Essay: Evaluating Seclusion Effects on Healthcare and RN's Role

This essay critically evaluates the effects of restrictive practices, specifically seclusion, on both healthcare personnel and consumers within the context of mental health. It explores the legal framework surrounding restrictive interventions, including the Mental Health Act of 2014, and discusses various types of restraints. The essay details the adverse impacts of restraint and seclusion, such as re-traumatization, feelings of dehumanization, and physical consequences, while also addressing the impact on healthcare staff, including emotional distress and potential injuries. Furthermore, the essay highlights the crucial role of registered nurses (RNs) in mitigating the use of restrictive practices through leadership, collaboration with consumers, and the use of data-driven practices, including trauma-informed care and the implementation of models like Safewards. The importance of creating a safe and supportive environment for both patients and staff is emphasized throughout.

Running head: ESSAY
Assignment topic 2
Name of the Student
Name of the University
Author Note
Word count- 2157

1ESSAY
Introduction- A mental illness is typically any health condition that brings about an
alteration in the feelings, thinking and behaviour of people, thereby leading to difficulty and
distress in functioning. Mental health encompasses the psychological, emotional and social
wellbeing of people and also facilitates determination of the manner in which they cope with
life stressors, associate with others and participate in making decisions (Worden, 2018).
Taking into consideration the perspectives of holism, mental health generally encompasses
the capability of a person to strike a balance between different activities of life and efforts
that help in attaining psychological resilience. A restrictive practice generally refers to any
practice that creates a significant impact by limiting the freedom or right of movement of an
individual with disability, with the chief objective of safeguarding the individual from harm
(Sustere & Tarpey, 2019). Also referred to as restrictive interventions, these practices are
typically authorised for usage as a significant part of behaviour support for a person, in order
to ensure that individuals are supported safely. This essay will critically evaluate the effects
of seclusion on healthcare personnel and consumers, in addition to highlighting the role of
registered nurses (RNs) in decreasing restraint use and seclusion.
Legislation regarding restrictive interventions- The restrictive practices typically
include seclusion, use of restraint, and fast tranquilisation. In addition, the interventions often
prevent patients from accessing outside spaces. The Mental Health Act formulated and
enforced in 2014 places individuals suffering from mental disorder at the core of decision
making, in relation to their care and treatment (Victoria State Government, 2014). The act not
only encourages mental health practitioners like psychiatrists to foster strong association with
the consumers of mental health services, but also promotes offering support and adequate
information for making informed care choices. The act also highlights the importance of
voluntary treatment, in place of compulsory treatment, apart from safeguarding the dignity,
rights and autonomy of people with mental disorder. One core principle of the act is that

2ESSAY
evaluation and treatment are delivered to people with mental illness in the least invasive and
restrictive approach. The directive of restrictive interventions is applicable to all individuals
who seek help from mental health services, notwithstanding the legal status or age of the
person under the Mental Health Act. Furthermore, the act makes it imperative for the
Victorian Government to display a commitment towards decreasing wherever conceivable,
the usage of restrictive interventions in mental health (Ross, 2018). Thus, following the rules
set out in the act, restrictive intervention application needs to be sanctioned by an authorised
psychiatrist or delegate, or a registered medical practitioner (when the former is not
available).
Impact of restraint and seclusion- Restraint is of different types like physical,
environmental or chemical. According to Burry, Rose and Ricou (2018) while physical
restraint involves placing a material or device near the body of the patient that cannot be
easily removed or controlled, chemical restraint focuses on the use of medications that are not
usually a component of the treatment regimen, and are used for controlling the behaviour of
the patient. Seclusion has been identified as a form of environmental restraint and the patient
is confined in a region with shut doors and windows to prevent their exit from the region,
thus imposing restrictions on free movement (Colaizzi, 2016). For several patients, being
physically restrained triggers the onset of reminiscences about previous instances that might
have been responsible for their mental illness, and are described as re-traumatising. These
practices have often been associated with the onset of post-traumatic stress disorder amid
patients (Morrissey & Collier, 2016). Eventually, the restraint is often perceived by patients
as ‘anti-recovery’, thereby making them apprehensive of upcoming treatment modalities
(Brophy et al., 2016). The poor condition in which patients are left at the time of restraint is
dehumanising and also leads to the onset of feeling of being ‘subhuman’, as a direct outcome
of being controlled. A number of patients who are subjected to restraint also report the belief

3ESSAY
that application of extreme force used by the healthcare staff demonstrates that the latter lack
any kind of compassion or empathy towards the patients (Holden, 2017). Subsequently,
several patients also have the perception that while using restrictive practices, the staff are
generally punishing them and applying influence over them, thereby leading to an emotional
state characterised by helplessness, vulnerability, worthlessness, losing control, being ill-
treated, guilt and low self-esteem (Lintner & Elsen, 2018). According to Payne-James (2016)
restraint also has severe physical consequences like bruises, strangulation and increased
mortality due to serious injuries. In elderly patients who are subjected to restrictive practices,
the physical symptoms are compounded with respiratory complications, decubitus ulcers,
impaired muscle strength, under nutrition, and reduced cardiovascular endurance.
As claimed by Rose et al., (2017) being subjected to restrictive practices often leads to
the generation of feelings related to distress and suffering during the entire treatment
procedure, and even after the treatment is over. Those patients who have been secluded or
restrained generally report tension, rage and fear, and are not able to adjust to the care
settings, eventually suffer from troubling or confusing experiences. Not only do they become
fearful of the healthcare staff, but also start manifesting hostile and aggressive behaviour. At
the core of seclusion and restraint is the subject of power (Kinner et al., 2017). For most
patients, this is generally professed as an unnecessary or unmannerly usage of supremacy,
whereby the healthcare staff exhibit authority over the patients. This in turn results in
potential breach of human rights since keeping patients under control or governing their
course of action interferes with their freedom of movement (McCarthy, 2018).
Healthcare staff often reported that the choice to implement seclusion and restraint on
patients diagnosed with mental illness was generally difficult, and they most often felt
conflicted about their involvement. Nonetheless, the staff express a complete positive outlook
about usage of the measures owing to the fact that they do not have access to any better

4ESSAY
treatment alternative (Kinner et al., 2017). In relation to the perspective of staff who
recommend seclusion and restraint, some of them become indifferent to the restrictive
practices and do not have any emotional reaction. Aggressive attitude demonstrated by
patients often lead to injuries in the staff, thereby threatening their health and safety. This in
turn leads to the development of a culture of fear and the staff typically perceive seclusion
and restraint as negative experiences. These restrictive practices also result in a disconnection
between the patients and the staff (Muir‐Cochrane, O'Kane & Oster, 2018). It has been
reported by healthcare staff that implementation of post‐seclusion and/or restraint review
(PSRR) intervention helps the nursing personnel to become familiar and gain a sound
understanding of the feelings of patients, thereby helping them to restore their therapeutic
association. The intervention is generally viewed as a learning opportunity that allows the
staff to improve the intervention and enhance patient outcomes (Goulet, Larue & Lemieux,
2018).
In the words of Gerace and Muir‐Cochrane (2019) nurses working in psychiatric units
consider seclusion and restraint as the last methods for maintaining consumer and staff safety
and have a tendency to differ that restraint approaches could be excluded from mental health
practice. Additionally, seclusion was regarded meaningfully more constructively, in
comparison to mechanical restraint, together with the abolition of mechanical restraint
realised as a matter of utmost concern, when compared to physical restraint or seclusion.
Likewise, reports from Vedana et al. (2018) suggested that majority of the nurses have to
encounter accidents due to restraint, with majority of the accidents encompassing exposure to
biological material. While some nursing staff consider physical restraint as normal, punitive,
therapeutic or educational, they demonstrated a decreased likelihood of using restraint, in
comparison to nursing assistant. The staff also took all possible efforts for seeking
justifications for restraint, with the sole aim to lessen their negative feelings. The fact that

5ESSAY
nurses explored strategies for decreasing restrictive practice associated damages calls for the
need of adopting and implementing humanised, safer and more appropriate methods for
treatment of patients suffering from mental disorders. In addition, while exploring the
perception of nurses about the implementation of restrictive practices, it has been found that
the nurses hold the opinion that their actions directly contributes to significant occupational
hazards during mechanical restraint and seclusion practices (Varpula et al., 2020). This in
turn is in accordance to the fact that few nurses associate these restrictive practices with
unpleasant experiences, regret, anger towards patients, and anguish. However, there are few
nurses who still consider imposing seclusion or restraint to be a relieving experience
(Korkeila et al., 2016).
Role of RN in collaborating with consumers- Restraint and seclusion have been
widely identified as coercive strategies that have negative impacts for both the patients and
the healthcare staff involved. Taking into consideration the direct care role of RNs and the
fact that they spend maximum time with patients and family members, they are commonly
engaged in the implementation or management of these practices. RNs must demonstrate
adequate leadership strategies in order to bring about organisational change. Strategies that
they are expected to adopt focus on formulation and articulation of educational programs that
will facilitate delivery of mental health care services in a manner that will protect the human
rights of all patients (Schmidtke & Iverson, 2018). In addition, while working as leaders, RNs
are entitled with the responsibility of manifesting philosophies and values that prevent them
from causing emotional or physical harm to their patients, thus emphasising on the need of
preventing seclusion and restraint.
While collaborating with consumers, RNs must focus on positive consumer health
outcomes and this working partnership will be governed by therapeutic and professional
relationship that is based on core aspects of effective communication. This in turn can be

6ESSAY
accomplished by encouraging the patients to show adherence to the recommended treatment
and therapies, which in turn will decrease the need of imposing restrictive practices (Wilson
et al., 2018). The formal and complete inclusion of patients, family members, children and
external advocates by the RNs in different roles at the healthcare organisations will also help
nurses to effectively decrease the use of restrictive interventions. This should encompass peer
support services, debriefing interviews and surveillance that will not only highlight the need
for protecting and mediating the patients and their issues, but will also increase their moral
and self-esteem (Brophy et al., 2016).
Another major role is associated with utilisation of data for informing practice.
Successful reduction of restraint and seclusion makes it imperative for the nurses to gather
adequate evidence highlighting the negative impacts of these practices on patient, thus
encouraging improvement towards adoption of practices that are more humane. While
adorning the role of a patient advocate, the RNs have the duty of protecting the dignity and
right to privacy for all patients, while allowing them to exercise their freedom of movement,
while taking all possible efforts to prevent the usage of unnecessary limitations (Shafer,
Staples & George, 2016). Collaboration of RNs with their consumers also encompasses
trauma-informed care that considers and understands the inescapable nature of trauma,
thereby promoting an environment of recovery and healing from mental illnesses, in place of
practices or interventions that restrict the patients and cause re-traumatisation.
The Safewards model in Victoria has been found effective in decreasing conflict and
restraint, besides increasing the mutual support and sense of safety for both patients and the
healthcare personnel. This model has been formulated by the Office of the Chief Mental
Health Nurse (OCMHN). This model has been trialled in Victoria across 18 units,
corresponding to seven services (Higgins et al., 2018). The model recognised the fact that
patients and staff of mental health services are commonly subjected to high amount of

7ESSAY
conflict such as, violence, aggression and absconding, following which restrictive
interventions are implemented (Victoria State Government, 2019). Thus, the model helps in
resolving the issue of seclusion and restraint by identifying and addressing the underlying
reasons behind such untoward and troublesome behaviours, thereby preventing the negative
impacts.
Conclusion- Thus, it can be concluded that though healthcare professionals are
expected to implement appropriate strategies for the prevention and management of mental
illness in the population, use of restrictive interventions is not always beneficial for the
emotional and physical wellbeing of patients. Majority of patients consider such practices to
be threatening and intimidating owing to the fact that it deprives them of their basic human
rights and freedom. Not only does the use of such intervention result in the onset of traumatic
experience but also make the patients more susceptible to physical injuries and even death.
Likewise, though most nurses consider restraint and seclusion as the last strategy that can be
implemented in mental health services, majority of them feel guilty for treating their patients
in an inhumane manner. Hence, all healthcare professionals must show adherence to the
Mental Health Act of 2014 and try to implement the Safewards model for decreasing
restrictive practices in the Australian mental health services.

8ESSAY
References
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016).
Consumers and their supporters’ perspectives on poor practice and the use of
seclusion and restraint in mental health settings: results from Australian focus
groups. International journal of mental health systems, 10(1), 6.
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.
Burry, L., Rose, L., & Ricou, B. (2018). Physical restraint: time to let go. Intensive care
medicine, 44(8), 1296-1298.
Colaizzi, J. (2016). Seclusion & restraint: A historical perspective. Journal of psychosocial
nursing and mental health services, 43(2), 31-37.
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., & Lemieux, A. J. (2018). A pilot study of “post‐seclusion and/or
restraint review” intervention with patients and staff in a mental health
setting. Perspectives in psychiatric care, 54(2), 212-220.
Higgins, N., Meehan, T., Dart, N., Kilshaw, M., & Fawcett, L. (2018). Implementation of the
Safewards model in public mental health facilities: a qualitative evaluation of staff
perceptions. International journal of nursing studies, 88, 114-120.

9ESSAY
Holden, J. D. (2017). A Toolkit to Support Nurse-Patient Communication through Nurse-
Expressed Empathy (Doctoral dissertation, doctoral dissertation]. Minneapolis, MN:
Walden University).
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.
Korkeila, H., Koivisto, A. M., Paavilainen, E., & Kylmä, J. (2016). Psychiatric nurses’
emotional and ethical experiences regarding seclusion and restraint. Issues in mental
health nursing, 37(7), 464-475.
Lintner, C., & Elsen, S. (2018). Getting out of the seclusion trap? Work as meaningful
occupation for the subjective well-being of asylum seekers in South Tyrol,
Italy. Journal of Occupational Science, 25(1), 76-86.
McCarthy, T. (2018). Regulating Restraint and Seclusion in Australian Government Schools:
A Comparative Human Rights Analysis. QUT L. Rev., 18, 194.
Morrissey, M., & Collier, E. (2016). Literature review of post‐traumatic stress disorder in the
critical care population. Journal of clinical nursing, 25(11-12), 1501-1514.
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.
Payne-James, J. J. (2016). Restraint Techniques, Injuries, and Death: Handcuffs.
Rose, D., Perry, E., Rae, S., & Good, N. (2017). Service user perspectives on coercion and
restraint in mental health. BJPsych international, 14(3), 59-61.

10ESSAY
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.
Schmidtke, S., & Iverson, L. (2018). Reducing Use of Restraints through Education on
Alternatives. Medsurg Nursing, 27(3), 157-159.
Shafer, M. S., Staples, V., & George, L. S. (2016). Self-advocacy and empowerment.
In Handbook of recovery in inpatient psychiatry (pp. 339-357). Springer, Cham.
Sustere, E., & Tarpey, E. (2019). Least restrictive practice: its role in patient independence
and recovery. The Journal of Forensic Psychiatry & Psychology, 30(4), 614-629.
Varpula, J., Välimäki, M., Lantta, T., Berg, J., & Lahti, M. (2020). Nurses' perceptions of
risks for occupational hazards in patient seclusion and restraint practices in
psychiatric inpatient care: A focus group study. International Journal of Mental
Health Nursing.
Vedana, K. G. G., da Silva, D. M., Ventura, C. A. A., Giacon, B. C. C., Zanetti, A. C. G.,
Miasso, A. I., & Borges, T. L. (2018). Physical and mechanical restraint in psychiatric
units: Perceptions and experiences of nursing staff. Archives of psychiatric
nursing, 32(3), 367-372.
Victoria State Government. (2014). Restrictive interventions – bodily restraint and seclusion.
Retrieved from https://www2.health.vic.gov.au/mental-health/practice-and-service-
quality/mental-health-act-2014-handbook/safeguards/restrictive-interventions-bodily-
restraint-and-seclusion
Victoria State Government. (2019). The Safewards story. Retrieved from
https://www2.health.vic.gov.au/mental-health/practice-and-service-quality/safety/
safewards/safewards-story

11ESSAY
Wilson, C., Rouse, L., Rae, S., & Kar Ray, M. (2018). Mental health inpatients’ and staff
members’ suggestions for reducing physical restraint: A qualitative study. Journal of
psychiatric and mental health nursing, 25(3), 188-200.
Worden, J. W. (2018). Grief counseling and grief therapy: A handbook for the mental health
practitioner. Springer Publishing Company.