Seclusion. The nursing challenge.

The research to date shows that there is not much data to guide nursing decisions about the use of seclusion. The justification for its use is not always as clear as one might hope. Although many patients are secluded for violence against themselves or others, there are others who have not been violent who are secluded. There may be justification for secluding violent patients, but, as indicated earlier, it may reinforce the behavior it is designed to stop. There probably is no justification for secluding patients who make loud noises, refuse to take medication, or refuse to participate in activities. In addition, it is disconcerting that a large percentage of patients are secluded for "escalating agitation," that is, they have not acted violently against themselves or others. What is problematic is that staff are undoubtedly predicting violent behaviors in these patients--predictions that might be erroneous. Thus, there is ample room for injustice to occur. The potential for injustice is even greater if certain patients are singled out for seclusion or if patients are secluded longer than they or the staff think that they need to be, as is indicated in some of the studies to date. Moreover, if unit variables are associated with seclusion activity, this too, may be indicative of decision making at certain times of the day or by certain staff members that may not be in the best interest of the patient. What seems fairly clear is that secluding a patient is a distressing event for staff and is viewed extremely negatively by some patients and as a reward by others.(ABSTRACT TRUNCATED AT 250 WORDS)