Seclusion practice: a critical examination of the nurses' decision-making process

Holmes, Dave; Jacob, Jean Daniel
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background Seclusion continues to be a widespread measure used in psychiatric settings. Furthermore, the humanitarian, ethical and legal issues associated with the use of seclusion make it one of the most controversial management strategies available. Despite these important issues, little nursing research has sought to gain an understanding of the nurses' decision-making process regarding the use of seclusion in psychiatric settings. Objective: The objective of this presentation is to outline the research results of a grounded theory study conducted in two major Canadian university affiliated psychiatric hospitals. Methods/results After conducting 27 semi-structured interviews with registered nurses, our qualitative analysis shows that the decision-making process involved in the use of seclusion is highly complex and relies on a combination of personal, professional, and organizational discourses and practices. Conclusion Several dimensions of the professional role must be considered in relation to seclusion; however, structural variables (examples: peer pressure, culture of blame) are most influential in the decision-making process involved in using seclusion. This is true even when those variables are in opposition to legal and ethical obligations of nurses.


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