International Journal of Law and Psychiatry
Seclusion: The perspective of nurses
Introduction
Seclusion as an intervention, subsequent to an aggressive incident or disruptive patient behaviour, is subject to much study and debate. Recent studies question its therapeutic necessity and effect. Beside this, legal and ethical issues dominate the discussion on reducing the use of seclusion and interventions and primarily aim at change of attitude and therapeutic culture.
Far less is known about the perception of the participants in the seclusion process. Even though best practice protocols favour a systematic evaluation of the seclusion with the team, as well as with the patients and their family members, few studies focus on experiences and emotions of those involved.
A Dutch study into the experience of patients (Hoekstra, Janssen and Lendemeijer, 2004) showed seclusion to be a stressful, often traumatising event. Clinical practice suggests that nurses also experience stress and negative emotions to some extent. Describing the perception and experience of nurses while secluding a patient is the main objective of this current study. The willingness and need to discuss emotions with colleagues and others is studied, to understand with whom and how nurses share their feelings subsequent to a seclusion incident.
Section snippets
The Use of Seclusion
By professionals seclusion is often seen as an effective intervention to restrain aggressive behaviour, as well as to protect ward security and atmosphere (Nijman et al., 1999, Lendemeijer, 2000). Seclusion is applied frequently in the Netherlands: one study showed seclusion is used in 25% of the situations, within a sample of 1000 admitted patients (Stolker, Nijman, & Zwanikken, 2004), a figure confirmed in a more recent nationwide study (Janssen et al., 2008). However, international studies
Objectives and main questions of this Study
This study focuses on nurses' feelings prior to, during and subsequent to a seclusion incident. The following questions will be addressed:
- 1
Which feelings do nurses recall concerning seclusion incidents?
- 2
How do these feelings interrelate, and what determinants can be identified?
- 3
To which extent do nurses feel a need for and to which extent do they allow sharing these feelings?
Method
Because of the explorative nature of the study a qualitative design using the Grounded Theory was chosen. (Glaser and Strauss, 1967, Morse and Field, 1998). This method focuses on the development of theory out of daily practice, by means of theoretical sampling and saturation. Theoretical sampling is the acquisition of data from literature, text sources and interviews, in the process of developing a conceptual framework. Theoretical saturation refers to the point where no new items arise from
Overall outcome
Eight subjects were interviewed, 4 male and 4 female. Their age varied between 24 and 56 years, job experience within mental health care between 3 and 27 years. Team members all had higher vocational training, either as a nurse or as a social worker. The interviews were performed in four subsequent months in 2005, with a time frame of two to three weeks between interviews, allowing analysis in between. Responders were asked not to discuss the content with fellow workers. Interview time varied
Discussion
In the current study a qualitative technique was used to explore nurses' feelings experienced during the seclusion process. As opposed to pre-structured surveys, this technique facilitates the investigation of perceptions and emotions. Following an open interview technique based on the grounded theory, this study revealed a number of general themes, also known from literature. Because many of the themes are supported by literature, it is plausible these perceptions will be recognised by many
Conclusion
Little is known about the experience and perceptions of nurses in the seclusion process. Feelings denied in former studies such as feeling superior, anger and disgust do arise from the interviews in this study. Tension, trust and power were identified as main themes. The tension increase corresponds with physiological stress response curves. The role of nurses during the seclusion process, but also being the person most concerned with the daily care of the patient, determine experienced
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