Nursing Law and Ethics

submitted that regarding these activities as `treatment' even in the light of the very
wide definition of treatment permitted by the MHA is not correct. Treatment,
regardless of the definition, should always be intended to have some curative or
ameliorative purpose or expectation, which will not be the case with the techni-
ques mentioned. As regards an informal patient, the same is true, but as the patient
may consent to treatment, it may be tempting to use the patient's consent as
justification for restraint. While this is not impossible, it is suggested that it is
difficult and also poor practice.

Seclusion

It is assumed that seclusion, albeit controversial, is lawful and will continue to be
used even if only rarely. Seclusion is the supervised confinement of a patient in a room, which may be locked to protect others from significant harm' [53].There is nothing inherent in seclusion which makes it unlawful, but it is subject to abuse by using it for too long, or as a means of punishment, and then it becomes an unlawful interference with a patient's freedom of movement or bodily integrity. Hence, the Code of Practice emphasises in paragraph 9.16, that seclusion should be seenas a last resort' and be `for the shortest possible time'. In addition,
seclusion should not be used:

`. as a punishment or threat;

. as part of a treatment programme;
. because of shortage of staff;
. where there is any risk of suicide or self-harm.'

If seclusion is imposed on informal patients, it should be a trigger to consider the
formal detention of the patient.
The Code of Practice also offers guidance as to the need for each hospital to have
apolicy on seclusion and for the procedure to be applied. Paragraph 19.18
provides that the decision to use seclusion may be made by the nurse in charge of
the ward. If seclusion is initiated without the involvement of the patient's rmo, they
must be notified at once in order that they may attend. Having placed a patient into
seclusion, the duty of care owed to the patient demands that account be taken of
the change in circumstances, and thus the Code of Practice further provides:

`19.19 A nurse should be readily available within sight and sound of the

seclusion room at all times throughout the period of the patient's seclusion, and

present at all times with a patient who has been sedated.

19.20 The aim of observation is to monitor the condition and behaviour of the

patient and to identify the time at which seclusion can be terminated. .. the

patient should be observed continuously. A documented report must be made at

least every 15 minutes.

19.21 The need to continue seclusion should be reviewed every 2 hours by 2

nurses #1 of whom was not involved in the decision to seclude) and, every 4

hours by a doctor. A multidisciplinary review should be completed by a con-

sultant or other senior doctor, nurses and other professionals, who were not

involved in the incident which led to seclusion if the seclusion continues for

176 Nursing Law and Ethics