Seclusion in an enriched environment versus seclusion as usual: A quasi-experimental study using mixed methods.

Cornelia G J M Van Der Venne,Mathijs Deen,Miranda Olff,Berno Van Meijel,Cornelis L Mulder,Kathleen Finlayson

doi:10.1371/journal.pone.0259620

Abstract

BackgroundFor patients, seclusion during psychiatric treatment is often a traumatic experience. To prevent such experiences, adjustments in the design of seclusion rooms have been recommended.MethodsAs there have been no empirical studies on the matter, we used a quasi-experimental design to compare the experiences in seclusion of two groups of patients: 26 who had been secluded in a room designed according to the principles of healing environment, a so called ‘Enriched Environment Seclusion room’ (EES), and 27 who had been secluded in a regular seclusion (RS) room. The enrichment included audio-visual facilities, a fixed toilet, a couch and a self-service system to adjust light, colour, blinds and temperature according to the patient’s preferences. Insight into their experiences was obtained using the Patient View-of-Seclusion Questionnaire, which comprises nine statements on seclusion, supplemented with open-ended questions.ResultsThe responses regarding seclusion experiences between the two groups did not differ significantly (U = 280.00, p = .21, r = -.17). Although those who had been secluded in the specially designed room had greatly appreciated the opportunities for distraction, and those who had been secluded in a regular seclusion room expressed the need for more distracting activities during seclusion, both groups described seclusion as a dreadful experience. If seclusion cannot be avoided, patients recommend facilities for distraction (such as those provided in an enriched environment seclusion room) to be available.ConclusionWhatever the physical environment and facilities of a seclusion room, we may thus conclude that seclusion is a burdensome experience.

Highlights

Until recently, eclusion often was considered to be an inevitable intervention for very severely agitated psychiatric inpatients
The responses regarding seclusion experiences between the two groups did not differ significantly (U = 280.00, p = .21, r = -.17). Those who had been secluded in the specially designed room had greatly appreciated the opportunities for distraction, and those who had been secluded in a regular seclusion room expressed the need for more distracting activities during seclusion, both groups described seclusion as a dreadful experience
We have found no studies on how a differently designed room may affect patients’ experiences of seclusion. In this quasi-experimental study we wished to compare the experiences of two groups of patients: those who had been secluded in a so-called ‘healing environment’ seclusion room, and those who had been secluded in a regular seclusion room

Summary

Introduction

Eclusion often was considered to be an inevitable intervention for very severely agitated psychiatric inpatients. It was justified on the basis of three premises: containment, to ensure safety for the patient and/or others,isolation and the reduction of sensory input to mitigate illness-induced responses to environmental stimuli [1,2]. Awareness of the negative impact of seclusion has led to wide-ranging research on patients’ experiences of seclusion [6,7,13–16] to the development of new interventions to prevent seclusion [17–20], there is sceptism. Seclusion during psychiatric treatment is often a traumatic experience. To prevent such experiences, adjustments in the design of seclusion rooms have been recommended

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Results

Discussion

Conclusion