NRSG263: Impacts of Seclusion on Consumers and Professionals

This essay provides a comprehensive analysis of the impacts of seclusion on both consumers and healthcare professionals within mental health settings. It explores the traumatic experiences, violations of human rights, and psychological effects of seclusion on patients, including the potential for retraumatization and the exacerbation of mental health conditions such as depression and aggression. The essay also examines the ethical dilemmas and potential for injury and trauma faced by healthcare professionals when implementing seclusion and restraint measures. Furthermore, it highlights the crucial role of registered nurses in collaborating with consumers to support state and national initiatives aimed at reducing and eliminating seclusion, such as the Safewards model and the Recovery approach, emphasizing the importance of education, communication, and patient-centered care. The essay underscores the need for alternative interventions and a shift towards practices that prioritize patient autonomy and well-being.

Running head: IMPACTS OF SECLUSION 1
Impacts of Seclusion to Consumers and Healthcare Professionals Alike
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Introduction
Seclusion is an intervention approach used to manage or control of individuals mental
sickness. The approach has historically been used and even encouraged in psychiatric settings.
However, with the recent development in the field of patient-based care and increased advocacy
of human rights, the approach has severally been critiqued and recommendations made for its
elimination. Most of the existing studies have examined the effects of seclusion on consumers
and healthcare professionals separately, yet there is evidence that healthcare professional is also
affected by the procedure just like consumers. Therefore, the current essay will examine the
impacts of seclusion to consumers and healthcare professionals alike in addition to the role of the
registered nurse in collaborating with consumers to work towards State/Territory and National
initiatives in reducing seclusion and restraint.
Impacts of Seclusion to Consumers
The use of seclusion as an intervention in the mental health services to regulate a
patient’s behavior has been used for along time. However, serious concerns have been raised in
Australia by both the health experts and the consumers thus necessitating the need for minimal
use of seclusion and in some cases elimination. Consumers are perhaps the most affected by the
practice of seclusion.
Seclusion is associated with traumatic experiences because in most cases it is
accomplished through coercion. Patients feel disempowered, are irritated and feel vulnerable
during seclusion and these episodes can last for two years after seclusion. Studies have examined
the psychological effects of seclusion and found out that the negative emotional experiences
experienced during seclusion lead to trauma (van de Sande et al., 2011). Furthermore, seclusion

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resulted to retraumatization because it brought back memories of the past negative emotional
experiences. Consequently, the secluded patients suffer more mental pain than they were before
seclusion.
It has also been found out that traumatic experiences due to seclusion makes the patients
more aggressive and wit no emotional reaction. Brophy et al. (2016) conducted a study on the
view of consumers on the use of seclusion in mental health care. The authors found out that most
of the participants attributed seclusion to trauma and were sometimes reminded of the past
negative experiences of forceful seclusion. The patients also attributed their traumatic
experiences of seclusion to the poorly sanitized rooms in which the patients were secluded.
Knox and Holloman (2012) reported that lifetime trauma was prevalent in psychiatric settings.
Some patients have complained of sexual and physical assault during seclusion and even the act
of witnessing traumatic episodes affects even those patients not being secluded.
Seclusion has also been found to be a direct violation of human rights. Seclusion is
usually carried out through coercion even when it is not necessary. Nursing practice emphasizes
the essence of patient autonomy in which nurses should obtain informed consent before any
major treatment. However, seclusion breaches this right because it is characteristic of the
involuntary admission of patients. Additionally, there is usually a lack of accountability during
seclusion and yet there are several instances of violation of human rights. Most of the secluded
patients have mental illness and thus the nurses do not believe them even when they complain of
pain or abuse. The participants in the study by Chieze, Hurst, Kaiser, and Sentissi (2019)
recounted several incidences of being thrust on the floor and then injected because they
complained of the negative effects of the medication.

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The study by Mayers, Keet, Winkler, and Flisher (2010) found out that patients in
psychiatric settings highly valued an explanation for the reason of seclusion on them. This
clearly indicates that most of them had the mental ability to understand treatment procedures
even though they were not consulted leading to the violation of their human rights. Forced
seclusion also results in mental depression during the period and after. The experience of
loneliness and separation from family members and close acquaintances causes psychological
distress among the patients that are already sick mentally.
Steinert, Birk, Flammer, and Bergk (2013) carried out a randomized controlled study on
the experiences of secluded patients one year after interviewing them. The patients in the study
reported distressful feelings such as fear, anger, and powerless during seclusion. However, 58%
of them accounted for their benefits after recovery due to constant contact with the nurses during
the experience. Other studies have also found out that seclusion does not only result in mental
depression but also reignites the old forgotten hurtful memories.
Soininen et al. (2013) examined the effect of seclusion and the quality of life at discharge
of mentally ill patients. The study found out that most of the patients suffered from mood
disorders especially depression and delusional disorders. Mushtaq, Shoib, Shah, and Mushtaq
(2014) carried out a literature review on the association between loneliness and psychiatric
disorders and found out that loneliness, which is characteristic of seclusion resulted in
psychiatric disorders such as depression and drug and substance abuse in addition to personality
disorders.
Restraint and seclusion are used as a control mechanism among mentally ill patients and
a method of managing their environment. As a result, the secluded individuals often feel that
they do not have control. A study found out that some female patients felt they were to lose

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control before being secluded and thus became aggressive forcing the nurses to use coercion to
effect seclusion and control their behavior (Steinert et al., 2010).
Impacts of Seclusion on Healthcare Professionals
Seclusion does not only affect consumers but also healthcare professionals. The practice
of seclusion often places the nurses in an ethical dilemma in which they have to strike a balance
between adhering to the principles and practice of nursing and their safety. Patients have a right
to autonomy and thus an informed consent should be obtained from them before any major
diagnosis. However, seclusion contravenes this right because in most cases it involves
involuntary admission of patients. In most cases, nurses force the patients into seclusion because
they are often aggressive and nurses have ensured they and other patients are safe. In such cases
of aggression, it is difficult for nurses to obtain informed consent and at the same time ensure
they are safe.
Furthermore, most of the studies have pointed out the negative effects of seclusion and
restraint and often fault the nurses for using such aggressive measures. However, none of the
studies provide a practical and alternative way to manage mentally ill patients. For instance,
Brophy et al. (2016) examined the experiences of patients on the use of seclusion and restrain in
Australia. The study found multiple negative effects of seclusion on the consumers and even
recommends its elimination but with no alternative solution because either way nurses are still
handling mentally ill patients that are in most cases aggressive.
Professional nurses also face the risk of injury and even death while enforcing seclusion
to mentally deficient patients. In most cases, the patients would resist seclusion thus forcing the
nurses to coerce them into seclusion and as a result, nurses can physically be injured during this

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process. Khalil, Al Ghamdi, and Al Malki (2017) examined the knowledge and attitude of nurses
in the use of seclusion in psychiatric settings and found out that most of the nurses were
averagely cognizant of the use of physical restraint and seclusion. The study also found out that
there was a significant correlation between the inadequate knowledge on the effects of seclusion
and their performance and attitude in caring for mentally ill patients.
Traumatic experiences do not only occur to secluded patients but also to nurses as well.
The act of forced seclusion and restraint is often undertaken by healthcare workers against their
will. As much as they may sympathize with the mentally ill patients being forced into seclusion,
they have no option. Since nurses are also human beings they are traumatized by the experience
which further affects the quality of healthcare service. The study carried out by Doedens et al.
(2017) on the factors that necessitate the need for seclusion by nurses found out that nurses were
equally traumatized by seclusion including those that witnessed the ordeal. Additionally, the
nurses were mentally disturbed and could not concentrate on their work.
Seclusion and restraint have also been found to be a contributing factor to the increasing
prevalence of drug and substance abuse among nurses in psychiatric settings. Cares, Pace,
Denious, and Crane (2015) explored the use of drugs and mental sickness among nurses by
assessing the experience of 441 nurses enrolled in a peer health aid project. Almost half (48%) of
the patients took alcohol or other drugs while at work and 40% of them attributed their poor
performance to drug addiction. When asked the major reason for taking drugs at the workplace,
most of the participants attributed such behaviors to the traumatic experiences with mentally ill
patients. Some of the nurses had to take psychotic drugs prior to seclusion and restraint so that
they couldn’t feel the emotional pain and trauma associated with it.

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role of the registered nurse in collaborating with consumers to work towards State/Territory and
National initiatives in reducing seclusion and restraint
Due to the significant negative impacts of seclusion and restraint, state and national
initiatives have been recommended to help reduce or eliminate seclusion and restraint. However,
the success of such initiatives is dependent on the collaboration between nurses and consumers
with nurses playing a critical role. Nurses in collaboration with patients can help in the reduction
of seclusion and restraint through the Safewards model (Fletcher, Hamilton, Kinner, & Brophy,
2019). Nurses can help in identifying the possible causes of the aggressive behaviors among
patients and help in addressing them. Nursing leadership can provide a suggestion box to obtain
the causes of aggressive behaviors from the perspectives of both nurses and consumers. By
identifying the causes the nurses can explore the most suitable approaches to reduce and
eliminate seclusion and restraint. Additionally, the suggestion boxes can be an ideal approach to
obtaining ideas from patients about an alternative method to seclusion or restraint.
Registered nurses can also collaborate with consumers to reduce seclusion and restraint
by accepting the national initiatives of providing education to mental health practitioners and
consumers on multi-intervention strategies. Nurses can accomplish this by improving
organizational culture through the adoption of the lived experiences of patients, supporters and
existing research. Nurses can be trained on the significance of communication to the patients as
an effective approach to help improve the culture. Nursing leadership can also establish an
internal system of data collection, performance evaluation and continuous improvement as a way
of determining the areas that require education (National Mental Health Commission, 2015).
The National Mental Health Commission (NMHC) recommends the Recovery approach
as an effective initiative in reducing seclusion and restraint. Nurses in collaboration with

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consumers can a significant role in reducing seclusion and restraint through the implementation
of this initiative. The recovery approach recommends understanding the consequences and
effects of seclusion, safety promotion, supporting consumer control and freedom among others.
Nurses can play an educational role in creating awareness on the effects of seclusion and how to
avoid it. They can also provide patient-based care before seclusion as a way of avoiding
aggression and minimizing the traumatic acts associated with it (National Mental Health
Commission, 2015).
Conclusion
The use of seclusion in psychiatric settings may appear to be the easy way to manage
behaviors of patients in mental health services, but its deleterious effects require that seclusion
be limited or where possible eliminated. Both the healthcare professionals and consumers have
critiqued the use of seclusion and restraint in healthcare services, hence the urgent need to
eliminate it. Seclusion worsens the mental health of the patients leading to trauma, risk of harm
injury violates patient rights, and affects physical health as well. On the other hand, healthcare
professionals are also affected by seclusion and restraint. The dramatic episodes experienced
during seclusion is traumatic to healthcare professionals and affect their performance and quality
of work. However, nurses can collaborate with consumers to implement various and applicable
initiatives designed and developed by the State or National government. The impact of seclusion
and restrain on patients and staff is more deleterious and thus should be reduced or eliminated as
much as possible.

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References
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