La Palette des émotions : une médiation graphique pour améliorer les pratiques d’isolement et de contention

Abstract

Background and objectivesThe use of seclusion and restraint within mental health settings has long been considered controversial. According to the literature, patient experiences of seclusion and restraint are mainly negative, harmful or traumatic. Patients express a need to discuss the seclusion or restraint event and their feelings afterwards. This paper describes the Emotional Palette, a graphical tool for enhancing patients’ expression of emotional experience after seclusion or restraint. Materials and methodsOn the basis of a focused review of literature, demonstrating the relevance of investigating patients’ experiences after seclusion or restraint, this article presents the Emotional Palette, a graphic tool created in a psychiatric ward for helping patients express their emotional experience. This graphical tool (figure 1) consists of a coloured checkerboard which presents terms typically used to express emotions relating to seclusion or restraint's experience. Each term is associated with a colour, ranging from red (negative feeling) to white (intermediate feeling) and green (positive feeling). Patients are interviewed a few days after seclusion. Firstly, they are asked to complete three Emotional Palettes, which refer to three moments of their experience : the time when they were put inside the seclusion room, the time spent during the seclusion process, and the time after the seclusion. For each moment, patients identify the predominant emotions on the corresponding Palette. After completing the Palettes, they are interviewed. The aim is to promote a relationship of confidence to make the persons feel free to say what they like. They are also encouraged to express their own proposals for alternative methods and suggestions for improving seclusion practice. In this article, the usefulness of the approach based on this tool is discussed within three clinical case studies. For each patient the result of the Emotional Palette was transcribed and a thematic analysis was used to analyse the verbatim. ResultsThe seclusion-related negative emotions mainly identified by patients were fear, anger, boredom, helplessness, resignation, loneliness and humiliation. Negative feelings were linked to perceived lack of interaction with the staff before and during seclusion. Patients reported that they were not given enough information about the reason for their seclusion and what would happen next. After the seclusion process, they mentioned positive experiences such as finding calm, gratitude and confidence in the nursing staff. Some patients’ suggestions regarding the improvement of seclusion practices were related to a need for more interaction with nurses and doctors. These emotions and views expressed by patients echo the findings of previous studies and surveys. Beyond these results, the main benefit lies in the fact that, by giving the opportunity to have a debrief, the Emotional Palette tends to strengthen the patient's position and involvement. All of them expressed a satisfaction to be able to discuss the seclusion event and their feelings afterwards. They suggested alternatives to seclusion that could expressly work for them (one-to-one intervention, specific activities..). They stressed the importance of interaction with the nurses and the doctors, through empathetic listening, attention and understanding, active communication and for more staff presence in the ward. Thanks to the Emotional Palette, patients experienced that their views and emotions had been heard and recognized. Finally, by giving every patient an opportunity to discuss his/her experience with the staff, the Emotional Palette helps to develop a personal prevention strategy that could offer alternative methods for seclusion in case of crisis. Future research is needed to provide generalizable data and validate the usefulness of the Emotional Palette. ConclusionsBy helping patients to express their emotions after a seclusion process, the Emotional Palette offers a framework and a therapeutic approach which prove useful in regaining a positive interpersonal relationship with a patient. By allowing the patient to give their views and suggestions for improvement and alternatives, this tool could also constitute a means to reduce seclusion practices.