Seclusion Process Research Articles

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

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.

Polar lows – moist-baroclinic cyclones developing in four different vertical wind shear environments

Abstract. Polar lows are intense mesoscale cyclones that develop in polar marine air masses. Motivated by the large variety of their proposed intensification mechanisms, cloud structure, and ambient sub-synoptic environment, we use self-organising maps to classify polar lows. The method is applied to 370 polar lows in the north-eastern Atlantic, which were obtained by matching mesoscale cyclones from the ERA-5 reanalysis to polar lows registered in the STARS dataset by the Norwegian Meteorological Institute. ERA-5 reproduces most of the STARS polar lows. We identify five different polar-low configurations which are characterised by the vertical wind shear vector, the change in the horizontal-wind vector with height, relative to the propagation direction. Four categories feature a strong shear with different orientations of the shear vector, whereas the fifth category contains conditions with weak shear. This confirms the relevance of a previously identified categorisation into forward- and reverse-shear polar lows. We expand the categorisation with right- and left-shear polar lows that propagate towards colder and warmer environments, respectively. For the strong-shear categories, the shear vector organises the moist-baroclinic dynamics of the systems. This is apparent in the low-pressure anomaly tilting with height against the shear vector and the main updrafts occurring along the warm front located in the forward-left direction relative to the shear vector. These main updrafts contribute to the intensification through latent heat release and are typically associated with comma-shaped clouds. Polar-low situations with a weak shear, which often feature spirali-form clouds, occur mainly at decaying stages of the development. We thus find no evidence for hurricane-like intensification of polar lows and propose instead that spirali-form clouds are associated with a warm seclusion process.

Subtropical Cyclone Formation via Warm Seclusion Development: The Importance of Surface Fluxes

AbstractSubtropical cyclones (STCs) are characterized by a thermal hybrid structure with tropical and extratropical features. STCs are considered a numerical modeling challenge because of their rapid intensification. A fundamental part of their strength is derived from diabatic processes associated with convection and heat fluxes from the ocean. This study evaluates the importance of surface turbulent heat fluxes during the transition of an extratropical precursor into a STC. This cyclone evolved embedded within a strong meridional flow, having a Shapiro‐Keyser structure and undergoing a warm seclusion process. To assess the importance of those heat fluxes, two Weather Research and Forecasting simulations were defined considering the presence and absence of those fluxes. Results of both simulations reveal a warm seclusion process, which weakened in absence of the heat fluxes. During the system genesis and in absence of heat fluxes, the wind and rainfall values were increased due to the remarkably intense area of frontogenesis to the northwest. Given these results and the lack of transition in the absence of heat fluxes, the frontal nature of the system was verified. Considering the heat fluxes, the obtained potential vorticity values diminished, reducing wind shear and intensifying convection in the system, which favored its transition into an STC. This study is groundbreaking in that no STC has been linked to a warm seclusion process in the Eastern North Atlantic. Additionally, simulated wind field shows an underestimation in comparison with Atmospheric Motion Vectors, used as observational data so as to give a weight to the wind analysis.

What are adult psychiatric inpatients' experience of seclusion: A systematic review of qualitative studies.

WHAT IS KNOWN ON THE SUBJECT?: Seclusion involves isolating a patient in a room away from other patients in order to contain aggressive behaviour, and it is used in psychiatric hospitals. Research has found that seclusion is often viewed by patients as negative; however, there is limited in-depth understanding of the deeply personal experience. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This systematic review found that the published research may have flaws with the quality of analysis, mainly due to limited researcher reflexivity. The review of qualitative research revealed that during seclusion, patients feel vulnerable, neglected and abused, disconnected from the experience and that it is dangerous to their mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: For clinicians facilitating the seclusion process to use their therapeutic skills to provide patients with a sense of being cared for. For clinical supervision to allow space to explore interpersonal dynamics during seclusion in order to enhance therapeutic staff-patient interaction. Abstract Introduction There is limited understanding of patients' seclusion experience. A 2013 systematic review provides some insight; however, more knowledge is required in order to improve patient care. This is a systematic review of qualitative research into the patient experience of seclusion. The qualitative focus enables the phenomena to be the central focus. Question "What are adult psychiatric inpatients' experience of seclusion?" and "What is the quality of the applicable research?" Method Electronic searches for qualitative research published between 2006 and 2017 were undertaken. Data were excluded if it was not explicitly related to seclusion. Research was appraised using three standardized appraisal criterion. Themes were generated through thematic synthesis. Results Eight papers met inclusion criteria; four had been translated into English. Four themes were identified: "feeling vulnerable," "feeling neglected and abused," "disconnecting" and "seclusion is dangerous to mental health." Participants felt vulnerable and without control. They experienced staff and room as neglectful and abusive. Participants mentally disconnected. The experience threatened participants' mental health. Discussion Participants' experience is an amalgamation of interpersonal experience and the environment. Disconnecting may be a coping strategy. Implications for practice The findings have implications for seclusion practice, staff training and clinical supervision. Specific attention needs to be paid to the staff-patient interaction.

The Tropical Transition of the October 1996 Medicane in the Western Mediterranean Sea: A Warm Seclusion Event

The processes leading to the tropical transition of the October 1996 medicane in the western Mediterranean are investigated on the basis of a 50-member ensemble of regional climate model (RCM) simulations. By comparing the composites of transitioning and nontransitioning cyclones it is shown that standard extratropical dynamics are responsible for the cyclogenesis and that the transition results from a warm seclusion process. As the initial thermal asymmetries and vertical tilt of the cyclones are reduced, a warm core forms in the lower troposphere. It is demonstrated that in the transitioning cyclones, the upper-tropospheric warm core is also a result of the seclusion process. Conversely, the warm core remains confined below 600 hPa in the nontransitioning systems. In the baroclinic stage, the transitioning cyclones are characterized by larger vertical wind shear and intensification rates. The resulting stronger low-level circulation in turn is responsible for significantly larger latent and sensible heat fluxes throughout the seclusion process.

Tropical Transition of an Unnamed, High-Latitude, Tropical Cyclone over the Eastern North Pacific

Abstract In early November 2006, an unnamed tropical cyclone (TC) formed via the tropical transition (TT) process at 42°N over the eastern North Pacific. An extratropical cyclone (EC), developing downstream of a thinning upper-tropospheric trough over the eastern North Pacific, served as the precursor disturbance that would ultimately undergo TT. The TT of the unnamed TC was extremely unusual—occurring over ~16°C sea surface temperatures in a portion of the eastern North Pacific basin historically devoid of TC activity. This paper 1) identifies the upper- and lower-tropospheric features linked to the formation of the EC that transitions into the unnamed TC, 2) provides a synoptic overview of the features and processes associated with the unnamed TC’s TT, and 3) discusses the landfall of the weakening cyclone along the west coast of North America. As observed in previous studies of TT, the precursor EC progresses through the life cycle of a marine extratropical frontal cyclone, developing a bent-back warm front on its northern and western sides and undergoing a warm seclusion process. Backward air parcel trajectories suggest that air parcels isolated in the center of the transitioning cyclone were warmed in the lower troposphere via sensible heating from the underlying sea surface. Vertical cross sections taken through the center of the cyclone during its life cycle reveal its transformation from an asymmetric, cold-core, EC into an axisymmetric, warm-core, TC during TT. Ensemble reforecasts initialized after TT highlight the relatively low forecast skill associated with the landfall of the weakening cyclone.

Nurses' knowledge about psychiatric patient seclusion in Jordan

Background: Seclusion is used with or without restrain to confined violent clients who do not respond to less restrictive interventions and protect the client himself and others of harm. Understanding nurses' knowledge about seclusion is essential for the success in reducing or limiting its usage and improving the quality of patient care and prevention of work related stress in nurses. Objective: The study aimed to assess psychiatric nurse's knowledge about using seclusion for hospitalized patients & to establish a guideline for using for seclusion. Methodology: Semi-structured interview was conducted; the researcher use self- reported questionnaire to collect the data of 20 mentally health nurses. The questionnaire included seven items with multiple-choice options about personal knowledge of nurses throughout the seclusion process. Period of the study was between 8th and 30 of March 2011. Percentages were used primarily in this study to indicate the highest proportion of the proper answer for each question. Results: shows that half of the studied sample explained that seclusion used to reduce environmental stimuli for agitated patients, and it was very important for nurses. Results also indicated that the concept of seclusion was not so clear to the nurses who working with psychiatric patients. Conclusion: nurses believe in seclusion to be very necessary even in minor disturbance as a means of power and control. Recommendations: that using seclusion process and restraint should be used only when there is a risk or danger to the individual or others.

Use of Seclusion: Finding the Voice of the Patient to Influence Practice

Seclusion for escalating behavior in psychiatric patients has been a controversial intervention over the past 3 decades. The current study investigated the experience of seclusion from the perspective of inpatient psychiatric patients in the mid-western United States. Twelve patients were interviewed about their experiences; the interviews were transcribed into a written text. A phenomenological method was used to analyze the text, and themes were generated. Three themes emerged: (a) Patient Hope for Respect and Open Communication described patients' desires for discussion about their individual problems before their behavior escalated; (b) Patient Emotional Response to the Seclusion Process described accelerating emotions such as anxiety and anger. Patients perceived disrespect from staff prior to and during seclusion; and (c) Patient Insight into Behavior and the Importance of Positive Coping Skills described the importance of debriefing with staff and learning positive coping skills. Further improved education for nurses is needed to help manage psychiatric patients, for it is the goal of the mental health profession to understand the reasons these seclusion episodes occur and to directly take the steps to eliminate the need for the seclusion process entirely.

Cyclone Interactions and Evolutions during the “Perfect Storms” of Late October and Early November 1991

Abstract This paper examines the cyclogenesis of the “Perfect Storms” of late October and early November 1991 over the North Atlantic and focuses on the influence of Hurricane Grace (HG) toward their development. The two storms considered are the “Perfect Storm” (PS) that underwent a warm seclusion process and an extratropical cyclone (EC1) with two development phases. HG, which initially formed via tropical transition (TT), influenced the first phase of EC1 via reduced atmospheric static stability and enhanced low-level baroclinicity. As a result, deep moist convection and latent heat release produced maxima in midtropospheric diabatic heating and lower-tropospheric potential vorticity (PV) that aided the development of EC1. Backward air parcel trajectories and large diabatic contributions to eddy available potential energy (APE) generation suggests that EC1 developed as a diabatic Rossby vortex (DRV)-like feature. The second and explosively deepening phase of EC1 occurred as the cyclone coupled with an upper-tropospheric PV disturbance (PVD) over the eastern North Atlantic. Backward air parcel trajectories demonstrate the explosive deepening of EC1 involved airstreams originating from east of HG and from over the Labrador Sea. Parcel trajectories and a large baroclinic contribution to eddy APE generation further suggests that the two-phase development of EC1 may have involved a DRV-like feature. The subsequent recurvature and extratropical transition (ET) of HG occurred in the warm sector of the PS downstream of a second upper-tropospheric PVD over the western North Atlantic. Reduced atmospheric static stability, enhanced warm air advection, and strong latent heat release during the recurvature and ET of HG contributed to the development of a strong, zonally oriented warm front and the warm seclusion of the PS. Parcel trajectory analysis demonstrates that the PS warm seclusion involved the isolation of air parcels by a bent-back warm front that were warmed via sensible heating from the underlying Gulf Stream.

Seclusion: The perspective of nurses

Knowledge of how nurses experience the process of secluding a patient can be useful in improving the quality of patient care and in the prevention of work related stress in nurses. This study describes personal experiences of nurses throughout the seclusion process. The emotions which came to surface in semi-structured interviews with 8 nurses were categorized in three main themes (Tension, Trust and Power) and a stress response curve was identified in the seclusion process, with specific feelings in each phase. Feelings denied in former studies such as feeling superior, anger and disgust were found in the interviews in this study.

Through the eye of the beholder: to seclude or not to seclude.

The objective of this study is to provide new knowledge and understanding of the decision making used throughout the seclusion process. Seven mental health nurses and one doctor were each interviewed within 48 hours of making the decision to seclude a patient. The interviews were analysed using content analysis. This study provides valuable information regarding factors that are central to, and/or influence, the decision-making process surrounding seclusion. More importantly, the results demonstrate that seclusion is initiated only when all other less restrictive patient management strategies have proven to be unsuccessful with the patient.

The seclusion intensification of the New Year’s day storm 1992

The Bergen School meteorologists realized that not all cyclones follow their conceptual cyclone model. In particular they found cases with re-generation of occluded cyclones. In their literature, for instance as found in Godske and co-workers, 2 kinds of re-generation were considered challenging to weather forecasting: a thermodynamic intensification with similarities to the development of tropical cyclones, and intensification of what was called the non-frontal trough, or the back-bent occlusion, of strong cyclones. It has been believed that the latter kind is characteristic of the strongest surface winds observed in the Northwestern Atlantic. In this paper such a case, resulting in the strongest cyclone landfall on the Norwegian west coast this century, has been investigated from a simulation of a small synoptic-scale (∼ 1000 km), fast-moving extratropical cyclone (∼ 25 m/s−1). It is found that the cyclone evolves as the conceptual frontal model of Shapiro and Keyser (1990), and that the strong winds are developed by a secondary, mesoscale (∼ 500 km) cyclogenesis closely linked to the seclusion process. The time scale of the intensification is 12 h, starting with what is called the seclusion trough at the tip of the back-bent warm front. As the cold air secludes the warm core, the disturbance develops into a separate low, here called the seclusion low. Release of latent heat connected to the back-bent warm front is found to play an important role in forming the seclusion. A part of the generated potential vorticity (PV) remains within the warm air in the seclusion process. Inversion of the low-level PV anomalies results in a low-level jet along the outer side of the seclusion trough. The strong winds are observed when the seclusion trough develops into the seclusion low and the low-level jet becomes parallel to the large scale westerly flow. A positive PV anomaly streamer, formed from a larger scale upper PV anomaly in phase with the surface low, takes part in this stage of the development. DOI: 10.1034/j.1600-0870.1995.00116.x

Numerical simulations of the synoptic conditions and development of Arctic outbreak polar lows

Four cases satisfying the necessary conditions for development of Arctic outbreak polar lows have been investigated from numerical simulations. Characteristic synoptic conditions are a mature extratropical cyclone situated over Scandinavia and a northerly, baroclinic flow in the Norwegian Sea. This flow has a convective planetary boundary layer (PBL) caused by heat fluxes from the warm ocean in cold Arctic air masses coming from the sea ice areas to the north and west. The height of the PBL may reach 700 hPa and even more. The synoptic situation is also characterized by a dry intrusion of stratospheric air west of the cyclones. When the tropopause is defined by the surface of potential vorticity (PV) equal 2 PVU (1 PVU = 10 −6 m 2 s −1 K kg −1 ), the intrusion lowers the tropopause typically down to levels between 450 and 750 hPa, bringing large positive anomalies of PV to levels normally in mid-troposphere. These synoptic conditions are ideal for cyclogenesis from mutual interaction of positive upper air and boundary layer PV anomalies. The Rossby height is high, which means that small-scale polar lows may form. It is found that simply the height between the tropopause and the top of the convective PBL is a good indicator of the risk of polar low formation. This height was found to be 2500 m or more in two of the cases when no polar lows were observed. When polar lows developed in the other two cases, heights of 1000 m or less were measured (in numerical simulations). The simulated development of these two polar lows has been investigated. The polar low cyclogenesis was found to be caused by the baroclinic instability in agreement with the conceptual model of Montgomery and Farrel. Diabatic intensification is important and seems to be necessary to seclude the warm core disturbance which is characteristic of Arctic outbreak polar lows. The seclusion process implies that warm air is being surrounded by cold air. DOI: 10.1034/j.1600-0870.1995.00121.xv

Location and Interaction of Upper- and Lower-Troposphere Adiabatic Frontogenesis

Abstract Both upper-air and surface frontogenesis have often been depicted as processes whose dynamics could he reduced to 2D balanced problems in which “self-sharpening” configurations could be highlighted. This paper reports on a 3D adiabatic simulation of a baroclinic wave life cycle. Great care has been devoted to the vertical resolution, allowing for a good description of both surface and upper-air frontogenesis. The authors introduce a kinematic diagnostic (Q′ vector) that permits the identification of frontogenetic areas in such complex 3D flows where classical, low-Rossby number balance conditions can be violated. Relations and specificity with respect to frontogenetic forcing diagnostics are discussed. First, Q′ is used for surface frontogenesis, where it describes well the actual frontal activity, including the complex warm-frontal seclusion process. Upper-air frontogenesis is also investigated, both in terms of this kinematic diagnostic or in terms of potential vorticity displacements on isentr...

The view from within: how patients perceive the seclusion process.

1. Reported patient perceptions of seclusion revealed many negative feelings. The quest for the human element, dignity, to understand and to be understood, and to be reassured was a theme throughout. 2. Whatever nurses can do before or during the seclusion process that results in more positive perceptions by patients helps promote more comfortable feelings and more appropriate behavior. Frequent reviews of seclusion policies and procedures are important. 3. Debriefing may be one of the most important ways that staff can help the patient in diminishing the emotional impact of seclusion. It provides an opportunity to clarify the rationale for the seclusion, offer mutual feedback, and promote the patient's self-esteem.

Attitudes of nonsecluded patients toward seclusion rooms

This study investigated the attitudes toward seclusion rooms of a group of hospitalized psychiatric patients who were not at the time secluded. Those patients who had never been secluded endorsed more negative feelings about seclusion room use than did those who had actually been secluded during prior hospitalizations. Women were more critical of the seclusion process than were men.

Toward a rationale for the seclusion process.

The present paper summarizes three studies focusing on different aspects of seclusion room practices. The first study involved chart review to collect empirical data on reasons for seclusion, length of seclusion, and characteristics of secluded patients. The second study focused on staff attitudes toward seclusion; the third dealt with the attitudes of both secluded and nonsecluded patients. The average time of seclusion was approximately 4 hours and in most cases aggressive behaviors of various types were cited as the precipitating event. In addition, patient and staff attitudes implied that a major function of the seclusion process was to isolate patients from disturbing interactions and to maintain the smooth functioning of the ward minisociety. Two models of seclusion, an ethological model and a behavioristic "time out" model, were developed in order to integrate the results of these studies. Implications of the findings and models are presented for changes in seclusion room procedures.