The experience and process of seclusion practice: A qualitative analysis

Abstract

This qualitative study explored the experience of seclusion practice with particular reference to those nurses, patients and relatives who were involved in the procedure. A literature review of international publications revealed that there was little cohesion within studies undertaken so far.
A systematic review of research methods previously adopted in order to explore patient and staff experience indicated that research into seclusion practice had reached an impasse and that qualitative methodologies would provide a means of understanding the depth of experience required for appropriate policy making. The methods used within this study were derived from phenomenological inquiry and used grounded theory methods in order to explore this substantive area.
In-depth interviews of both nurses and ex-patients (n=14) provided a rich source of data. In addition to this, field visits and various meetings took place with user groups and NE-IS Trusts. Findings were then examined in the light of other research evidence and contemporary theory.
Categories arising were centred upon three rich conceptual themes. These were 'control', 'punishment' and 'knowledge'. The core theme, "issues of silence" influenced all interactions taking place regarding seclusion practice. The route into seclusion was defined as a trajectory which began in the community setting and ended with the locked door. It was identified that
nurses and patients negotiated these silent issues surrounding seclusion in order for patients to gain exit from the seclusion room.
The practice of seclusion was a physically observable phenomenon which led to uncomfortable awareness within those who experienced the practice. This awareness caused both patients and nursing staff to review their role and the caring alliance which was initiated during admission. This review led to a sense of powerlessness within both practitioner and patient.
Coping with this awareness then led to silence concerning aspects of care and behaviour. It appeared that the silent issues were largely unchallenged by those who utilised them and that those who did challenge them were diverted from the issues by a policy system which could, be ineffective. The system of psychiatric care and the wider society within which the system
functioned were not felt to be supportive of exploration of these silences due to misinformation and general disinterest in the carers and those who experience mental illness.
It is put forward that it is only by providing means to realistically address and acknowledge the silence surrounding seclusion practice that real change can begin. Recommendations which seek to provide an arena whereby the silences can be safely reviewed are made. These include the use of the new model for analysis and debriefing, more appropriate policy guidelines and suggestions for future research agendas.