This is a process where a nurse prepares a room in a manner appropriate for confinement and care of an acutely disturbed patient. Seclusion is the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving. This is indicated for: destructive patient, situation of increasing agitation by environmental stimuli and control undesirable behaviour. It is essential that a patient in seclusion is closely observed and given proper care. This must be prescribed by the Doctor/Psychiatrist. Do not leave a patient in seclusion for more than twenty (20) minutes without observation or talking to him/her. Take patient out of seclusion room if he/she becomes more disturbed and ensure that at least two (2) nurses are available when the seclusion door is opened.
Aims
Protect the patient from harming him/herself and others
Maintain a safe working environment for the health team
Prevent patient from causing damage to property
Requirements
1. Seclusion room which must satisfy the following:
· Room must be painted in calming colours
· Room must be lit
· Mattress should be on the floor
· Walls should be padded
· Disposable bedpan and urinal
2. Patient’s folder (Electronic/Manual)
3. Observation chart
Steps
1. Advance Preparation:
a. Ensure that seclusion is prescribed
b. Prepare seclusion room with secured lock
c. Determine duration and provide for the needs of patient
· Regular observation (15- 20mins intervals)
· Provision of adequate fluids and meals
· Opportunity for communication
d. Arrange for contingency strategy if seclusion has to be abandoned
e. Identify restrain team
f. Prepare observation chart
2. Establish rapport (refer procedure) and explain procedure
3. Lead team to restrain patient with extra clothing and remove dangerous articles from him/her
4. The team takes restrained patient into the seclusion room and locks him/her in
5. Maintain patient’s dignity and value as an individual while restraining
6. Observe patient’s behaviour in seclusion every 15 -20 minutes and record on observation chart
7. Ensure that patient receives his/her meals and water while in seclusion (use disposable plates and cups)
8. Serve bedpan/urinal upon request by patient in seclusion
9. Maintain communication with patient during the period of seclusion
10. Administer prescribed medication at appropriate time
11. Appraise the effectiveness of the seclusion
12. Document the procedure in nurses’ notes/patient’s folder; indicating incident leading to use of seclusion, duration of seclusion, time patient was out from seclusion, reaction of patient and all nursing care given
13. Find alternative means of calming patient if he/she is still disturbing in the seclusion room
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