Unit.B.7.3.
Restraint/Seclusion
Australia |
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points
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| "The
debate about the appropriateness of seclusion
as a nursing practice in inpatient settings in the 21st
century continues, with powerful and often emotive arguments
from those who view it as an anachronistic and punitive
form of ward management, and from others who see it
as a useful emergency measure to protect individuals
from imminent harm. This is the first paper, however,
to focus on legal and ethical issues in relation to
the use of seclusion, with policies and
practices in Australian psychiatric institutions viewed
within the context of worldwide trends. The interplay
of ethical principles and international mental health
law has encouraged a move towards the provision of care
and treatment of the disturbed psychiatric patient within
the least restrictive environment, supposedly reducing
the potential for the inappropriate use of control mechanisms.
Nevertheless, current legislation can be seen to preserve
the status quo because it legitimizes seclusion
as an acceptable nursing practice, albeit within given
parameters, thereby defusing the imperative to promote
the reduction and abolition of psychiatric control mechanisms
and seek new possibilities in mental health care"
(Muir-Cochrane & Holmes, 2001, p. 501). |
Canada |
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Insert forensic
focus points here
International |
focus
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Insert forensic
focus points here
Scotland |
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"There are
considerable differences between he USA and the UK, in terms
of the practice of inpatient care, particularly in the use
of restraint. The American system defines restraint in terms
of physical, mechanical and chemical restraint. Of which
only physical and mechanical are used in the UK" (Macilwaine,
Watson, MacKenzie, 1999, p. 27).
"There is a lack of clarity in the literature about
the key concept of restraint. The British and American literature
use the concept differently and there is considerable variation
on practice between the USA and the UK" (Macilwaine,
Watson, MacKenzie, 1999, p. 27).
"The frequent
and routine use of the mechanical restraints in the USA
is at odds with British practice where such restraints are
not used routinely, even within forensic facilities"
(Macilwaine, Watson, MacKenzie, 1999, p. 27).
"The need
to define and measure the concept more accurately is apparent,
as is the need to relate the frequency of use to patterns
of nursing education and nursing practice culture"
(Macilwaine, Watson, MacKenzie, 1999, p. 27).
Restraint: "In
the state of Massachusetts, the legal definition of restraint
is quite complex. Restraints may only be used in emergencies
when the patient exhibits behaviour which demonstrates immediate
treat to himself or others. In addition restraint is subdivided
into three types. Physical- the use of people to restrain
the individual. Mechanical- the use of restraints which
can be made of leather or clothe and can be used to pinion
the person to a bed or trolley. These can be four point:
i.e. both writs and both ankles, or two point: i.e. wrist
restraints or even nine point - both wrists and ankles,
and five pints restraining other parts of the body and the
whole body" (Macilwaine, Watson, MacKenzie, 1999, p.
28).
United Kingdom |
focus
points
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"The three
Special Hospitals for England and Wales, Broadmoor, Rampton
and Ashworth (formerly Moss Side and Park Lane), cater for
those patients who are deemed dangerous, violent or have
criminal propensities" (Mason, 1994, p. 54).
"In the
general psychiatric field, some hospitals provide a seclusion
room as part of their repertoire for dealing with extremely
disturbed individuals, whilst others do not" (Mason,
1994, p. 54).
"From the
literature reviewed on the use of seclusion and restraint
in Canada, it appears that they are bedevilled with the
same thorny issues that other countries face, but accept
that limitation of freedom of movement in itself has no
therapeutic benefit and is necessary only for the application
of other treatments" (Mason, 1994, p. 55).
"Sceenivasan
(1983) notes, "mechanical restraints are used for geriatric
patients seven times more often in Canada as in Britain".
A growing concern over the levels used" (Mason, 1994,
p. 56).
"Concerns
are expressed in regards to the legality of seclusion, which
the psychiatrized countries addressing the civil and human
rights of the patients in the courts of law and the non-psychiatrized
Laotian referring the use of restraints to the police"
(Mason, 1994, p. 59).
"The legal
position of restraint is clarified by the Mental Health
Act (1983) and the Code of Practice (1993) which dedicates
a chapter to patients with management problems and says
that "any restraint must be reasonable in the circumstances.
It argues that restraint must be the minimum necessary to
deal with the harm being prevented" (Chandley &
Mason, 1995, p. 22).
"Seclusion
has as much to do with myth and magic as with madness and
science" (Mason, 1997, p. 15).
"Seclusion
and the moon share a popularly held cause-and-effect relationship"
(Mason, 1997, p. 15).
"Seclusion,
in one form or another, is a universal phenomenon (Mason,
1994).Seclusion is used both in Westernized psychiatric
settings (Mason, 1994) and traditional folk societies"
(Westermeyer & Kroll, 1978; cited in Mason, 1997, p.
15).
"The perceived
relationship between psychiatric disturbances and the moon
appears to be related to the established "scientific"
fact that the moon affects the Earth's tides, and thus,
to some extent, weather conditions" (Mason, 1997, p.
16).
"This relationship
was posited by Hippocrates some 2,500 years ago when he
explained that "one who is seized with terror, fright
and madness during the night is being visited by the goddess
of the moon"." (Geller & Shannon, 1976; cited
in Mason, 1997, p. 16).
"This study
found no correlation between the use of seclusion and the
lunar cycle, but the limitation inherent in the data collection
and analysis were sufficient to warrant further investigation"
(Mason, 1997, p. 16).
United States |
focus
points
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"The purpose
of this study was to learn about the experience from the
experience of seclusion from the patients perspective, including
the associated feeling thoughts and beliefs that patients
hold about the process" (Martinez, Grimm & Adamson,
1999, p. 13).
"A deeper understanding of patient experiences may
assist staff in defining appropriate care for patients who
may benefit from this highly restrictive intervention"
(Martinez, Grimm & Adamson, 1999, p. 13).
"Other potential
benefits from this study include receipt of patient input
that might create the benefit for shorter seclusion episodes,
or better yet seclusion prevention" (Martinez, Grimm
& Adamson, 1999, p. 13).
"Patient
participants viewed seclusion as a form of punishment that
maintains physical, and at times psychological control over
the secluded person" (Martinez, Grimm & Adamson,
1999, p. 22).
"A seclusion
episode should serve no greater function than simply containment
or preserving safety. During this period of crisis for patient,
they felt an even greater need for a therapeutic intervention"
(Martinez, Grimm & Adamson, 1999, p. 22).
"Environmental,
procedural and attitudinal changes were emphasized by the
patients in this study as a means to enhance the therapeutic
potential of seclusion" (Martinez, Grimm & Adamson,
1999, p. 22).
Focus Points
Reference
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Macilwaine,
H., Watson, C., MacKenzie, I.(1999). Restraint versus
restraints: Defining the concepts for review and measurement.
The British Journal of Forensic Practice, 1 (3),
27-33.
Martinez,
R. J., Grimm, M. & Adamson, M. (1999). From the
other side of the door: Patient views of seclusion.
Journal of Psychosocial Nursing, 37 (3), 13-22.
Mason,
T. (1994). Seclusion: An international comparison.
Med. Sci.Law, 34 (1), 54-60.
Mason,
T. (1997). Seclusion and the lunar cycles. Journal
of Psychosocial Nursing, 35 (6), 18-23.
Muir-Cochrane,
E. C., & Holmes, C. A. (2001). Legal and ethical
aspects of seclusion: An Australian perspective. Journal
of Psychiatric & Mental Health Nursing, 8(6),
501-506. Retrieved December 31, 2002, from Academic
Search Premier database:
http://search.epnet.com/direct.asp?an=5691508&db=aph
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B - Forensic Psychiatry > Section B.7.0. Forensic Issues > Unit.B.7.3.
Restraint/Seclusion
