Seclusion and Restraint - Behavioral Management

Running Head: SECLUSION AND RESTRAINT 1
Seclusion and Restraint
Name of Student
Name of Professor
Institution Affiliation
Date

SECLUSION AND RESTRAINT 2
Introduction
Seclusion and restraint are the types of interventions for behavioral management. They
should be undertaken as a last solution to control behavioral emergencies due to the negative
impacts associated with them. Behavioral emergencies are regularly as a result of psychosocial
or functional needs and unmet health. To manage or eliminate such emergencies, one should
adequately address circumstances that produced them. Restraint incorporates the usage of
chemicals, physical force, or mechanical devices for immobilizing a person. While seclusion is a
type of control that incorporates the confinement of an individual in a room from which the
individual cannot freely exit (Al-Maraira & Hayajneh, 2018). There exists a strong agreement
that restraint and seclusion are human rights concerns, that they have no therapeutic value and
have significantly impacted on physical and emotional wellbeing for staff and consumers.
Seclusion does not have any known long-term assistance in reducing behaviors. This essay aims
to critically analyse the impacts of seclusion to healthcare and consumers alike and also discuss
how nurses can collaborate with consumers to decrease restraint and seclusion.
Impacts of seclusion
Seclusion poses significant harm to both the individual in care and healthcare
professionals. While it is only useful while managing an occurrence of aggressive behavior,
seclusion can have severe negative impacts on the social, physical, and psychological wellbeing
of the person in care. Healthcare professionals may be injured while trying to administer
seclusion (Nyttingnes, Ruud & Rugkåsa, 2016). Some of the impacts of seclusion among
consumers and healthcare professionals include;

SECLUSION AND RESTRAINT 3
When a person is subjected to seclusion, then he/she might not be willing to seek
treatment. This affects the psychological and physical wellbeing of the consumer. The practices
associated with seclusion are brutal and stressful. Once an individual gets out of the hospital, the
fear of being stressed again makes them unwilling to seek medical assistance again (Goulet &
Larue, 2016). A mental ward practicing seclusion ought to know that seclusion results in
insomnia, stress, pain, distrust in services offered, and nightmares. Victims also experience poor
hospitalization, constant depression, and trauma of torture flashbacks. This poses a lot of danger
in their health status and more risks to the relatives and friends around them or the entire
community. The impacts associated with the use of seclusion are intense and unfavorable, and
hence nobody will be willing to experience such circumstances again (Cusack, Cusack,
McAndrew, McKeown & Duxbury, 2018).
Seclusion also poses a significant challenge to healthcare professionals taking care of the
patients. The same way it affects the physical and psychological wellbeing of the consumers,
also the healthcare professionals are influenced. The environment for offering mental care calls
for perseverance, resources, patience, and ample space to facilitate the delivery of quality
services by the care providers in order to achieve distinct requirements of patients. The current
practice of seclusion poses a significant challenge to healthcare professionals by making the
environment unfavorable since it can result in injuries and emotional damage (Ramluggun,
Chalmers & Anjoyeb, 2018). Some healthcare professionals have not been able to realize the
dangers that seclusion poses on them. Seclusion does not only harm the patient but also creates a
platform for a horrible working environment. Furthermore, potential people who admire such
professions may be scared to undertake the profession if it is associated with causing harm to the

SECLUSION AND RESTRAINT 4
patients instead of helping them. No one would wish to work in such an environment (Foster,
Roche, Giandinoto & Furness, 2020).
Seclusion also results in trauma and excessive control over the patients. Seclusion results
in trauma, and since the patient is isolated, chances are he/she is capable of reflecting on the past
trauma. Also, the act of using excessive force and exposure to a consumer with traumatic
patients can trigger trauma among healthcare professionals. Patients who have previously
experienced traumatic events like sexual or physical abuse assault are more vulnerable to trauma.
If previously suffered a trauma, a person is more vulnerable to experience post-traumatic stress
disorder as the re-experiencing of flashbacks, events, nightmares, intrusive, and repetitive images
from the event occur. Also, the experiences of seclusion may result in trauma. Trauma results in
patients and healthcare professionals being unable to balance between seclusion and crisis.
Seclusion also results in excessive control by the healthcare professionals since through it,
healthcare professionals are capable of gaining control over consumers and managing the
environment they are in (Peterson, 2017). The acts of controlling make it hard to develop
therapeutic communication between the healthcare professional and the patient. Therapeutic
communication is one of the essential element in the provision of care since healthcare
professionals use it to build trust and rapport. Without effective therapeutic communication, then
the quality of care provided can be low. This is because nurses and patients are not capable of
imagining, informing, expressing feelings, influencing and meeting the social expectations of the
care provided (Franke, Buesselmann, Streb & Dudeck, 2019).
Additionally, seclusion results in emotional instability. Emotions that are more likely to
be experienced by consumers during seclusion include; fear of the confined space,
disempowerment, ongoing feelings of vulnerability, and anger linked with physical practices that

SECLUSION AND RESTRAINT 5
habitually accompany the seclusion process. Also, loss of autonomy related to experiences of
humiliation, powerlessness and dependence, loneliness, and impaired trust have been reported
during the seclusion process. There is a high likelihood of these unfavorable emotional effects to
be experienced by the consumer after two years. A study conducted by Chieze, Hurst, Sentissi &
Kaiser (2019) linked the seclusion process to feelings of anxiety, boredom, crying, distress,
anger, sadness, abandonment, shame, and fear for the healthcare professionals. This is because
of aggression encountered in their care setting.
Despite the negative impacts of seclusion, it is considered vital in maintaining a
consumer who is capable of harming other people. When it is identified and clear that a person
presents a significant degree of harm to other people and the circumstance cannot be managed or
controlled more appropriately or safely by any other method, then seclusion is very important.
Seclusion is justified by healthcare professionals on the basis of containing an aggressive
behavior that, in most instances, can harm other people (Morphet, Griffiths, Beattie, Reyes &
Innes, 2018). In some cases, it can be resolved by healthcare professionals removing themselves
from a circumstance. However, healthcare professionals may encounter a situation where a
person is extremely distressed as a consequence of some form of learning disability, mental
illness, or related circumstance (Peterson & Peterson, 2017). This is where they are actively
violent or threatening other people, and hence seclusion is essential. In such situations, seclusion
may be seemed by healthcare professionals as a method of decreasing the effects associated with
the use of medications or prolonged restraint (Jury et al., 2019).
The role of the registered nurse in reducing seclusion
As discussed above, it is evident that seclusion mostly negatively impacts healthcare
professionals and consumers. The Australian Government National Safety Priorities in Mental

SECLUSION AND RESTRAINT 6
Health admits that restraint and seclusion are potential sources of harm to consumers. This
necessitates the formulation of effective strategies to help in reducing seclusion and restraint.
Nurses are required to collaborate with consumers to work towards State/Territory and National
initiatives that can support in decreasing the use of restraint and seclusion. In order to promote
safe care, it is essential to adopt and implement restraint and seclusion prevention strategies.
Such strategies should be focused on the skills of the care staff, appropriate assessment of the
consumer, nature of the care environment, and culture of care provision (Ross, 2018). Some of
the strategies and role of registered nurse include;
Provision of recovery-oriented care
Recovery-oriented care incorporates using care that value choice above control for the
consumer who is in need. This approach supports the prevention of the usage of seclusion and
restraint. Some of the ways through which registered nurses (RNs) can work with consumers to
promote a culture of recovery-oriented care include;
 Allowing flexibility in procedure and practice to meet consumer requirements in given
situations
 Implementing care approaches that are consumer centered
 Instituting procedures and practices that are grounded on concepts regarding recovery-
oriented care.
 Proposing and instituting policies that encourage healthcare settings to be innovative in
the care they provide and trying new ways of supporting care provision
 Establishing policies and guidelines that are easy to understand, user-friendly, and easy to
remember (Muir‐Cochrane, O'Kane & Oster, 2018).

SECLUSION AND RESTRAINT 7
It is essential to take into account the challenges that these recovery-oriented approaches may
encounter. The challenges include health care professionals’ attitudes and prejudices. For
example, clinical staff who work with patients in a non-recovery state can develop a sense of
hopelessness for these patients and hence believe that recovery-oriented care is not attainable.
This results in the clinical staff using seclusion and restraint as a means of controlling the patient
rather than enhancing empowerment (Gerace & Muir‐Cochrane, 2019). Another instance is
when healthcare professionals panic while treating individuals who have a history of aggressive
or violent behavior. The individuals may also fear as a consequence of having no control over
his/her life or the nature of his/her situation. Hence, there is an establishment of a cycle whereby
fears trigger staff to use restraints to manage aggressive behaviors, and also it triggers aggressive
actions from the individuals under care (Brophy, Roper, Hamilton, Tellez & McSherry, 2016).
Alterations should be aimed at supporting healthcare professionals to work and understand a
recovery framework.
Adherence to standards
Involuntary restraint and seclusion demonstrate a failure by healthcare nurses to conduct
care under consideration with their profession set standards. For instance, the Australian
standards for competency necessitate a registered nurse should provide a holistic and individual
patient-centered care, and a nursing care plan should be implemented, evaluated, and established
with the active involvement of the consumer. A registered nurse should always ensure a return
and practice of this fundamental and highly skilled practice of nursing that can support in
mitigating the requirement of involuntary restraint and seclusion (Raveesh, Gowda & Gowda,
2019). The National Mental Health Consumer and Carer Forum (NMHCCF) postulates that a
critical strategy for ending and reducing restraint and seclusion is simply that there ought to be

SECLUSION AND RESTRAINT 8
regular monitoring of the compliance to relevant standards. For instance, a mental health nurse
should be complying with the Australian Competency Standards for the RN and other necessary
standards. Hence, registered nurses can reduce the practice of restraint and seclusion by adhering
to these standards. They should also have their own position papers on restraint and seclusion
that outlines and reminds them of best practices they should undertake regarding their
responsibilities, role, and accountabilities when participating in restraint and seclusion practices
(Khalil, Al Ghamdi & Al Malki, 2017).
Safewards
Safewards is an initiative that supports improvement in patient-centered care provided.
Everybody is entitled to feel safe, whether at a street, hospital, or home. Application of
Safewards support in decreasing conflict (rule-breaking, aggression) and enhancing containment
(coerced medications, seclusion, and restraint) in acute mental health inpatient units (Fletcher,
Hamilton, Kinner, & Brophy, 2019). As the Safeward program model postulates, conflict can
arise within the ward when a consumer is faced with circumstances that upsurge their emotional
distress. A registered nurse in such cases should undertake necessary and appropriate measures
to decrease the impact, containment technique for the case and be aware of potential factors that
are triggering the emotional distress. The Safewards technique helps in reducing restraint and
seclusion by making registered nurses work together with the patients and hence decrease
conflict and enhance containment as much as possible. This makes inpatient units to be a more
peaceful and therapeutic place (Mann-Poll, Smit, Noorthoorn, Janssen, Koekkoek &
Hutschemaekers, 2018). Safewards aims at developing good relationships between the patients
and healthcare professionals, decreased coercion and increased safety, promoting fewer injuries
and fewer assaults, less time wasted on containment and more invested in engagement and lastly,

SECLUSION AND RESTRAINT 9
creating an environment that is conducive and peaceful to support consumers towards their
recovery journey (Fletcher et al., 2017).
Conclusion
In conclusion, it is evident from the essay that the use of restraint and seclusion in
psychiatry has been responsible for many negative impacts on the consumer and the healthcare
professionals. Consumers are influenced by restraint and seclusion, which in most instances
results in unbearable physical and psychological effects, which eventually deter them from
seeking health assistance. Healthcare professionals have not been spared since the experiences of
using seclusion have a lot of negative emotional and physical experiences. The environment
within which healthcare professionals operate is distressing and can result in injuries.
Alternatives strategies like Safewards, ensuring adherence to standards, and enhancing recovery-
oriented care should be undertaken to limit the use of seclusion and restraint.

SECLUSION AND RESTRAINT 10
References
Al-Maraira, O. A., & Hayajneh, F. A. (2018). Use of restraint and seclusion in psychiatric
settings: a literature review. Journal of psychosocial nursing and mental health services,
57(4), 32-39.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016).
Consumers’ and their supporters’ perspectives on barriers and strategies to reducing
seclusion and restraint in mental health settings. Australian health review, 40(6), 599-
604.
Chieze, M., Hurst, S., Sentissi, O., & Kaiser, S. (2019). Effects of Seclusion and Restraint in
Adult Psychiatry: A Systematic Review. Frontiers in psychiatry, 10, 491.
Cusack, P., Cusack, F. P., McAndrew, S., McKeown, M., & Duxbury, J. (2018). An integrative
review exploring the physical and psychological harm inherent in using restraint in
mental health inpatient settings. International journal of mental health nursing, 27(3),
1162-1176.
Fletcher, J., Hamilton, B., Kinner, S. A., & Brophy, L. M. (2019). Safewards impact in inpatient
mental health units in Victoria Australia: Staff perspectives. Frontiers in psychiatry, 10,
462.
Fletcher, J., Spittal, M., Brophy, L., Tibble, H., Kinner, S., Elsom, S., & Hamilton, B. (2017).
Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and
fidelity measurement. International journal of mental health nursing, 26(5), 461-471.
Foster, K., Roche, M., Giandinoto, J. A., & Furness, T. (2020). Workplace stressors,
psychological well‐being, resilience, and caring behaviours of mental health nurses: A

SECLUSION AND RESTRAINT 11
descriptive correlational study. International journal of mental health nursing, 29(1), 56-
68.
Franke, I., Buesselmann, M., Streb, J., & Dudeck, M. (2019). Perceived institutional restraint is
associated with psychological distress in forensic psychiatric inpatients. Frontiers in
psychiatry, 10, 410.
Gerace, A., & Muir‐Cochrane, E. (2019). Perceptions of nurses working with psychiatric
consumers regarding the elimination of seclusion and restraint in psychiatric inpatient
settings and emergency departments: An Australian survey. International journal of
mental health nursing, 28(1), 209-225.
Goulet, M. H., & Larue, C. (2016). Post-seclusion and/or restraint review in psychiatry: a
scoping review. Archives of psychiatric nursing, 30(1), 120-128.
Jury, A., Lai, J., Tuason, C., Koning, A., Smith, M., Boyd, L., ... & Gruar, A. (2019). People who
experience seclusion in adult mental health inpatient services: An examination of health
of the nation outcome scales scores. International journal of mental health nursing,
28(1), 199-208.
Khalil, A. I., Al Ghamdi, M. A. M., & Al Malki, S. (2017). Nurses’ knowledge, attitudes, and
practices toward physical restraint and seclusion in an inpatients’ psychiatric ward.
International Journal of Culture and Mental Health, 10(4), 447-467.
Mann-Poll, P. S., Smit, A., Noorthoorn, E. O., Janssen, W. A., Koekkoek, B., &
Hutschemaekers, G. J. (2018). Long-term impact of a tailored seclusion reduction
program: Evidence for change. Psychiatric Quarterly, 89(3), 733-746.

SECLUSION AND RESTRAINT 12
Morphet, J., Griffiths, D., Beattie, J., Reyes, D. V., & Innes, K. (2018). Prevention and
management of occupational violence and aggression in healthcare: A scoping review.
Collegian, 25(6), 621-632.
Muir‐Cochrane, E., O'Kane, D., & Oster, C. (2018). Fear and blame in mental health nurses’
accounts of restrictive practices: Implications for the elimination of seclusion and
restraint. International journal of mental health nursing, 27(5), 1511-1521.
Nyttingnes, O., Ruud, T., & Rugkåsa, J. (2016). ‘It's unbelievably humiliating’—Patients'
expressions of negative effects of coercion in mental health care. International journal of
law and psychiatry, 49, 147-153.
Peterson, d. M., & Peterson, h. L. (2017). Seclusion and restraint in mental health care 55.
Incidence of suicidality and seclusion and restraint in inpatient psychiatric care for people
with schizophrenia, 54.
Peterson, H. L. (2017). Patient abuse and trauma: a policy analysis of the regulation of seclusion
and restraint in mental health care. Journal of policy practice, 16(2), 187-204.
Ramluggun, P., Chalmers, C., & Anjoyeb, M. (2018). The practice of seclusion: a review of the
discourse on its use. Mental Health Practice, 21(7).
Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path
toward humanistic care. Indian Journal of Psychiatry, 61(Suppl 4), S693.
Ross, D. (2018). A social work perspective on seclusion and restraint in Australia’s Public
Mental Health System. Journal of Progressive Human Services, 29(2), 130-148.