Special Hospital seclusion and its clinical variations

Some specific problems of secluding female patients

This paper reports on a study of secluded female patients in a special hospital. A random selection of seclusions occurring within one week of initiation were chosen and data were collected by a structured interview, involving nurses who had made the decision to initiate the seclusion. The interview schedule contained 18 items and the analysis utilized chi square test for categorical data and Speraman's rank coefficient for correlation on the scores on two variables. The results indicated that there was an erratic use of alternative approaches attempted prior to the use of seclusion and that the stripping of patients as they are secluded is rationalized as 'in the interest of their safety'. It is argued that further research is urgently required to interview the female patients concerned and to explore the specific issues pertaining to the seclusion of female patients. We question whether a high security psychiatric hospital is the most appropriate placement for females.

Foucault and nursing: a history of the present

While a commitment to the development of nursing theory has been a significant force in nursing scholarship, particularly in the US, the authors have noted a recent trend among nurses in different countries to develop Foucauldian interpretations of nursing. The objective of this paper is to identify those publications by nurses that employ a Foucauldian perspective and to provide a useful summative review of these works to date, which illustrate the potential contribution of a Foucauldian reading of nursing. The authors have reviewed 27 publications written by nurses which present a Foucauldian analysis. These publications were issued between 1987 and 1998 in English, Portuguese and German. The most frequent concepts treated in the literature reviewed are power/knowledge, surveillance, discourse, discipline, resistance, docile bodies, clinical gaze, and panopticon. The literature reviewed illustrates that Foucault's concepts can have a profound impact on the way we conceive of nursing as a discipline and as a profession. Nursing care becomes a political event, nursing knowledge contributes to the dissemination of regimes of truth, and nurses, rather than being powerless, are perceived as professionals who exercise power over life in society. A Foucauldian reading of nursing enables nurses to move into a broader interdisciplinary and critical scholarship.

Gender differences in the use of seclusion

This paper offers a contribution to the research on the use of seclusion by focusing specifically on gender. The study was carried out in a special hospital which provides care in conditions of high security. Data were collected on all seclusions over a one-year period which resulted in a database of 823 episodes of seclusion. The results indicate that female patients account for more seclusions than their male counterparts and that they are secluded more often but for shorter durations. Whereas the mentally ill category are subject to more seclusions it is the psychopathically disordered classification that is responsible for more female episodes. Further research is under way to examine the reasons for the disparities.

An ethnomethodological analysis of the use of seclusion

The use of seclusion in psychiatric practice is a contentious issue. This paper reports on an ethnomethodological approach to understanding the decision-making process in the use of seclusion. Through first-level and second-level reasoning analysis, three themes emerged which underscored the subjects' rationalization process. These were: (a) mechanistic searching, (b) frame conflict, and (c) asylum status. This research suggests that the decision to use seclusion is based on a complex interplay of cultural and organizational factors rather than due to the presentation of symptoms by the patient.

Seclusion and the Lunar Cycles

1. The lunar cycle's influence over psychological disturbances in the human being is known as the Transylvanian effect. 2. Seclusion is used predominantly for the control and management of violence and aggression in patients. 3. If the Transylvanian effect is supported, a relationship between lunar cycles and the use of seclusion should exist; no such correlation, however, was found in this study.

A study of the official records of seclusion

The official records of seclusion on one locked ward in a city hospital were analysed. In the first instance we examined the frequency of seclusion, the sex and type of the patients secluded over a 4-year period. Following the introduction of a new recording system, a more detailed analysis of all the official records of seclusion over a 2-year period was then carried out (n = 225). The findings are presented here as simple frequency counts and provide a detailed picture of the use of seclusion in this particular area. They include details about the way in which seclusion was used on the ward and the reasons staff provided for secluding patients. The use of official records as research data illustrate how important insights into the daily care of psychiatric patients may be explored in a fruitful manner.