An exploration of ethical issues associated with the seclusion of psychiatric patients

Muir‐Cochrane, Eimear

doi:10.1016/s1322-7696(08)60111-0

Cited by 18 publications

(41 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…According to Lendemeijer and Shortbrige-Baggett (1997), up to 20% of psychiatric patients are secluded during their stay in North American psychiatric hospitals. Furthermore, the humanitarian, ethical, and legal issues associated with the use of seclusion make it one of the most controversial management strategies available (Muir-Cochrane, 1995;Muir-Cochrane & Holmes, 2001). Despite these important issues, little nursing research has sought to gain an understanding of this controversial measure from the patient's perspective.…”

mentioning

confidence: 99%

The Mentally Ill and Social Exclusion: A Critical Examination of the Use of Seclusion From the Patient's Perspective

Holmes

Kennedy

Perron

2004

Issues in Mental Health Nursing

110

131

View full text Add to dashboard Cite

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.

show abstract

mentioning

confidence: 99%

The Mentally Ill and Social Exclusion: A Critical Examination of the Use of Seclusion From the Patient's Perspective

Holmes

Kennedy

Perron

2004

Issues in Mental Health Nursing

110

131

View full text Add to dashboard Cite

show abstract

“…() ran a practice development project with staff group forums. The remaining Australian articles used grounded theory and were from one study (Muir‐Cochrane , ; Muir‐Cochrane & Harrison ). Three studies were conducted in high security settings, one at a PICU (Psychiatric Intensive Care Unit), two at metropolitan hospitals, and two in district/rural settings.…”

Section: Resultsmentioning

confidence: 99%

“…The articles retrieved were of mixed quality. Their generalizability and transferability could be questioned as samples were small (Johnson ; Muir‐Cochrane , ; Muir‐Cochrane & Harrison ; Steele ), diverse, and undertaken in a range of differing healthcare settings (Steele ). Additionally, local clinical factors such as policies, inpatient population, and cultural influences varied widely (Hyde et al .…”

Section: Resultsmentioning

confidence: 99%

What factors influence the decisions of mental health professionals to release service users from seclusion?

Jackson

Baker

Berzins

2018

Int J Mental Health Nurs

View full text Add to dashboard Cite

Mental health policy stipulates seclusion should only be used as an intervention of last resort and for the minimum possible duration. Current evidence details which service users are more likely to be secluded, why they are secluded, and what influences the decision to seclude them. However, very little is known about the decision to release service users from seclusion. An integrative review was undertaken to explore the decision-making processes of mental health professionals which guide the ending of seclusion. The review used a systematic approach to gather and thematically analyse evidence within a framework approach. The twelve articles identified generated one overriding theme, maintaining safety. In addition, several subthemes emerged including the process of risk assessing which was dependent upon interaction and control, mediated by factors external to the service user such as the attitude and experience of staff and the acuity of the environment. Service users were expected to demonstrate compliance with the process ultimately ending in release and reflection. Little evidence exists regarding factors influencing mental health professionals in decisions to release service users from seclusion. There is no evidence-based risk assessment tool, and service users are not routinely involved in the decision to release them. Support from experienced professionals is vital to ensure timely release from seclusion. Greater insight into influences upon decisions to discontinue episodes may support initiatives aimed at reducing durations and use of seclusion.

show abstract

“…Despite existing laws that prohibit the use of seclusion as a punitive nursing intervention and protect patients against arbitrary acts and excessive use of force, psychiatric nurses will sometimes use confinement measures to correct socially unacceptable behaviours (Holmes & Jacob, 2007;Holmes et al, 2004). The use of seclusion as a punitive (disciplinary) technology is, therefore, one of the most controversial approaches deployed by nurses because it is above all a matter of imprisonment Á it is, therefore, a matter of law (Friard, 1998;Holmes & Jacob, 2007;Holmes et al, 2004;Muir-Cochrane, 1995;Muir-Cochrane & Holmes, 2001). Yet, this type of practice is often institutionalized as a therapeutic strategy, embraced by psychiatric nurses as a valid and effective practice and taught to new staff members as 'the' way to address problematic behaviours (Angold, 1989;Friard, 1998).…”

Section: The Use Of Seclusion In Psychiatric Nursingmentioning

confidence: 99%

Sovereign power, spectacle and punishment: a critical analysis of the use of the seclusion room

Jacob

Gagnon

Perron

et al. 2009

International Journal of Culture and Mental Health

View full text Add to dashboard Cite

Sovereign power, spectacle and punishment: a critical analysis of the use of the seclusion room, The purpose of this paper is to engage with the reader in a theoretical reflection regarding the use of the seclusion room as a punitive nursing intervention (behaviour modification technique for instance). To set the stage, we explore the internal structure and functioning (culture) of the psychiatric institution Á as total institution Á from a Goffmanian perspective. Then, drawing on the works of the late French philosopher Michel Foucault, we introduce the concept of sovereign power and explore how various forms of punishment (as manifestations of power) came into play at different moments in history. Through an exploration of seclusion and its use in the psychiatric domain, we critically examine this practice when used as a behaviour modification technique. Finally, the use of seclusion is discussed in terms of the concept of sovereign power with the purpose of highlighting the political forces surrounding such a coercive practice in psychiatric nursing.

show abstract

An exploration of ethical issues associated with the seclusion of psychiatric patients

Cited by 18 publications

References 26 publications

The Mentally Ill and Social Exclusion: A Critical Examination of the Use of Seclusion From the Patient's Perspective

The Mentally Ill and Social Exclusion: A Critical Examination of the Use of Seclusion From the Patient's Perspective

What factors influence the decisions of mental health professionals to release service users from seclusion?

Sovereign power, spectacle and punishment: a critical analysis of the use of the seclusion room

Contact Info

Product

Resources

About