The place of ethics in mental health nurses’ clinical judgment in the use of seclusion

Abstract

Seclusion is an intervention used in mental health settings, with nurses playing a key role in decisions related to secluding a patient. The purpose of this interpretive description study was to explore the place of ethics in mental health nurses’ clinical judgements on seclusion use. Data collection involved interviews of nine registered psychiatric nurses and eight registered nurses. Nurses described their experiences with seclusion and identified factors that impacted their decision to seclude. Ethical tensions related to seclusion use were outlined. Two themes were identified. The complexity of promoting safety and preventing harm illustrates nurses’ sometimes competing responsibilities to keep people safe, understanding of power differentials and patient vulnerability, and recognition of the various types of harms that can arise with seclusion. The importance of knowing for ethical action with seclusion use highlights the role of knowing oneself, the patient, other team members, and the unit in judgments to seclude.