Nurse perceptions of the use of seclusion in mental health inpatient facilities: have attitudes to Māori changed?
| Published date | 12 March 2018 |
| Date | 12 March 2018 |
| Pages | 100-111 |
| DOI | https://doi.org/10.1108/JMHTEP-12-2016-0055 |
| Author | Chris Drown,Thomas Harding,Robert Marshall |
| Subject Matter | Health & social care,Mental health,Mental health education |
Nurse perceptions of the use of seclusion
in mental health inpatient facilities: have
attitudes to Māori changed?
Chris Drown, Thomas Harding and Robert Marshall
Abstract
Purpose –The purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion
rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and
alternatives to seclusion.
Design/methodology/approach –A questionnaire was circulated to mental health inpatient staff. Data
from the Ministry of Health for seclusion numbers and rates for Māori and non-Māori were also collected.
Findings –The major barriers to reducing the use of seclusion related to staffing issues, a lack of
management and medical support, and physical characteristics of the facility. Data from the Office of the
Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion
events, the number of patients secluded, and the percentage of total patients secluded. However, the
percentage of Māori secluded compared to the total number of patients secluded showed little change from
2007 to 2013.
Originality/value –Further analysis of the nurs e’s responses showed that four of the six least-used
strategies incorporat ed Māori cultural appro aches. The authors surm ise that an inability to p rovide
culturally sensitive care, either through staffing or education factors, may be implicated in the lack of
change in the seclusion rates for Māori. This may also be pertinent to seclusion rates for indigenous
peoples in other countri es.
Keywords Māori, Mental health, Behaviour control, Culturally competent care, Inpatients, Seclusion
Paper type Research paper
Introduction
In 2008, the results of a survey of New Zealand’s 20 district health boards (DHBs) which
evaluated implementation of initiatives to reduce seclusion and restraint indicated all had
initiatives in place (Te Pou o Te Whakaaro Nui, 2008). Six DHBs had initiated comprehensive
programmes, while the remaining 14 had i mplemented or were in the process o f implementing
approaches. One of their results was that interviewees recommended surveying nurses
directly involve d with patients rega rding their views o f seclusion and rest raint. This curren t
project was designed to gain the views of those nurses as well as review changes in seclusion
events since 2007.
Background
Standards New Zealand (2008a) defines seclusion as a form of restraint, “Where a consumer is
placed alone in a room or area, at any time and for any duration, from which they cannot freely
exit”(p. 30). Seclusion with or without additional restraint is a procedure for managing aggressive
or agitated clients and promoting site security, particularly in an emergency psychiatric setting
(Larue et al., 2009). These authors also note the complex interaction of factors which are involved
Received 6 December 2016
Revised 19 April 2017
9 August 2017
Accepted 17 October 2017
Chris Drown is based at the
Faculty of Education,
Humanities and Health
Science, Eastern Institute of
Technology, Hawke’s Bay,
New Zealand.
Thomas Harding is a Senior
Lecturer at the School of Health
Sciences, University of
Canterbury, Christchurch,
New Zealand.
Robert Marshall is based at the
Faculty of Education,
Humanities and Health
Science, Eastern Institute of
Technology, Hawke’s Bay,
New Zealand.
PAGE100
j
THE JOURNAL OF MENTALHEALTH TRAINING, EDUCATION AND PRACTICE
j
VOL. 13 NO. 2 2018, pp.100-111, © Emerald Publishing Limited, ISSN 1755-6228 DOI 10.1108/JMHTEP-12-2016-0055
To continue reading
Request your trial