182 Unit 3 CURRENTSOCIAL ANDEMOTIONALCONCERNS
Box 9-2
➤ RESTRAINT ANDSECLUSIONSTANDARDS FORBEHAVIORALHEALTH
- The leaders (medical director, director of patient services) establish and communicate the organization’s
philosophy on the use of restraint and seclusion to all staff who have direct care responsibility. - Staffing levels and assignments are set to minimize circumstances that give rise to restraint or seclusion
use and to maximize safety when restraint and seclusion are used. - Staff are trained and competent to minimize the use of restraint and seclusion and in their safe use.
- The initial assessment of each client at the time of admission or intake is used to obtain information about
the client that could help minimize the use of restraint or seclusion. - Nonphysical techniques are the preferred intervention in the management of behavior.
- Restraint or seclusion use is limited to emergencies in which there is an imminent risk of a client physically
harming himself or herself, staff, or others, and nonphysical interventions would not be effective. - A licensed independent practitioner orders the use of restraint or seclusion.
- The client’s family is notified promptly of the initiation of restraint or seclusion.
- A licensed independent practitioner sees and evaluates the client in person.
- Written or verbal orders for initial and continuing use of restraint and seclusion are time-limited.
- Clients who are in restraint or seclusion are regularly re-evaluated.
- Clinical leadership is informed of instances in which clients experience extended or multiple episodes of
restraint or seclusion. - Individuals in restraint or seclusion are assessed and assisted.
- Individuals in restraint or seclusion are monitored.
- Restraint and seclusion are discontinued when the individual meets the behavior criteria for their
discontinuation. - The individual and staff participate in a debriefing about the restraint or seclusion episode.
- Medical records document that the use of restraint or seclusion is consistent with organization policy.
- The organization collects data on the use of restraint and seclusion in order to monitor and improve its
performance of processes that involve risks or may result in sentinel events. - Organizational policies and procedures address the prevention of the use of restraint and seclusion, and,
when employed, guide their use.
© Joint Commission on Accreditation of Healthcare Organizations. (2000). Restraint and seclusion standards for behavioral
health.Oakbrook Terrace, IL: Joint Commission Resources. Reprinted with permission.The goal of seclusion is to give the client the opportunity
to regain self-control, both emotionally and physically.
Most clients who have been secluded, however, have
very different feelings and thoughts about seclusion.
Clients reported feeling angry, agitated, bored, frustrated,
helpless, and afraid while in seclusion. They perceived
seclusion as a punishment and received the message that
they were “bad.” Many clients were not clear about the
reasons for seclusion or the criteria for exiting seclusion.CLINICALVIGNETTE: SECLUSION
Most believed they were secluded for too long. In gen-
eral, clients thought that other interventions such as in-
teraction with staff, a place to calm down or scream when
needed, or the presence of a family member could reduce
or eliminate the need for seclusion. Clients who had not
been secluded described seclusion in more positive
terms such as helpful, caring, fair, and good. Both se-
cluded and nonsecluded clients agreed that clients would
be “worse off” without the seclusion room.Adapted from Martinez, R. J., Grimm, M., & Adamson, M. (1999). From the other side of the door. Journal of Psychosocial
Nursing,37(3), 13–22.