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seclusion practices

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sassygirl

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  • Joined: Aug 2005
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Sat Aug 06, 2005 5:08 pm

I am also interested in hearing about the use of seclusion in inpatient units. We are currently having a review as the head of Psychiatry thinks we are 'overusing' seclusion. It's quite a frustrating exercise considering the increasing levels of violence seen, the staff shortages, the lack of skilled nurses. What's happening everywhere else.

elvira

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  • Joined: May 2006
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May 23, 2006, 05:10 am

I think the situation is probably the same in most inpatient units as we were recently told that we are "overusing" seclusion, but with the levels of violence we see in our patients we really do need it at times. In the last couple of years I have seen the level of general violence on the ward increase greatly with no formal training in the management of such violence forthcoming, therefore we are often left with little choice but to use seclusion to de-escalate situations.

Senior RN

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  • Joined: Dec 2008
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Dec 30, 2008, 10:41 am

What I've seen introduced, in recent years, is the use of 'Health & Security Assistants' ( HASA )in Mental Health Inpatient Units.

These guys have a NSW Security Licence ( with the Cert.II level course as a minimum ). They also go through an 'intro to Mental Health' course at Area Health Service level, and an 'aggression management' course.

The HASAs are usually out in 'the yard', interacting with, and observing the patients.

Of course, there are nurses out in the yard occasionally as well, but not all the time.

I think someone, somewhere, must have done a study, that shows, that when there is a 'high' level of staff : patient interaction / observation in common areas, like the courtyard, the rate of patient aggression decreases.

Those of you, who have had incidents of assault / violence in your unit, think of the 'scene'..... how much staff supervision was present at the time of the event? Would a higher level of supervision have prevented the event?

The HASAs don't need to 'write notes', they pass information onto nursing staff.

With HASAs on the unit, plus 'control' policies, such as 'everyone out of the dorms' by 0800hrs. the incidents of violence decrease.

Of course, you need experienced RNs / ENs to pick up on the precursors to aggression, and get the right medication into the patient as well.

The HASAs are apart of the 'team', that goes to making a 'safer' work environment.

regards,

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