University Assignment: Nurses' Role in Seclusion Reduction Report

This report delves into the critical issue of seclusion practices within mental healthcare institutions, analyzing their detrimental effects on both patients and nursing staff. The author, drawing from clinical experience, highlights the need for seclusion reduction and explores alternative strategies. The report defines seclusion, reviews supporting literature, and discusses the negative impacts of seclusion on patients' mental health, including sensory deprivation and emotional distress. It also examines the role of nurses in reducing seclusion through leadership, data-driven practices, workforce development, sensory modulation techniques, and family involvement. The report concludes by emphasizing the importance of reducing seclusion and suggests practical steps for healthcare units to adopt, advocating for the use of alternative therapies and patient-centered approaches to improve mental health outcomes.

Running head: ROLE OF NURSES IN SECLUSION REDUCTION
Role of Nurses in Reducing Seclusion in Mental Healthcare Institutions
Name of the Student
Name of the University
Author Note

1ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
Executive Summary
The paper aims to discover the negative impact of seclusion, practised in many mental
healthcare institutions, on the patient as well as nurses and the staffs. The following sections
of the paper will discuss the seclusion and restraint of inpatients, along with the reasons to
employ such practices. A brief discussion of an incident experienced by me during clinical
practice is also mentioned in the paper. The report will further explain the alternatives of
seclusion and ways to reduce the seclusion period. Lastly, the paper will conclude why
seclusion reduction is the need of the hour and how nurses have a crucial role to play in it.

2ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
Table of Contents
Introduction....................................................................................................................3
Definition of Identified Issue.........................................................................................3
Overview of Literature Supporting Issue.......................................................................5
Discussion......................................................................................................................6
Strategies to Eliminate Seclusion Practice.................................................................6
Experienced Issue and the Literature.........................................................................7
Conclusion......................................................................................................................9
References....................................................................................................................10

3ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
Introduction
Seclusion reduction is one of the most critical topics of discussion among mental
healthcare providers. Seclusion refers to the act where the patient is kept isolated in a
furnished/unfurnished place, and all the services are cut. This kind of isolation is psychiatric
inpatient care designed for the patient with violent or disturbing behaviour. Such measures
are taken to ensure that the patient does not harm anyone and reduce any kind of stimulant
that might trigger the patient’s abnormal behaviour. However, according to my experience of
dealing with a secluded patient, I would consider it as an inhumane act. The following paper
discusses one such incident that I faced during my clinical practice session at mental
healthcare unit and further mentions why all healthcare organisations should practice actions
to reduce seclusion. I firmly believe that seclusion is not the proper way to treat patients
requiring mental support and nurses have a crucial role to play in reducing such practices.
The paper will aim to mention the steps that the authorities in mental health care units can
practice, in order to decrease such kind of inpatient treatment and ensure that number of
seclusion and restraint patients decreases gradually. These actions have proven to be effective
in reducing seclusion, and the paper provides pieces of evidence for the same.
Definition of Identified Issue
Seclusion is a common practice in mental health care units where the inpatient is
formally placed in a designated locker or unfurnished room (Larue et al., 2013). Patients who
are generally categorized as a threat are taken to restraint or seclusion, and the higher medical
authorities take up this decision. Seclusion is an inhumane as it is involuntary, i.e. the patients
are kept in isolation against their will, and all their services are cut out (Chieze et al., 2019).
The mental healthcare follows a general rule that patient considered as a threat, is to be

4ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
secluded. However, the impact of getting isolated from the group, and being confined to a
small room where freedom is restricted, and the door is held shut, can affect poorly the
mental health of the patient. Mental health refers to the psychological, emotional and social
well-being of an individual. Nurses have crucial role to play in improving patient’s
psychiatric mental health (Townsend, & Morgan, 2017). Moreover, seclusion, which is
commonly practised in mental health care units, negatively influences all the three aspects of
mental health, as it has adverse psychological effects, make the patient feel alone, thus letting
them emotionally down with no social life at all (Soininen et al., 2013). Even if seclusion is
argued to be a valid measure of keeping the patients from harming themselves or the staffs, I
believe there can be good alternatives, and it is high time to reduce such practices.
One such incident of seclusion I faced was during my clinical practice session in one
of the mental healthcare care organisations. I voluntarily applied to go check an inpatient who
is kept in seclusion because of his anger issues and was considered a significant risk to
himself and the hospital staffs. Moreover, he was kept in restraint with very little freedom to
move or do something at all. The patient was receiving a diagnosis for IED (Intermittent
Explosive Disorder). The patient had sudden episodes of aggressive, impulsive and violent
outbursts because of such disorder and threw tantrums when such episodes occurred. The
doctors and senior nurses of the hospital decided to move the patient to seclusion and
restraint in order to prevent any harm to the patient or other staff. My visits were scheduled
every two hours. I felt terrified, yet pity while staying beside the patient. Everything that was
done to the patient felt inhumane. In the absence of any moderator, the patient was hitting
everything in his reach, to get attention. The other thing I cannot help notice was the
condition of the room. The room was not well furnished and was small, where he was kept
with his hands and legs tied up. Everything felt very bad over there, which pushed me to do
research on seclusion reduction in mental healthcare institutions and the role of nurses in it.

5ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
Overview of Literature Supporting Issue
Australian mental health policy does not support the practice of seclusion, as it
believes in providing mental healthcare services in the least restraining and restrictive
atmosphere. Seclusion not only has negative impacts on the patient getting secluded but the
nurses, too, who are taking care of them. Researches have shown that seclusion has a
negative impact on the patient, which often leads to sensory deprivation, emotional
negativity, and inability to self-control and hampers the patient-nurse relationship
(Kuosmanen et al. 2015). Nurses have a vital role to play in seclusion reduction as they are
the ones who get to spend the most time with the inpatients and even suffer from the temper
of the secluded patient. Circumstances in which the inpatient is taken to seclusion is
significant too, as the patient might not be ready for such isolation and react more adversely
(Chieze et al., 2019. Many surveys and researches have concluded that the seclusion room is
usually ascetic and too basic, which is humiliating for the patient. Seclusion has shown a
negative impact on the inpatient as their anxiety increased with boredom in complete
isolation (Kinner et al., 2017). The seclusion also means that the patient secluded, gets to talk
with the nurses only, and this has affected the workload of the nurses too.
Seclusion reduction is a set of practices that will help to reduce the number of
seclusion cases in as many as possible mental healthcare institutions. Standard practices that
should be followed after an inpatient is secluded involves continuous monitoring, proper
documentation, training and assessment, ideal interventions, reevaluation and then
discontinuation (Väkiparta et al., 2019). Only extreme cases of involving high risk of patient
harming anyone, including their own self, should be taken to the point of seclusion.
The common reasons that force the authority to place the patient in restraint are
assistance in treatment or therapy programs, preventing chaotic behaviour & destruction of

6ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
property and sometimes may include a patient request for such action. Even if the patient
seems to be a risk, the reasons that seclusion should not be implemented are convenience,
punishment and lack of resources to monitor such patients adequately. The use of seclusion is
discouraged in many countries as more researches reveal that seclusion results in more
frustration and anxiety among participants. According to Green, 2018, a redesigning of the
seclusion practices and facilities are required in mental healthcare providers that are still
using seclusion for treatments. However, the motive is not to improve seclusion facilities, but
to eliminate such practice at all and for this, the healthcare units have to search for positive
alternatives.
A systematic review of literature concludes the statement that seclusion is only a
temporary behavioural management session and not a therapeutic care practice. In fact,
mental health settings with higher seclusion practices are contradicting their principal
purpose, which is to diagnose the mental health of the inpatients. This is due to the fact that
seclusions have significantly resulted in inducing more physiosocial trauma to the patient.
Decreased staffing results in the increased workload of existing staffs, as they have to keep
constant surveillance on the patient in restraint (Newman, Paun, & Fogg, 2018). This has also
resulted in many cases in which the hospital has to keep the patients in seclusion for more
time than recommended, only because they do not have the required staff to diagnose the
patient and improve their behaviour.
Discussion
Strategies to Eliminate Seclusion Practice
Seclusion practices not only hampers the mental health of the patient but has negative
influences on the nurses too. It is challenging for a nurse to take proper care of the patient

7ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
kept in restraint, and the mental healthcare providers should adopt some strategies for
seclusion reduction.
Following strategies have termed to be useful in reducing seclusion.
 Leadership: The senior team of the healthcare units should hold regular meetings and
keep a track on the development of the inpatient.
 Statistical Data to Inform Practice: Visual representation of the data collected from
seclusion episodes and the various changes implemented to reduce seclusion practice
are displayed. Post this, the staffs and the nurses overlooking seclusion patients are
acknowledged and praised for their determination and efforts.
 Workforce Development: The staffs and the nurses are encouraged to use alternatives
of seclusion, which includes sensory modulations, trauma-informed care ethics and
de-escalation techniques.
 Sensory Modulation: The nurses should be well-trained of different de-escalation
techniques, including the use of sensory modulation when the patient is in distress.
This is a positive kind of intervention that helps to reduce the duration of which the
inpatient has to be kept in seclusion (Lloyd, King, & Machingura, 2014).
 Inclusion of Family: Community meetings can help the patients to voice their
opinions, which should be noted by the staff nurses. Such remarks significantly help
in adopting patient-specific treatment principles and reducing seclusion or restraint
period.
Experienced Issue and the Literature
The patient that I voluntarily applied for assistance during my clinical practice was
suffering from IED. For behavioural management, he was taken to restraint and was given
chemicals to immobilise his body (Medeiros et al., 2019). His first review was scheduled

8ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
after six hours, until which the two nurses, including me, kept monitoring him constantly.
The senior doctors decided after the first review that he needs an additional session of
behavioural management, which I thought was not that much necessary. The patient felt
restless and kept begging to release him. This was an extreme case of IED where seclusion
was exceptionally required to keep the patient away from harming himself. However, after
the first session, the patient should have been brought back to the ward. A small interaction
with the patient made me feel that he wanted someone to listen to him patiently. This is
where the literature of alternative of seclusion can be applied. According to McCloskey,
Fahlgren, & Coccaro, 2018, problem-solving methods, along with techniques to initiate
cognitive restructuring of the patient are the best alternatives for such case.
Moreover, the patient should be allowed to participate in community meetings of the
patient under supervision, where he can voice his opinions and can be taught to accept
reasonable replies and adopt a rational way of thinking. It was visible that the patient
deliberately needed a change in the environment as the small-unfurnished room made him
more frustrated and deteriorated his mental health.
The particular mental health unit where I experienced this incident should have
employed psychotherapy & sensory modulation along with medications instead of sending
the patient to seclusion. After the first session of seclusion, instead of sending him again, the
doctors should have employed the use of mood-stabilizing medications. Such mood
stabilizing medications include anti-depressant, anticonvulsant and SSRIs (Selective
Serotonin Reuptake Inhibitors) (Lee, Wang, & Coccaro, 2019).
Most of the above-mentioned literature review direct the mental healthcare providers
to reduce the number of seclusions and adopt other alternatives such as sensory modulation if
possible. Nurses have a crucial role in seclusion reduction in mental healthcare settings as

9ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
they can directly employ other alternatives during seclusion, collect data on whether the
patient is responding positively and then conduct a meeting with the doctors to assure them
that the patient can be treated without the use of seclusion or restraint mechanisms (Muir‐
Cochrane et al., 2018).
Conclusion
The paper provides conclusive evidence on why seclusion is a poor way of
behavioural management and how the use of such practice can be reduced in mental
healthcare units. It also mentions the impact of seclusion and restraint on the patient’s mental
health as well as the nurses monitoring them. Seclusion is required when the patient is
required to be subjected to temporary behavioural management. Seclusion and restraint are
often conducted in poor room settings and environment, with complete isolation from the
outer world. This can result in psychosocial trauma in the patient, which has a severe
negative impact on the patient’s mental health. Thus, every staff and nurses in mental
healthcare institutions have a crucial role to play in adopting alternatives to seclusion and
making sure that there is a significant decline in such practices.

10ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
References
Andersen, C., Kolmos, A., Andersen, K., Sippel, V., & Stenager, E. (2017). Applying sensory
modulation to mental health inpatient care to reduce seclusion and restraint: a case
control study. Nordic journal of psychiatry, 71(7), 525-528.
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.
Goulet, M. H., Larue, C., & Dumais, A. (2017). Evaluation of seclusion and restraint
reduction programs in mental health: A systematic review. Aggression and violent
behavior, 34, 139-146.
Green, P. (2018). Creation of an Evidence-Based Practice Guideline for a Seclusion
Alternative.
Kinner, S. A., Harvey, C., Hamilton, B., Brophy, L., Roper, C., McSherry, B., & Young, J. T.
(2017). Attitudes towards seclusion and restraint in mental health settings: findings
from a large, community-based survey of consumers, carers and mental health
professionals. Epidemiology and psychiatric sciences, 26(5), 535-544.
Kuosmanen, L., Makkonen, P., Lehtila, H., & Salminen, H. (2015). Seclusion experienced by
mental health professionals. Journal of psychiatric and mental health nursing, 22(5),
333-336.
Larue, C., Dumais, A., Boyer, R., Goulet, M. H., Bonin, J. P., & Baba, N. (2013). The
experience of seclusion and restraint in psychiatric settings: perspectives of
patients. Issues in Mental Health Nursing, 34(5), 317-324.

11ROLE OF NURSES IN REDUCING SECLUSION IN MENTAL HEALTCARE UNITS
Lee, R. J., Wang, J., & Coccaro, E. F. (2019). Pharmacologic Treatment of Intermittent
Explosive Disorder. Intermittent Explosive Disorder: Etiology, Assessment, and
Treatment, 221.
Lloyd, C., King, R., & Machingura, T. (2014). An investigation into the effectiveness of
sensory modulation in reducing seclusion within an acute mental health
unit. Advances in Mental Health, 12(2), 93-100.
McCloskey, M. S., Fahlgren, M. K., & Coccaro, E. F. (2018). Assessment and treatment of
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the Diagnostic Spectrum, 31.
Medeiros, G. C., Seger-Jacob, L., Garreto, A. K., Kim, H. S., Coccaro, E. F., & Tavares, H.
(2019). Aggression directed towards others vs. aggression directed towards the self:
clinical differences between intermittent explosive disorder and nonsuicidal self-
injury. Brazilian Journal of Psychiatry, (AHEAD).
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.
Newman, J., Paun, O., & Fogg, L. (2018). Effects of a Staff Training Intervention on
Seclusion Rates on an Adult Inpatient Psychiatric Unit. Journal of psychosocial
nursing and mental health services, 56(6), 23-30.
Soininen, P., Välimäki, M., Noda, T., Puukka, P., Korkeila, J., Joffe, G., & Putkonen, H.
(2013). Secluded and restrained patients' perceptions of their treatment. International
Journal of Mental Health Nursing, 22(1), 47-55.