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Therapeutic communication skills chapter 44
Therapeutic communication skills chapter 44
Therapeutic communication skills
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Seclusion is a clinical intervention used in mental health inpatient settings that focuses on the management of violent and aggressive behavior when that behavior compromises the safety of the consumer, co consumer, visitors and staff.
The reason for selecting this topic is that being an enrolled nurse in an acute mental health inpatient unit for the past 7 years, I have found myself in the situation where I have been a participant in placing a patient in seclusion on numerous occasions and I have conflicting views as to its appropriateness.
This paper will clarify the practice of seclusion, its impact on patient's mental health, interventions during seclusion and another possibility to seclusion.
According to the Australian Mental Health
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Some mental health staff defend seclusion as an acceptable way to manage destructive or violent behavior, with others believing it to be counter constructive and not desirable.
Since, seclusion is a matter conflicting between patient's rights and safety, this issue becomes one of great concern for mental health professionals. If seclusion becomes necessary, then it is important that throughout the seclusion the patient receives a high level of nursing care in a way which maintains their
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Patients may also have physical needs that should be considered when using these interventions. It is important that patients are treated in a fair and non-judgmental manner irrespective of culture, gender, diagnosis, sexual orientation, disability, ethnicity or religious / spiritual beliefs
Mental health nurses are skilled at using therapeutic communication techniques. They use different forms of communication with patients to help them either heal or cope with their mental state. Giving recognition, being available and accepting, offering encouragement, verbalising observations, restating what the patient has said, seeking clarification, putting feelings of the patient into words, and many other therapeutic techniques are used when communicating with a patient.
Giving verbal instructions, guidance and reassurance to mental health patients is essential for nurses. Teaching patients how to cope with their mental disorders helps them feel more empowered and in control, in a situation where they have very little control over their
Modern psychiatric hospitals evolved from, and eventually replaced the older lunatic asylums. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint with successive waves of reform, and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment, and attempt where possible to help patients control their own lives in the outside world, with the use of a combination of psychiatric drugs and
Yet, solitary confinement is still considered necessary in order to maintain control within the prison and among inmates. Solitary confinement is seen as an effective method in protecting specific prisoners and altering violent/aggressive disobedient behaviors, (Maria A. Luise, Solitary Confinement: Legal and Psychological Considerations, 15 New Eng. J. on Crim. & Civ. Confinement 301, 324 (1989) p. 301). There is some discrepancy among researchers as to the varying effects on inmates who have undergone an extensive solitary confinement stay. Most researchers find that inmates who had no previous form of mental illness suffer far less than those who do, yet most if not all of these individuals still experience some difficulties with concentration and memory, agitation, irritability, and will have issues tolerating external stimuli, (Stuart Grassian, Psychiatric Effects of Solitary Confinement, 22 Wash. U. J. L. & Pol’y 325 (2006) p. 332). Although these detrimental psychiatric repercussions of solitary confinement currently appear, several researches have made suggestions as to how these may be avoided. These requirements being that
Solitary confinements are a prison within prisons, that isolates inmates from the rest of the world. Solitary confinement was originally founded by the Quakers and Anglicans in the early 1800s, in Philadelphia. The purpose of solitary confinement when the Quakers and Anglicans first created it, was to give the inmates the opportunity to get the chance to find Christ (Biggs 2017). Now the purpose of solitary confinement is to serve as punishment for criminals that are killers or cause a problem within the prison. Inmates in solitary confinement sit in a cell that is 80 square feet for 22-23 hours a day, with 1 hour of free time without human contact (Breslow 2014). One side believes solitary confinement is a good and a easy way to protect society
Physical restraint, according to Health Care Financing Administration, can be defined as any handling, physical and mechanical methods applied to a patient with the aim of denying him or her the freedom of movement or access to his or her own body (Di Lorenzo et al., 2011). It may involve use of belts or ties that restrain movement of an individual such as seclusion. Seclusion refers to isolation from others, often done in a room that’s I avoid of any furniture and has a small observable window as the only connection to the outside world (Chandler, 2012). The use of physical restraint in handling patients has been on debate for several years now. In most countries such Italy, it
Since the early 1800s, the United States has relied on a method of punishment barely known to any other country, solitary confinement (Cole). Despite this method once being thought of as the breakthrough in the prison system, history has proved differently. Solitary confinement was once used in a short period of time to fix a prisoners behavior, but is now used as a long term method that shows to prove absolutely nothing. Spending 22-24 hours a day in a small room containing practically nothing has proved to fix nothing in a person except further insanity. One cannot rid himself of insanity in a room that causes them to go insane. Solitary confinement is a flawed and unnecessary method of punishment that should be prohibited in the prison system.
Solitary confinement is a mandated arrangement set up by courts or prisons which seek to punish inmates by the use of isolated confinement. Specifically, solitary confinement can be defined as confinement in which inmates that are held in a single cell for up to twenty-three hours a day without any contact with the exception of prison staff (Shalev, 2011). There are several other terms which refer to solitary confinement such as, administrative segregation, supermax facilities (this is due to the fact that supermax facilities only have solitary confinement), the hotbox, the hole, and the security housing unit (SHU). Solitary confinement is a place where most inmates would prefer not to go. There are many reasons for this.
Solitary confinement ranks as one of the most controversial forms of governmental punishment. The controversy regards the constitutionality, or in other terms the humaneness of prolonged isolation. The justice system regards prisoners who are assigned solitary confinement as potentially too dangerous to be permitted any form of interaction with other inmates or prison guards. Solitary confinement is the isolation of a prisoner in a small, artificially lit cell that is generally about eight by four feet in dimension. This containment lasts for approximately 23 hours a day, and when permitted to exit the cell for an hour, the prisoner still receives no amount of significant social interaction and is simply allowed to pace in a longer isolated chamber.
For most prisoners, solitary confinement is, by far the worst and most unhealthy place one could be sent. Each criminal that is automatically placed or eventually sent to solitary confinement is isolated from cell mates, peers, friends, and visiting family, relying solely on the prison guards themselves. Even more so than within the basic prison setting, a person sent to solitary confinement is extremely closely monitored and controlled, having very little space, and little to none fresh air, sunlight, or activities to keep themselves occupied. This form of punishment was coined by Eastern State Penitentiary (E.S.P.). According to, E.S.P.’s website, solitary confinement officially ...
If an inmate continues to be violent, the result is a longer time in solitary confinement. Solitary confinement is inhumane and should be called torture. Putting and keeping an individual in solitary confinement puts them at a very serious risk of developing a mental illness, which may not be recoverable. Solitary confinement causes many effects that range in severity; it is not something that inmates should be subjected to, though. Inmates/offenders entering the prison system need to be screened for mental health and substance abuse disorders.
The relationship between the person seeking help and the nurse/counsellor should be appropriate for producing therapeutic change, to ensure that the patient maximizes from the therapeutic relationship. The health care provider should ensure that they communicate effectively to the patient/client. The skills explained in the above essay are the relevant skills that nurses in the contemporary hospital environment should adhere to and respect.
Stuart, G. W. (2009). Principles and Practice of Psychiatric Nursing (9th ed. pp 561). St. Louis, MO: Elsevier Mosby.
In 2001, over 450 million people worldwide suffered from mental illness (World Health Organisation, 2001) and these numbers have increased by a wide margin since then. Using restraints in treatment for those who are mentally ill is a topic that creates a large amount of controversy. Many are concerned with how the use of restraints can affect the person and if they are necessary or if alternative measures could be used. The National Alliance of Mental Illness has indicated their position on restraints, “The use of involuntary mechanical or human restraints or involuntary seclusion is only justified as an emergency safety measure in response to imminent danger to a patient or others.” (The National Alliance of Mental Illness, 2001) There have
As a nurse in a psychiatry emergency room, the staff must collaborate for the safety of patients and staff. There is a triage process that must be followed when a patient comes to the Psych ED, security takes any electronic devices, keys, purses, lighters, knives, wallets, etc. A nurse takes a mini-triage, which determines whether a patient needs to go to the medical ED side, if the patient is cleared to go to the Psych ED, the nurse must then decide whether to place the patient in a locked involuntary area or unlocked voluntary area. Any patient that goes into the involuntary waiting area must be searched, and go into a patient gown. Once there the patient must be seen by a nurse, then by a doctor. If a patient is agitated to the point of
According to Ruth Craven, Constance Hirnle, and Sharon Jensen in Fundamentals of Nursing Human Health and Function a restraint is used to stop a patient from being able to move freely, whether it be physically or assisted with medication. Types of restraints include physical, chemical, nonviolent/self-destructive, violent/self-destructive, and seclusion. Ultimately restraints are used in situations to help keep both the patient and the staff caring for that patient safe. The purpose of this paper is to recognize and explore ways to improve the use of bed restraints and further educate nurses on proper use to enhance patient safety. This is relevant in today’s healthcare setting, because there is still a need to keep patients safe and provide them with quality care, which may include the use of restraints.
The therapeutic nurse-client relationship is the basis, the very core, of all psychiatric nursing treatment ap- proaches regardless of the specific aim. The very first process between nurse and client is to establish an un- derstanding in the client that the nurse is entering into a relationship with the client that essentially is safe, confidential, reliable, and consistent with appropriate and clear boundaries (LaRowe, 2004). It is true that disorders that have strong biochemical and genetic components such as schizophrenia and major affective disorders cannot be healed through therapeutic means. However, many of the accompanying emo- tional problems such as poor self-image and low self- esteem can be significantly improved through a thera-