participants' narratives yielded three main themes that appeared to be central to their experience of seclusion: their experience of seclusion on an emotional level, their perception of this intervention, and how they coped during their stay in the seclusion room. Major findings emerging from this nursing study centred on the following dimensions: patients' perceptions of seclusion as a punitive measure and a modality for social control and, the experience of seclusion serving as an intensification of already existing feelings of exclusion, rejection, abandonment, and isolation. In addition the findings also suggest that it is not seclusion per se that impacts on their negative perception and negative emotional experience but rather the lack of nurse-patient contact during the seclusion experience. Furthermore, whether patients coped by regressing, acting out, or taking on a more compliant stance, they appeared to be motivated by a need to connect with staff. This points to the importance of the relational aspects of nursing care when applying this restrictive measure. A need for modifying the institutional culture surrounding seclusion and transforming nursing practices are discussed as are future research endeavours.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0161-2840 1096-4673
DOI:	10.1080/01612840490472101