Nurses' Roles in Reducing Seclusion and Restraints use in Mental Health

Physical restraint is defined as a physical or mechanical device that is utilized to limit a patient’s freedom of movement while seclusion is considered as the involuntary confinement of the patient to limit their movements (Khalil, Al Ghamdi and Al Malki, 2017). According to the American Psychiatric Nurses Association (APNA), the role of nurses in the delivery of patient care for mental health patients has progressively developed. Nurses in today’s practice are not only the primary care providers but also serve as executive level administrators as well as unit-based administrators (APNA, 2018). This hence squarely places the role of maintaining patient care safety squarely in the hands of the nurses. The push to ending the use of seclusion and restraints in patient management within the mental health departments has been a long-standing argument that seeks to find a balance between the inherent responsibility of the nurse to prevent harm and the patient’s right to autonomy (APNA, 2018).

Isolation; the patient is held alone within the area of confinement and reduction of sensory input- the area of confinement is usually bear (Mental Health Commission). The application of restraints on patients in mental health care has a variety of implications and relevance to practice. The use of restraints and seclusion in mental health care results in a negative patient experience of care. Psychiatric patients report experiencing feelings of shame, helplessness, and humiliation following seclusion or when physical restraints were used on them (Larue et al. The experience of restraint and seclusion resulted in the reawakening of previous traumatic experiences by the patients, which essentially contributes to poor patient outcomes of care in mental health (Larue et al. The search strategy limited the search to journal articles published and for which at least an abstract was available.

The search strategy also assessed the reference lists of the chosen articles for additional studies relevant to the topic of study. Professional websites such as the National Mental Health Commission website and The Australian College of Mental Health Nurses (ACMHN). The search identified relevant studies and inputs from the National Mental Health Commission on the topic. Nurse education and training on the reduction of seclusion and restraint use is one of the most effective approaches attain a reduction in the use of restraints and seclusion in the mental health units. , (2013), there was a reduction in the incidence of seclusion use in the wards compared to controls. Adopting this approach into nursing care can hence significantly enhance the reduction in seclusion use within the psychiatric departments.

The utilization of safe wards within the psychiatry care units for patients with mental health issues of concern is another critical approach that can be effective in reducing seclusion. The approach reduces the use of restrictive responses to patient aggression and conflicts within the psychiatric wards (Fletcher et al. The utilization of safe wards in Australian hospitals resulted in a significant reduction in the number of patient seclusions and restraint use (Fletcher et al. This assertation is similar to the assertions made by Vruwink et al. , (2012), that this has negative implications on the outcomes of the patient. Other similar research findings have established a need for the end or reduction of the use of seclusion and restraint use based on the safety impact it has on both nurses and patients with the intervention exposing them to risks of injuries and a lack of therapeutic value (Wale, 2011).

Evidence-based development of better alternatives to patient management in mental health has furthered the push for a reduction in seclusion use and the application of restraints in psychiatric management. The use of safe wards has been effective both in Australia and the UK as a model to reduce the need for patient seclusion and restraint use (Bowers, 2014). cfm?pageid=3728 Boumans, C. , Egger, J. , Souren, P. , & Hutschemaekers, G. Reduction in the use of seclusion by the methodical work approach. , Brophy, L. , Tibble, H. , Kinner, S. , Elsom, S. , & Hamilton, B. 1329330 Knowles, S. , Hearne, J. , & Smith, I. Physical restraint and the therapeutic relationship.  The Journal of Forensic Psychiatry & Psychology, 26(4), 461-475. , Katajisto, J. , & Välimäki, M. eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: A cluster-randomized trial.