Journal of Psychosocial Nursing and Mental Health Services
Vol. 47 No. 10 October 2009
Reflections on the Use of Seclusion: In an Acute Mental Health Facility
Damien Roberts, BNurs, Grad. Dip. (Mental Health Nursing), CN; David Crompton, OAM, MBBS, Grad. Dip. Soc. Sci. (Psych.), FRANZCP, FAChAM; Eleanor Milligan, PhD, Grad. Dip. Ed, BA (Hons.), BSc; and Aaron Groves, MBBS, FRANZCP
ABSTRACT
This pilot study provides a snapshot of the use of seclusion within an acute care mental health unit in Queensland, Australia. The study collected baseline data against which practice reform aimed at reducing its use could be gauged. A mixed methodology was adopted, undertaking retrospective chart reviews, collecting qualitative survey data from individual nursing staff (n = 71) and patients (n = 4), and conducting focus groups to identify factors contributing to seclusion use. The study revealed a local facility seclusion rate of 12% compared with a national average of 10%. The re-seclusion rate of 76% was significantly higher than the national average of 31%. Eighty-seven percent of seclusion episodes were longer than 4 hours, compared with a national average of 41%. In approximately one third of cases, the required documentation was incomplete. Consumers mostly perceived seclusion as punishing and nontherapeutic, in contrast to staff, who generally viewed it as appropriate and potentially therapeutic.
AUTHORS
Mr. Roberts is Clinical Nurse, Mr. Crompton is Associate Chair, Division of Mental Health, and Dr. Milligan is Clinical Ethics Coordinator, Princess Alexandra Hospital, Woolloongabba, and Dr. Groves is Director of Mental Health, Queensland Health, Brisbane, Queensland, Australia. Dr. Milligan is also Senior Lecturer in Medical Ethics, Griffith University School of Medicine, Southport, Queensland, Australia.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Eleanor Milligan, PhD, Grad. Dip. Ed, BA (Hons.), BSc, Clinical Ethics Coordinator, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia 4102; e-mail: Eleanor_milligan@health.qld.gov.au.
doi:10.3928/02793695-20090902-01
Addressing Nursing Students’ Stigmatizing Beliefs Toward Mental Illness
Debra A. Webster, EdD, RNBC, CNE
ABSTRACT
Implementing teaching methods that address nursing students’ stigmatizing beliefs toward people with mental illness is important for nurse educators. The purpose of this article is to describe how a creative reflective learning project was used to encourage nursing students to express feelings about working with clients with mental illness, address stigma, and facilitate development of empathy. While working with a client with mental illness over a 4-week period, students maintained a reflective journal exploring their assumptions about mental illness. In addition, students created an individual project to depict their understanding of what it was like for their client to live with a mental illness. Examples of students’ reflections and descriptions of their projects are presented to demonstrate how this experience affected students’ views of mental illness.
AUTHOR
Dr. Webster is Assistant Professor and Associate Chair, Salisbury University Department of Nursing, Salisbury, Maryland.
The author discloses that she has no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Debra A. Webster, EdD, RNBC, CNE, Assistant Professor and Associate Chair, Salisbury University Department of Nursing, 1101 Camden Avenue, Salisbury, MD 21801; e-mail: dawebster@salisbury.edu.
doi:10.3928/02793695-20090902-05
Mental Health and Medical Challenges: Management of a Depressed Patient with a Left Ventricular Assist System in an Inpatient Psychiatric Setting
Nancy Tylus-Earl, RN, MA, MSN; and Suzanne Chillcott, RN BSN
ABSTRACT
A depressed patient with a left ventricular assist device (LVAD) due to heart failure presented a unique challenge for staff in an inpatient psychiatric facility. Although depression in this patient population has been recognized and treated on an outpatient basis, the example described in this article may be the first known case to be treated in an acute inpatient psychiatric hospital setting. A variety of steps had to be taken to ensure the highest standards of care, as well as an optimal outcome for this patient. In addition to the individualized plan of care for depression, a more medically oriented and technologically advanced plan of care was also instituted. The inpatient psychiatric setting provides the necessary care and treatment to help the patient move beyond severe depression to engage in activities essential for health and the proper care and function of the LVAD. This article highlights an unusual psychiatric-mental health nursing situation to help others who may face this challenge in the future.
AUTHORS
Ms. Tylus-Earl is Clinical Lead Nurse, Cognitive-Behavioral Therapy Program, East Wing II, Sharp Mesa Vista Hospital, and Adjunct Clinical Psychology Professor, University of Oklahoma College of Nursing (California satellite location), and Ms. Chillcott is Mechanical Assist Device Lead, Mechanical Assist Device Department, Sharp Memorial Hospital, San Diego, California.
The authors disclose that they have no significant financial interests in any product or class of products discussed directly or indirectly in this activity, including research support.
Address correspondence to Nancy Tylus-Earl, RN, MA, MSN, Sharp Mesa Vista Hospital, East Wing II, 7850 Vista Hill Avenue, San Diego, CA 92123; e-mail: Nancy.Earl@sharp.com.
doi:10.3928/02793695-20090902-02
