Introduction
This study was conducted with the view to examine the effects of seclusion on mentally ill patients. Despite the fact that giving the patients medicines was vital to the effectiveness of seclusion, psychological and biological factors influenced a huge number of patients’ variations in drug absorption and metabolism. Therefore, the study indicated that if any of the above areas is improved, it could improve the effectiveness and specificity of treatment as well as improve the examination of any other factors; which could improve the results from these patients (Browne, Walters & LesGris, 1999).
Study purpose
This study aimed at exploring the results of seclusion alone; and when combined with other crucial treatment measurements, psycho-social variables, demographic measurements and sternness of diseases which would depict treatment results as described by the duration a patient has stayed in the hospital for psychotic complications. This information would help nurses to maintain safety to other patients within the hospital; despite the fact that it is difficult to predict patients whose behaviors may fall out of control. In nursing, seclusion should be carried out with care to avoid ill-treatment to the patients by denying them autonomy and control over themselves (Browne, Walters & LesGris, 1999).
Research questions and hypotheses
In this study there were many research questions the main one being; what the impact of seclusion of patients with mental illnesses on their treatment results. The other research questions include; what nursing concerns should be considered with regard to seclusion; and which awareness the patients had about mental illness. Other concerns were; what views the patients had towards hospitalization and treatment and lastly what level of social support was given to the patients, during their initial days in the hospital. On the other hand, the research question could also include; what harm seclusion had on mentally ill patients; what the social, psychological, psych-social, and disease severity factors, were caused by seclusion (Browne, Walters & LesGris, 1999).
The main hypothesis for the study was; seclusion affects the treatment results of psychotic patients. The other minor hypotheses for the study were; seclusion consequences on patients were influenced by social, psycho-social, psychological and disease severity factors. The last hypothesis is that seclusion reduces patients’ uncontrollable behavior, which directly affects the other patients in the hospital (Browne, Walters & LesGris, 1999).
Dependent and independent variables
Dependent variables are those that cannot be altered on their own, but their variations depend on those of the independent variables. In this study the dependant variables include; the time-span the patients stayed in the hospital, and reduced health complications. On the other hand, independent variables are those which can be altered on their own since they do not depend on any others. This study outlines the independent variables as; demographic variables, disease severity, seclusion, pharmacological differences and psychosocial variables (Browne, Walters & LesGris, 1999).
Theoretical framework
The theoretical framework guided this study in different concepts. Different concepts were considered in the study with dependent variables depending on the respective independent ones. This helped the study in determining how each independent variable influenced the respective dependent variables. For example, the length of hospital stays depended on factors like age, treatment given and previous admissions (Browne, Walters & LesGris, 1999).
Literature review
Seclusion frequency is directly proportional to the number of in-patients and treatment viewpoint of the hospital. Seclusion durations are determined by age, gender and presence of treatments or the patients’ attitude towards the hospital. The frequency of seclusion was determined by age where youngsters were frequently secluded irrespective of their sex, race and number of earlier hospitalizations. Studies showed that non-secluded patients did not stay in the hospital for a long period of time (Browne, Walters & LesGris, 1999).
Patients who were not secluded recovered quickly since they had more patient-staff interaction. Hospitals that had open interaction between patients and psychiatrists where patients were allowed to show their depressing feelings; had better results. The effectiveness of seclusion resulted from biochemical treatments; social support was identified as influencing the lives of mentally ill patients. On the other hand, mentally ill patients’ treatment results were affected by sociological, biological, environmental and psychological factors (Browne, Walters & LesGris, 1999).
Study design
Study charts were used in the study where at the initial stage, 170 charts of mentally ill patients hospitalized for over an 8-month period; were evaluated for precision and only 85 charts were used for the study. The research design was appropriate as for patient’s data to be collected; the patient must have been admitted for psychotic complications, diagnosed with schizophrenia, bipolar and schizo among others. Patients moved to other facilities and those that had signed out against medical advice were excluded from the study. An internal threat to the validity of the study design was that there may have been some particular treatments, which had taken place between the first week of admission and the last week before being set free. Since the research period was eight months, patients may have improved their states regardless of the treatment received during that period. On the other hand, external threats included that; patients’ results may have been affected by pretests. It may be very difficult to control the results of the preceding treatments, as various treatments may be given to the same patient (Browne, Walters & LesGris, 1999).
Sample and setting
The sample was taken from a hospital hosting mentally ill patients of both the primary and secondary levels; involving the residents of a large urban locality. The unit had 49 beds where three seclusion rooms were available. The rooms were served by a 24-hour registered nurse and one additional nurse when needs arose. The charts used for the study were recorded continuously by the staff attending to the patients; nurses assessing the patients’ mental statuses; within seclusion rooms and hence the information retrieved was reliable (Browne, Walters & LesGris, 1999).
Identification and control of Extraneous Variables
In this study, extraneous variables were unrelated variables that affected the dependent and independent variables. In this case, some patients had been given higher drug dosages than others during the first week of hospitalization. This was analyzed and changed to normalized chlorpromazine equivalents (Browne, Walters & LesGris, 1999).
Study instruments/tools
The study used the ‘Bigelow’s Psychiatric Symptom Assessment scale’, which rates the variables and quantifies patient psycho-pathology. The difference between the two tests’ scores was indicated as the ‘PSAS change score’. The PSAS could detect a change in treated and non-treated samples, making it reliable. It also normalized the data from a wide narrative chart reducing biasness (Browne, Walters & LesGris, 1999).
Data collection methods
Data was collected through a complete chart assessment. The patient’s appearance during the first week of hospitalization and the last week before release; was put into consideration in order to determine the changes which had occurred. Notes on how the patient was nursed on a daily and hourly basis were reviewed, as well as physician notes on the patient’s progress and medication records. Patients were nursed for 24 hours a day by a registered nurse hence their rights during hospitalization were addressed. There was a washroom to make sure that the patient’s cleanliness was addressed, and the seclusion rooms had beds to make the patients comfortable (Browne, Walters & LesGris, 1999).
Data analysis procedures
The data were analyzed using t-test analysis to determine the comparison of the results between the secluded and non-secluded patients. The data was analyzed putting into consideration all the variables both dependent and independent. T-tests indicated differences between secluded and non-secluded samples. The t-test analysis was appropriate because it gave relative differences between the secluded and non-secluded cohorts. It made it easy to predict how long the patients would stay in the hospital by the use of earlier medication control. The hypothesis was tested as the prediction made using the t-test data analysis method, indicating that the length of stay in the hospital could be predicted by seclusion (Browne, Walters & LesGris, 1999).
Strengths and limitations of the study
One of the strengths of the study was that it predicted how long a patient would be hospitalized using seclusion, as secluded patients stayed in the hospital for a longer period of time than non-secluded patients. The study indicated that youngsters were more secluded as compared to aged patients; where as secluded patients were more tolerant to drugs as compared to the non-secluded cohort. On the other hand, the study did not examine the risks of drug tolerance that could lead to a case of worsening the patients’ mental condition as their stay in the hospital lengthened. The study did not test the continuing improvement or worsening of patients’ conditions in seclusion, with interim PSAS scores. The study findings proved to be valid as they correlated with the literature review on the impacts of seclusion on patients. It further showed that seclusion could only be used as a last option. Through this study, the nursing staff was enlightened on the consequences of seclusion and hence enabling them to avoid it. Education on seclusion should be provided to all students taking nursing and especially psychiatrics, patients, the community and the entire staff on the consequences of seclusion to mentally ill patients (Browne, Walters & LesGris, 1999).
Implications of the study
The implications of seclusion practice are that; even though locked seclusion minimizes the number of nurses attending when quality care and cost control viewpoints are considered; the 12-day rise should be reflected on and examined further. A rational reassessment of both the rationale and carrying out of seclusion should be put into consideration, in order to come up with less restrictive therapeutic options. Despite the fact that the staff may benefit from the formulated rules and customs prevailing from locked seclusion, they obstruct the distinctive and personal needs of the patients. The staff should be informed that unlocked units give patients more self-esteem, autonomy and care by providing chances for evaluations and alteration in less intimidating and powerless situations. When patients are allowed to be free, they create good contact with the staff. Patients are allowed at their own will to relate with their family members to enjoy meaningful activities and dialogue, as their conditions could allow (Browne, Walters & LesGris, 1999).
Conclusion
Further study programs should be carried out to advance the use of healing options that are related to the patients and nursing views; since nurses’ support seclusion claiming that it is essential and beneficial for patients. The combination of complex patients and treatment variables, calls for additional investigations (Browne, Walters & LesGris, 1999).
Reference
Browne, G., Walters, M. & LesGris, J. (1999). The Impact of Seclusion on the Treatment outcomes of Psychotic in-patients. Journal of Advanced Nursing, 1999, 30(2), 448-449. Oxford: Blackwell Publishing Ltd.