Restraint and seclusion (RS) are some of the controversial methods that are commonly used in healthcare. Restraint stands for the physical restriction of patients’ ability to move freely with the help of chemical, mechanical, or physical means (Muir-Cochrane, Baird, & McCann, 2015). Seclusion represents the confinement of patients in locked rooms for the purpose of isolating them from other people in a facility due to their aggressive behaviors (Muir-Cochrane et al., 2015). Both of these practices are likely to result in various negative effects in patients (Goulet & Larue, 2016). That is why they must be used as a last resort only.
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As measures and methods of patient behavior management, restraint and seclusion are tightly connected to the deprivation of freedom. In most cases, patients who have experienced restraint or seclusion report these experiences as stressful and negative (Newton-Howes, 2013). The other issues seen with these practices include the potential for abuse and misuse, the application of RS for social control, and the absence of evidence of the effectiveness of the practices in regard to treatment progress or aggression reduction (Newton-Howes, 2013).
Setting Where the Problem Can Be Observed
The problem of common use of RS can be observed in a variety of settings. Most commonly, these measures tend to be used in adult inpatient care in psychiatric facilities and mental health settings (Knox & Holloman, 2012; Oster, Gerace, & Muir-Cochrane, 2016). Moreover, the use of RS is also observed as an intervention for elderly patients in geriatric facilities and nursing homes (Muir-Cochrane et al., 2015).
Restraint and seclusion have been used as measures of addressing patients’ behaviors that could cause harm to them and other people around them. These methods have been in use for three centuries (Masters, 2017). However, since the beginning of the 21st century, these practices have seen a decline (Smith, Ashbridge, Davis, & Steinmetz, 2015). Currently, the main drivers of the use of restraint and seclusion are patients’ verbal threats expressing intentions to cause physical harm to medical practitioners or other patients and actual assault attempts (Smith et al., 2015). Additionally, the causes of restraint and seclusion can be suicide and self-harm attempts, elopement intention, and property damage (Smith et al., 2015).
Impact and Significance of the Problem
The majority of RS cases result in the absence of physical harm to the patients but with a significant amount of stress (Smith et al., 2015). Some of the emotions reported by people who have experienced RS are the rage, fear, the feelings of being overpowered and dehumanized, and terror (Carlson & Hall, 2014; Goulet & Larue, 2016). Moreover, the US Mental Health System is reported to spend 375 million dollars annually on the outcomes of containment in facilities, as well as the cases of patient-staff or patient-patient conflicts (Carlson & Hall, 2014). As a result, it can be concluded that the impact of the problem is massive and that it is of high significance for every medical facility where RS is practiced.
A Proposed Solution
Experts agree that the use of RS needs to be minimized. In some cases, the application of RS is seen as the failure to provide treatment appropriately (Carlson & Hall, 2014). In particular, in order to reduce the incidence of RS, it is recommended to apply a combination of such actions as the creation of national policy regulating the use of RS, the improvement of the ward in healthcare facilities, and patient-focused interventions where RS strategies would be treated as the last resort (Newton-Howes, 2013). The latter can be found by means of a review of the literature with the purpose of finding appropriate EBPs.
Carlson, K., & Hall, G. M. (2014). Preventing restraint and seclusion: A multilevel grounded theory analysis. SAGE Open, 1-12.
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Goulet, M. H., & Larue, C. (2016). Post-seclusion and/or restraint review in psychiatry: A scoping review. Archives of Psychiatric Nursing, 30(1), 120-128.
Knox, D. K., & Holloman, G. H. (2012). Use and avoidance of seclusion and restraint: Consensus statement of the American association for emergency psychiatry project beta seclusion and restraint workgroup. The Western Journal of Emergency Medicine, 13(1), 35-40.
Masters, K. J. (2017). Physical restraint: A historical review and current practice. Psychiatric Annals, 47(1), 52-55.
Muir-Cochrane, E. C., Baird, J., & McCann, T. V. (2015). Nurses’ experiences of restraint and seclusion use in short-stay acute old age psychiatry inpatient units: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 22, 109–115.
Newton-Howes, G. (2013). Use of seclusion for managing behavioural disturbance in patients. Advances in Psychiatric Treatment, 19, 422-428.
Oster, C., Gerace, A., & Muir-Cochrane, E. (2016). Seclusion and restraint use in adult inpatient mental health care: An Australian perspective. Collegian, 23, 183-190.
Smith, G. M., Ashbridge, D. M., Davis, R. H., & Steinmetz, W. (2015). Correlation between reduction of seclusion and restraint and assaults by patients in Pennsylvania’s state hospitals. Psychiatric Services, 66, 303–309.