[Seclusion]

By

Table of Contents

INTRODUCTION3

Abstract3

General Structure of Paper4

BACKGROUND/LITERATURE REVIEW6

Literature review6

Theoretical Framework7

Aims8

Problem Statement8

Hypotheses9

METHODOLOGY10

Methods10

Instruments11

Sampling12

Rigour & Ethics12

FINDINGS13

Analysis13

Results13

Discussion15

Limitations of findings16

SUMMARY17

Conclusion17

Implications17

Recommendations For Practice18

REFERENCES20

APPENDICES22

Introduction

Abstract

The purpose of this study was to investigate the frequency and type of post-seclusion debriefing provided by nurses at a psychiatric unit in Melbourne, Australia. The study employed an exploratory research design. An analysis of the seclusion register was undertaken to identify the total number of seclusions over a 1-year period. A file audit tool was developed to identify seclusion debriefing interventions documented in consumer case files. Post-seclusion debriefing is not routinely performed following an episode of seclusion. A post-seclusion debriefing framework needs to be developed to support best practice in managing seclusion. Seclusion is an intervention commonly used in psychiatry to manage acute behavioral disturbance. The practice of seclusion involves isolating individuals in a locked room from which they "cannot freely exit". Seclusion should only be used as a last resort, and only if the person is presenting as a risk to themselves, others, or to prevent the consumer from absconding. The continuing use of seclusion in mental health has been an ongoing source of controversy and debate; in particular, questions have been raised regarding the moral, ethical, legal, and humanitarian dimensions of a practice that severely restricts a person's liberty, freedom, and control. Additional concerns raised in the literature relate to the coercive nature of seclusion, lack of communication with consumers throughout the seclusion process, and ultimately, the issue of confining acutely unwell people in an isolated comfortless environment. The study employed an exploratory research design. An analysis of the seclusion register was undertaken to identify the total number of seclusions over a 1-year period. A file audit tool was developed to identify seclusion debriefing interventions documented in consumer case files. Increasingly over the last decade, awareness has been raised both nationally and internationally as the potentially negative implications of seclusion practice have been reported to include serious injury, psychological harm, and death. The commitment to seclusion and restraint reduction programs gathered momentum in the mid-1900s, and further escalated in response to the exposé on trauma and deaths associated with seclusion in the Hartford Courant in 1998 Pennsylvania State hospitals (in the United States) were among the first to introduce seclusion reduction initiatives and described seclusion as a "treatment failure." This approach influenced both skill development and the use of alternative strategies for crisis care. Post-seclusion debriefing is not routinely performed following an episode of seclusion. A post-seclusion debriefing framework needs to be developed to support best practice in managing seclusion. More recently in Australia, a project called Creating Safety Addressing Seclusion Practices has been introduced. The objective of the project is to promote safe, appropriate care in tandem with seclusion reduction strategies, which has also rendered impressive results (VQC & CPQAC).

General Structure of Paper

The paper consists of 5 sections on general level.

Introduction

Literature Review

Methodology

Findings

Summary

Background/Literature review

Literature review

A literature review for the current study revealed that very few post-seclusion debriefing empirical studies have been conducted to provide an evidence base to guide ...