Reducing restraint and seclusion in psychiatric settings: a paradigm shift in nursing practice

Restraint and seclusion are reported as highly traumatic experiences for clients with mental illnesses. Hence, government agencies, the general public, and mental health advocates\u27 concern for inappropriate use of restraint and seclusion, and the requirement of The Joint Commission (TJC) make restraint and seclusion reduction the focus of care in psychiatric hospitals. Psychiatric staffs are not adequately prepared nor are they equipped with the education and training required for managing the aggressive behavior they face on psychiatric units. Professional experiences in psychiatric hospital, networking with psychiatric staff, data and literature reviewed, did not show consistent reduction in the use of restraint and seclusion regardless of the current creative restraint reduction education as suggested by data of restraint and seclusion use in the Psychiatric Department of a large urban Midwestern hospital. The purpose of this project is to develop a practice model to reduce restraint and seclusion use in psychiatric settings, which could likely be a precursor to a paradigm shift in nursing practice in caring for patients with mental illness. The practice model uses Margaret Newman\u27s Theory of Health as Expanding Consciousness as a theoretical framework. Trauma informed care, non-violence, and the concepts of safety, relationship, pâttern, and transformation also informed the practice model. The future application of the practice model was explored both for areas outside of psychiatric care units in the hospital and within the context of nursing school curriculums