Nursing Assignment: Effects of Seclusion in Mental Illness Patients

This nursing assignment explores the practice of seclusion in patients with mental illness, examining its effects on both patients and healthcare professionals. It delves into the ethical considerations surrounding seclusion, including the balance between patient autonomy and safety, and the potential for psychological distress and trauma. The assignment highlights the role of registered nurses in advocating for patients, reducing restrictive practices, and promoting patient-centered care. It emphasizes the importance of nurses adhering to ethical principles and legal guidelines, advocating for patients' rights, and utilizing alternative interventions to seclusion. The essay concludes by reinforcing the need for stringent regulations and the promotion of alternative approaches to patient management, such as active listening, empathetic gestures, and distraction techniques.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Assignment topic 2
Seclusion in patents with mental illness
Introduction
Seclusion and restrictive measures are the ways of restricting the movement of an
individual who is suffering from mental illness or any form of disability. Traditionally, a large
number of restrictive practices were practiced in order to the control behavioural disorders or
aggressiveness due to any mental illness. Owing to its adverse effect both the physical and the
psychological health of people, restrictive practices has either been banned or has been reduced
to moderate restraints in case of too aggressive patients.
The report will give an account of the effect of seclusion in the patients as well as the
health care experts. Following this, the paper will also discuss about the roles of the registered
nurses to develop partnership with the consumers for working alongside with the State/National
territory initiative for reducing the incidence of restraints and seclusion.
Effect of seclusion on patients and the health care professionals
The main types of restrictive measures that were applicable to the mental health patients
were mainly physical and the chemical restraints. Chemical restraints included the use of
sedatives that were used on the mental health patients for calming their behaviour. Restrictive
practices were carried out in various settings like age care units, the residential care units, those
under supported living and widely in the incarcerated mentally ill patients (Ezeobele et al.,
2017).

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One of the restrictive practices is seclusion. Seclusion is confinement of a mental health
patient in a locked room from which he cannot exit on his own (Chieze, Hurst, Kaiser & Sentissi,
2019). This is mainly done when the patient is aggressive and violent and is likely to cause harm
to himself, health care professionals and the other patients present in the ward. According to
Haugom, Ruud and Hynnekleiv, (2019), seclusion raises social as well as an ethical question. In
their work Foucault (1967) and Goffman (1961), they have directly said against the practice of seclusion
to be inhuman, power laden and hierarchical. The basic ethical problem associated to behavior control
involves the law of dilemma of how to advocate the autonomy of a patient in situation where the
suppression can be rationalized with respect to common good of the ward community. In this way the
clinicians often explain or rationalize the restrictive practices. According to Joubert and Bhagwan,
(2018), all individuals have the basic right to be protected from any kind of bodily harm and if seen from
this perspective, the autonomy of an individual should not be negotiated under the protection of the self or
the others. Ideally, the health care professionals can only intervene to seclude the mental health patients,
when they are harming themselves or the others. Riahi, Thomson and Duxbury (2016) on the contrary
have clearly stated that seclusion is against the fundamental rights like the freedom to movement,
physical integrity, dignity and autonomy. A large of evidences have informed about the disadvantages of
coercion and seclusion. Seclusion has been associated with the emotions like fear of confinement
disempowerment, anxiety, depression, shame, anger, stigma, fear of confinement of claustrophobic
atmosphere, feeling of vulnerability, loneliness, loss of autonomy, humiliation and uncertainty
(Ezeobele et al., 2017). Apart from raising an ethical question, it is also an issue or social justice, as the
individual in the patient side is powerless and vulnerable and the right to provide treatment is in the hands
of the health care professionals.
The process of seclusion is against the principle of patient centered care. Patient centered care
can be defined as provision of care that is responsive to the preferences, needs and the values of

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individual patients, ensuring that it is the value of the patient that guides the clinical decision (Timothy,
2016). In seclusion, a mental health patient is kept in isolation against the will of the patients. Hence,
seclusion can be considered to be against the “patient centered care” (Timothy, 2016). However, the
mental health clinicians in certain case might argue “seclusion” to be a part of a patient centered care, as
the decision is take for individual patients for the sake of their own safety and the others. Steinert et al.,
(2013) have seclusion, can deteriorate the condition of mental health patients as seclusion have been
found to be causing severe psychological distress in mental health patients. It can traumatize the patients
and bring back the past experiences. People in seclusion are more vulnerable to diseases illness like post-
traumatic disorders. Seclusion and restraints not only develop acute suffering to the patients but might
also exert long term effects like traumatization, self-stigmatization, traumatic memories , negative attitude
towards psychiatric treatment and mental health institution. Patients who are psychotic or having a history
of sexual and physical abuse have the risk of being under seclusion at the time of hospitalization and thus
of being retraumatized, with a negative impact on their cognitive health (Steinert et al., 2013).
Owing to the above mentioned disadvantages, the patients of the mental health services have strongly
protested against the restrictive practices like seclusion. A strong voice of protest can be raised against the
harm caused by seclusion to the patients. The patients have stated that they often cannot raise their voice
of protest due to their vulnerability and hierarchical pattern of the psychiatric organization. They have
termed seclusion as “emotional restraints” as they feel their views and opinions to be constricted.
The perception of the health care professionals about the restraints are different from that of the
health care professionals. They have described seclusion to be a stimulus limiting approach and a
protective tactics for ensuring patient safety in order to manage high risk injury to the staffs and the other
patients. They have admitted the fact, that they apply restraints and seclusion only in extreme cases and
are usually used as a milieu therapy in presence of the other staffs. On the contrary, in a study by
Haugom, Ruud and Hynnekleiv, (2019), it has been stated that there are health workers, that have

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doubt r are not sure about the therapeutic impact of the restriction, as they want to safeguard the patients
and have a focus of avoiding harm, but they are stuck in a setting that restricts the autonomy of the
patients. “do no harm” is surely an ideal principle, but the breaches in the ethical principle can be
defensible, as it could be argued legitimately, that the benefits that are long term would overshadow the
short term benefits. For example, it has been stated by the participants that seclusion often takes place in
rooms, while it has been argued by the staffs that they are provided with a greater autonomy of movement
by using a seclusion unit. Hence, the likelihood of providing autonomy can be considered greater the in a
seclusion unit than by isolation in an ordinary unit (Haugom, Ruud & Hynnekleiv, 2019). Seclusion
can be termed as a treatment that is not consistent with personal recovery process and is more likely to
delay the healing process, as seclusion increases self-stigmatization. Seclusion has termed o be equally
dehumanizing as the physical or the chemical restraints. According to Chieze et al., (2019), seclusion
has been termed to be supporting the medical model of disability, which perceives mental illness to be a
mere disease that can be easily managed by applying restraints and administering pharmacological
interventions. They have considered this model to be too harsh for an individual.
Role of the registered nurse in forming partnership with the consumers for eliminating the
practice of seclusion
Restrictive measures like restraints and seclusion are still in use in the mental health
settings, after knowing the ill effects of such practices, even after the practice has been banned in
many countries. Campaigns and programs has been conducted to spread awareness about the
disadvantage of this practice and how there are affecting the recovery of the mental health
patients. Although nurses work in front line with the clinicians and provide care to the mental
health patients, nurses were reported not to perform any restrictive practices and not to use
sufficient clinical information in conducting such practices (Evans, Nizette & O’Brien, 2017).
The fact that the nurses play critical roles in patients’ rights, restrictive practices can cause

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psychological, social and judicial violation of the human rights (Balci & Arslan, 2018). It is the
duty of the nurses to provide a person catered care, hence restrictive practices should only be
kept as the last resort after all the feasible alternatives have been tried, because according to the
standard 6 of NMBA , nurses are ethically and legally obligated to provide a safe quality of care
responsive the nursing requirement of the people (NMBA, 2018). It can be stated that the
registered nurses should abide by the restraint and seclusion rules of the organisation, as
according to the NMBA standard, registered nurses are liable to practice in accordance with the
policy guidelines, standards and regulations (NMBA, 2018). As per the principle of justice, it is the
moral obligation of the mental health staffs to seclude patient in such a manner that guarantees a high
degree of autonomy for the patient (Haugom, Ruud & Hynnekleiv, 2019). Nurses should act as
advocate for the mental health patients, who are unable to stop restrictive practices and should preserve
the basic rights of freedom for these patients (NMBA, 2018). It should be remembered the practice of
seclusion is contradictory to the ethical principles of autonomy and justice, that stresses on involvement
of the patient in the decision making process (Riahi, Thomson & Duxbury, 2016).
It has been mentioned in the Mental Health act 2007, section 68, that mental health patients
should receive the best possible care in an ambience that is conducive and least restrictive. Nurses should
be able to identify any deterioration in the patient (NSW Government, 2007). However, it has also been
mentioned in the section 190, that health care professionals, if necessary can apply restraints on anybody,
if the individual can indulge in self harm or pose harm to the entire community. Registered nurses should
be kept updated about the various empirical findings of all the restraint laws along with their adverse
effects. Apart from using seclusion and restraints they can be recommended to remain prepared by
relevant data driven interventions and therapies that can be applied as the first line of treatment, other
than putting them in seclusion. It is the duty of the nurses to escalate the matter to the higher authority, if
any such cases of restraints are witnessed within the hospital premises (Joubert & Bhagwan, 2018).

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Conclusion
In conclusion, it can be said that although restraints and seclusion, has been referred to as
harmful, they are being used in a large number of health care settings. However, stringent laws
should be made against the use of seclusion. It should only be used in extreme cases where
seclusion is required for the patient safety. Nurses can practice gestures like active listening,
empathetic gestures, warm back rubs or might keep the patient distracted.

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References
Balci, H., & Arslan, S. (2018). Nurses' Information, Attıtude and Practices towards Use of
Physical Restraint in Intensive Care Units. Journal of caring sciences, 7(2), 75–81.
https://doi.org/10.15171/jcs.2018.012
Chieze, M., Hurst, S., Kaiser, S., & Sentissi, O. (2019). Effects of Seclusion and Restraint in
Adult Psychiatry: A Systematic Review. Frontiers in psychiatry, 10, 491.
https://doi.org/10.3389/fpsyt.2019.00491
Evans, K. Nizette, D. & O’Brien, A. (2017). Psychiatric and mental health nursing (4th ed).
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Ezeobele, I. E., Malecha, A. T., Mock, A., Mackey‐Godine, A., & Hughes, M. (2014). Patients’
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