Experience Of Seclusion Research Articles

Inpatients had mostly negative experiences of seclusion during short term treatment in a mental health facility

(2000) J Adv Nurs 31, 370. Meehan T, Vermeer C, Windsor C. . Patients' perceptions of seclusion: a qualitative investigation . . . Feb; . : . –7. . [OpenUrl][1][CrossRef][2][PubMed][3][Web...

Restraint and seclusion: a review of the literature

The author reviewed the literature published since 1972 concerning restraint and seclusion. The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.

Hallucinatory experiences of psychiatric patients in seclusion

Seclusion is a common treatment method in psychiatry. However, there are contradictory reports about the effects of the sensory deprivation involved in seclusion on the distortions of perceptions seen in some psychiatric patients. This descriptive study explored the seclusion experiences of seriously ill psychiatric patients; described the hallucinatory experiences of these patients during seclusion; and examined the relationship between hallucinations and sensory stimulation, as reflected in staff visits and length of time secluded. Consenting adult male and female psychiatric inpatients ( n = 25), with DSM III-R diagnoses of schizophrenia or schizoaffective disorder were interviewed within 5 days after a seclusion experience, using a modification of Richardson's structured interview guide. Approximately half of the patients hallucinated in seclusion; however, 70% of these had also hallucinated before seclusion. There were no significant relationships between hallucinating in seclusion and frequency of staff visits or length of time secluded; however, patients who hallucinated received significantly more “as needed” (PRN) medications and had more therapeutic visits than patients who did not hallucinate.

Impact of the seclusion room experience.

The seclusion room is a repository of intense feeling and strongly held opinion for members of psychiatric inpatient units. Patients, nurses, and doctors often find themselves in intrapsychic and/or interpersonal conflict over its use and misuse. Perhaps because of general discomfort, relatively little is known about what a patient actually experiences while secluded. In this report, we utilized an unexpected source of information on the meaning of the seclusion room experience for our patients: their art productions. The observations are based upon our therapeutic and research experience with acutely schizophrenic patients hospitalized on an NIMH clinical research unit located in NIH's Clinical Center. On this unit, pharmacotherapy was not used during investigation periods and, in keeping with the unit's treatment philosophy, was used sparingly or not at all during noninvestigative periods. As a result, the seclusion room was used frequently for severe management problems. Systematic collection of art productions was a routine part of the research protocol. Patients attended three individual art therapy sessions: during drug-free periods 2 to 3 weeks after admission, 2 to 3 weeks before discharge, and at follow-up 1 year after admission. The patient was asked to use pastels to draw the following pictures: a free picture (patient's choice), a self-portrait, a picture of his/her psychiatric illness, a picture of any hallucination experienced, and a picture of any delusion experienced. After completing each picture, the patient was encouraged to discuss it. Sixty-two patients were evaluated with this methodology. Particulary noteworthy is the fact that in no instance was a patient requested to draw a picture about a seclusion room experience. Nevertheless, over one third of the patients did so, underscoring the prominence of the experience for them. Furthermore, these pictures did not emerge from a large array of patient art, but from only threee art sessions per patient. The nature of the pictures fell into the following patterns: a) pleasurable hallucinations occurring while in seclusion; b) frightening delusions connected with the experience of seclusion; c) strong nondelusional feelings about being in seclusion (often the picture of the psychiatric illness was a representation of the seclusion room experience); d) special focus on the staff member in attendance outside the seclusion room door. The implications of these graphic expressions are discussed, with particular emphasis on the impact of the seclusion room experience for the patient.