NRSG 263 Mental Health - Restrictive Practices

Unit: NRSG 263 Mental Health
Assignment 1: Topic 2
Student Name:
Word Count:

1.

Restrictive practice is defined as the use of seclusion or restraint to control risky
behaviour of patient with serious mental illness. Seclusion is an intervention that involves
confining a person alone in a room and separating them from other patients, whereas restraint
involves restricting freedom of movement of a client by physically or mechanically
restricting them (Goulet, Larue & Dumais, 2017). Human Rights advocate across the world
are against the use of restrictive practices in mental health because of its potential to infringe
basic human right to freedom, dignity and autonomy. According to Australian Institute of
Health and Welfare (2020) report, the Australian National Human Commission has
encouraged all health leaders to monitor and control use of restrictive practices across their
respective jurisdictions. In the Australian mental health care system, eliminating use of
seclusion has become a policy priority too (AIHW, 2010). The Mental Health Act 2016
regulates the use of restrictive practices like seclusion and mechanical restraint too
(health.qld.gov.au 2020). Thus, as national and regulatory bodies have taken action regarding
this practice, understanding the reason behind the controversy is important. This essay will
argue regarding the adverse impact of seclusion on consumers and mental health care
professionals and discuss how registered nurse can take the initiative to adapt alternative
method to prevent use of such restrictive practice in mental health setting. To support the
argument, the essay will discuss about pros and cons of seclusion in terms of physical,
psychological and ethical outcome of care.
Different opinion exists among consumers regarding the experience of seclusion and
patients have mostly reacted negatively to the coercive practice because of its adverse
psychological consequences. The study by Prophy et al. (2016) defined impact of seclusion
by conducting focus group discussions with people with lived experience of seclusion.
Seclusion is an intervention which is beneficial to control or manage difficult behaviour of
patient and prevent them or other patient from any harm. By the analysis of the results,

several disadvantage of seclusion emerged. Both consumers and carers were against the use
of seclusion because of poor physical outcomes and overuse of the coercive practice leading
to poor staff-patient relationship. In addition, practice gap issues included inappropriate use
of force, lack of empathy, poor communication and interaction with patients and lack of
alternative approach to contain violent behaviours. Patients mainly reported being humiliated
and expressed feelings of helplessness, isolation and traumatization. They were also
overwhelmed with feelings of injustice and powerlessness. (Prophy et al., 2016). The study
by is Prophy et al., (2016) consistent with Larue et al. (2013) which revealed feelings of
shame and humiliation among patients who were secluded and Haugom, Ruud and
Hynnekleiv (2019) indicated about staff experience of feeling burdensome because of ethical
challenges associated with the procedure. Similarly, the evidence on poor practice related to
the coercive measure is consistent with other research papers too. Chieze et al. (2019)
revealed similar outcomes of seclusion by showing that 62% participants held negative
perception about seclusion because of overuse of the practice. Thus, the significance of the
paper by Prophy et al. (2016) is that gives valid and reliable data related to depict negative
impact of seclusion by review of lives experiences of consumers and supporters.
Seclusion is not favoured by many staff because of its adverse physical consequences
too. The systematic review by Chieze et al. (2019) opined regarding the lack of evidence on
efficacy and therapeutic benefit of coercive measures like seclusion. By the meta-analysis of
studies on impact of seclusion and restraint in adult psychiatry, the Chieze et al. (2019)
revealed that seclusion is associated with deleterious physical or psychological consequence.
It reported about high incidence of post-traumatic stress disorder (PTSD) after seclusion.
Participants also suffered from hallucinations and hopelessness due to exposure to trauma
during the process. The study gave evidence regarding the high and intense feelings of
negative emotions and distress in such patients. The only positive outcome reported in this