Literature Review on Nurses' Role in Mental Health Seclusion Reduction

This report examines the critical role of nurses in reducing patient seclusion within mental healthcare settings. The introduction highlights the issue of seclusion, defining it as the confinement of individuals in a restricted environment, and emphasizes the need for improved practices. The paper then delves into a literature review, analyzing various articles that support the importance of nurses in seclusion reduction. Key themes include the implementation of safe wards, the assessment of patient mental states, therapeutic communication, and the development of individualized care plans. The report also discusses the American Psychiatric Nurses Association (APNA) guidelines, emphasizing the need for organizational changes, professional development, and the promotion of patient rights. The discussion section further elaborates on APNA's policies and standards, advocating for respectful treatment, the use of seclusion only as a last resort, and the importance of a supportive organizational culture. The conclusion summarizes the findings, highlighting the need for nurses to be proactive change agents, implement evidence-based practices, and collaborate with patients and organizations to reduce seclusion and improve patient outcomes.

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Solution Paper
Student’s Name
Institutional Affiliation

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Mental health: Nurses roles in seclusion reduction
Introduction
The issue I encountered during my clinical placement was the seclusion of patients in
mental healthcare. Seclusion means confining an individual in a room where the person cannot
exist freely. As an illustration, seclusion comprises containment, isolation, and reduction of the
sensory input. I did not like how the psychiatry patients were being handled it could be done
better especially if nurses are fully involved. There has been deep interest in the reduction of
seclusion in the mental health service inpatients nationally and internationally. The objective of
this paper is to cover the role of nurses in seclusion reduction in mental healthcare. The advice
on the best practices has also been discussed within the paper.
Definition of the Issue
Seclusion has always been employed with beliefs that it promotes patients' safety.
Accordingly, there have always been beliefs that without seclusion, then patients can injure
themselves or others, which includes nursing staff and even visitors (Bigwood, 2018).To start
with, putting a person in a room with closed doors, and where the freedom to exit is only
determined by the staff is called containment. On the other hand, Isolation is where the person is
in a room alone. Accordingly, the reduction of the sensory input is where the room is bare and
has nothing to sleep on. Research has proved that seclusion can further physical or psychosocial
trauma. Seclusion has no known long term advantage in reducing behaviors.
Overview of literature supporting the issues
Bigwood (2018) in Nurses key to solving the challenge of seclusion states that safe wards
can help to reduce seclusion. Bigwood argued that safe wards can help reduce the level of

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violence within the in-patient wards. However, this article does not cover what exactly the nurse
should do in order for the wards to be safe. Accordingly, the article should have covered several
approaches in detail how and what particularly nurses should do in order for seclusion to be
reduced. The article should have stated that nurses in mental health needs to be aware that
patients may be exhibiting signs of mental illness. However, the nurses can reduce seclusion by
assessing the patients’ mental state, establishing excellent communication with the patients,
creating a relation with the patients, using a considerate language, providing sensitive patient-
centered care, and also consulting with the knowledgeable mental health experts. All these can
help patients to avoid being hostile and hence cooperative, thus minimizing seclusion.
The strength of this article as per the topic is that nurses should be at heart of the project
that tries to reduce seclusion in mental health patients. The article states further that Nurses ought
to use the physiological approaches such as investigating the symptoms which indicates the
development of complications such as hypoxia, delirium, or fever. As an illustration, these
interventions usually focus on patient behavior and also addresses that need. In that case, nurses
have to talk to patients about their physical activities. The nurses are supposed to be educated
and intensively be evaluated to meet the required standards.
It is covered in the article that nurses have to work with individuals, families, and groups
within the medical and community environment. Nurses should also create a care plan for
nursing care and carry out those plans to help calm down the patients. Nurses usually strive to
establish a therapeutic relationship with patients in order to engage them positively and
collaboratively to avoid patients from being violent and dangerous to caregivers. The nurses also
needs to assess mental health needs and develop a diagnosis.

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The nurses may also help with the management of the therapeutic environment, assisting
patients with safe care during the intervention process. Nurses in mental health are usually
skilled in mental health assessment, medication, crisis intervention, and therapy, and patient
assistance. In order to reduce seclusion in mental health, the nurses are supposed to first
understand the patient by knowing the ailment, history, and daily habits. The nurses then create
individualized patient plans, which helps to maximize patient care. These points makes this
article relevant to this topic.
The weakness of this article is that all the strategies it suggests arrives at conclusion
without having solved the issue of seclusion. The article did not cover anything about the
American Nurses Association which supports the nurses in reducing patient seclusion within the
healthcare setting. The Seclusion of patients is usually perceived as doing contrary to the goals
and objectives of the nursing profession that upholds the autonomy of each patient. Therefore,
open communication and dialogue at the highest administrative levels should be there, which
comprise registered nurses and staff from all the departments in order to reduce seclusion
(Bigwood, 2018). The nurses have to target the specific unit of patients or groups and then
identify who is restrained and why. They should then lay grounds for intervention that is aimed
at eliminating seclusion.
Even though seclusion is an interprofessional phenomenon, it is clear that nurses are the
logical change agents due to their constancy within the psychiatric care environments, influence
to the hospitals, their positions within units and within chain in command in facilities. Nurses
should, therefore, integrally be engaged within the design of psychiatric care environments in
terms of physical design along with the cultural foundations of care processes (Strazisar et al.,

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2015). They are also supposed to take a more proactive stance for setting the policies for both
preventions of seclusion and the cultural stigmatization of mental illness.
The nurses needs to be more accountable for developing the required leadership skills in
reducing seclusion in mental healthcare. Accordingly, nurses are in a position to compete for the
service grants, which can fund the nurse-led model programs seclusion reduction by basing on
the redefinition of the mental health issues. Furthermore, the nurses need to join associations
such as the American Psychiatric nurses along with the international society of psychiatric
mental health nurses to actively promote different curriculums for the preparation of psychiatric
mental health practitioners within the nursing schools and also reinforce the trauma-informed,
safety and respect driven (Townsend & Morgan, 2017). In that case, they also needs to be willing
to take stands for patients who lack voice and be more politically savvy.
The psychiatric nursing course is supposed to clearly identify seclusion as unsupported
and non-therapeutic by citing research and evidence-based model. They are also supposed to be
given an extended mentoring period in order to learn the prevention methods of seclusion instead
of laying focus on how to do seclusion interventions. In that case, they have to focus on how to
establish therapeutic relationships in order to sustain the non-violent cultures of care (Park &
Jang, 2018).
In developing organizational strategies and practice standards to ensure the overall
commitment of staff and also patient safety, the issue of assault to caregivers by psychiatric
patients needs to be addressed. From a research, the main reason for seclusion and restraint is to
prevent aggression by; ensuring constant presence which facilitate the detection of early changes
in patient condition, provision of quick intervention with little or no measures of restriction like
verbal or non-verbal communication, active listening, reduced simulation, medication or limit

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setting, promotion of the unit culture of calmness, structure, collaboration and negotiation
(Orthwein, 2017).
The current evidence shows that there is a revolutionary change in psychiatric treatment
philosophy which leads to improved patient behavior, consequently impacting the application of
seclusion in treating patients. At the same time, there is a growing sense of awareness that
psychiatric in-patients treatment should be based on trauma-informed care principles and
recovery process. A combination of these principles provided a collaboration enabling
environmental bossing of efforts to eliminate the use of seclusion and restraint practices. It is also
essential to recognize the risks involved in the use of seclusion (Noorthoorn et al., 2016).
It is crucial to understand the possibility of the dangers posed by the use of seclusion or
restraint when patient behavioral changes are emanating from a physiological problem that needs
medical intervention. Use of seclusion and restraint practices predisposed such a person to
increased physiological risks (Toftdahl, Nordentoft & Hjorthøj, 2016). The use of skilled
assessment of patient's physiological health will, in addition to improving safety, ensure
vulnerable patients get medical attention, and prevent potential or further seclusion and restraint.
Discussion
According to APNA, psychiatric-mental health nurses have a crucial role to play in the
provision of psychiatric care to people with a mental health condition. Their purpose that nurses
have calls for them to offer treatment that is effective, and also provide milieu leadership in
maximizing the patient's ability to manage effectively any potential dangerous behaviors. In
doing so, it creates an environment that minimizes the chances of using seclusion and restraint

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measures (Norvoll, Hem & Pedersen, 2017). In supporting the elimination of patient seclusion
and restraint, APNA has established policies and standards that;
Advocate for the establishment of systems within federal, state, as well as organizational
level, to protect staff safety and patients from the potential risks and trauma associated with
seclusion and restraint practices. Establish and provide the much-needed opportunities for
continued professional education, training, and learning for psychiatric-mental health nurses by
promoting their safety, patient safety, autonomy, and sense of self of control. Promulgation of
professional standards applicable in all communities, especially in all settings of behavioral
emergencies, and establish the framework for quality and safe care for patients whose behavior
pose a safety threat to the patient or others. In the case where organizational characteristics
contribute to patient safety, measures that ensure shared responsibility by leaders in the creation
of a better environment that discourages patient seclusion and restraint (Wang & Miller, 2017).
Among the fundamental principles that promote the elimination of seclusion and restraint,
APNA notes that patients have the right to respectful and dignified treatment. The organization
also advocates for psychiatric patients to be treated in a humane, safe, socially sensitive, and
appropriate way that respects autonomy and the right of choice. More so, seclusion is required
not be adopted for convenience or to punish individuals. The seclusion and retention have to be
used sporadically only when necessary to ensure an individual's safety, staff, and other patients
after other less restrictive interventions have been established to be worthless (Noorthoorn et al.,
2016).
The use of seclusion is mostly determined by the organization's culture, which shapes
ethics and norms on how individuals are treated. Organizations, therefore, need to focus on
cultural changes that promote the reduction of patient's seclusion and restraint. Effective

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administrative, clinical processes, and structures have to be put in place to counter behavioral
emergencies by using alternative practices. Continued professional enhancement through
education and training of psychiatric-mental health nurses should be adopted within the
organization as well as partnering with relevant organizations (Nagayama, 2019). Lastly,
organizations need to establish an oversight committee to measure and share performance
regarding the efforts to reduce the practice of seclusion and restraint.
The nurses can also partner with organizations to create an atmosphere of care which is
experienced as healing and positive that embeds the principles of recovery-oriented trauma-
informed paradigms. In that case, the leadership development on all levels is essential in
implementing the seclusion reduction policy with fidelity. Nurses can collaborate with patients
and hence incorporate the psychiatric advanced care directives within the treatment planning.
There has been an attempt to appropriate funds on the federal policy level to change the current
state of culture of containment (Norvoll, Hem & Pedersen, 2017).
The nurses who work in psychiatric settings are not always aware of the basic rationale
for seclusion prevention practice, together with a lack of explicit knowledge concerning how to
prevent their use. The seclusion is usually used in response to disruptive, noncompliant, and
disruptive behavior, which is contrary to how nurses and psychiatric healthcare knows.
Conclusion
In summary, seclusion has always been thought to be an effective way of treating people
with a mental health condition by healthcare givers. However, there is no proven long tern
benefit for changing the patients ‘behavior. In that case, the psychiatric in-patients has to be
treated basing on the trauma informed care principles together with the recovery process.

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Furthermore, it is advised to use the skilled assessment of the patients' physiological health since
it improves safety and also ensures that patients get medical attention thus preventing further
seclusion.
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