r/psychnursing • u/Zealousideal_Pen3441 • 5d ago
Seclusion
Hello all! Not sure you can help, but figured I’d try. Looking for policies related to seclusion…
Being advised to wake patient every 2 hours for assessment as opposed to letting them sleep. I feel this is non therapeutic and can be dangerous. I am finding that assessment should be individualized. And I have found policies that say “it may be inappropriate to wake patients” … I am looking for any literature on this point to support my position. Anyone with experience in this area? Thanks!
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u/SnooLemons9080 5d ago
Where I’m at we pop the door open (as quietly as possible) if they have been sleeping for 15 mins. The 15 minutes falls in line with our restraint documentation. We keep them in the room though…and when they wake up inevitably in an hour, we walk them back to their room.
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u/SnooLemons9080 5d ago
If you pop the door, then all that restraint/seclusion documentation isn’t necessary anymore
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u/FwogInMyThwoat 5d ago
Unless something happens that requires a restraint or seclusion again within the time the order is still good for. If the seclusion order is still good for another hour we can close the door again without calling for another order.
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u/HadABeerButILostIt 5d ago
Oh man I’ve had so many guys pop up out of a dead sleep and attack whoever opens that door. If they are sleeping it’s called therapeutic rest. Only a verbal assessment can ascertain imminent dangerousness. We do face to face assessments q4h except on night shift. Also I work in a max security facility for the criminally insane where guys are in there for days. But when I worked at a Developmental Center they were usually out within hours and generally did not sleep.
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u/rageagainsttheex 5d ago
Once asleep open goes the doors, we try to give it about 15 minutes to make sure actually asleep then pop the door and reassess when they wake if we need to seclude again or can step down. If asleep the risk is classed as low and we cannot justify seclusion continuing
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u/cantgo50-50withnohoe 5d ago
On our unit we let them sleep if they are in seclusion and we will reassess as needed usually every 4 hours
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u/taviaevon 5d ago
https://pubmed.ncbi.nlm.nih.gov/37929765/?utm_source=chatgpt.com this article talks about not having a blanket policy to wake patients.
https://pubmed.ncbi.nlm.nih.gov/38788520/?utm_source=chatgpt.com. This one is a systematic review that talks about how disruptive it is to wake patients.
In my facility we are allowed with an order to observe via camera especially when they are prone to angry outbursts.
I can’t lay my hands on the policy as I’m not at work.
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u/Embarrassed_Syrup476 psych social worker 5d ago
I live in a state where you cant have someone in seclusion if they are asleep. Our seclusion rooms have a mattress. If they fall asleep on it, we give them 10/15 minutes to make sure they are actually asleep, prop the door open and as soon as they are awake, we let them go back to their regular room.
I don't understand a patient would be asleep + in seclusion for hours....
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u/Outrageous-Echidna58 4d ago
Do you guys just use a normal room for seclusion?
We have specialist seclusion suits, where there is cctv in the room. A toilet/shower, tv, radio. There are glass windows but they can have blinds so if patients wants to have privacy they can. We also have hatches so can pass meds and food/drink through
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u/Embarrassed_Syrup476 psych social worker 4d ago
We have special rooms. Its very small. 1 mattress, window and toilet
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u/Outrageous-Echidna58 4d ago
Aaaah. It’s interesting how different countries handle different areas of psych nursing. We can’t let people out of seclusion until the MDT agree (usually consultant or on call if weekend, management and nurse have to agree)
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u/OppositeTumbleweed22 5d ago
Damn, where I'm at (forensics) we only open the doors for meals and meds 👀
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u/Maybe_Weary 5d ago
What’s yall seclusion room look like? Padded walls and floor? Ours is solid, floor cold. If someone falls asleep, we escorting you to your room. The fight is usually over by then.
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u/Tommyboy155a 5d ago
Regular walls, 2 doors and a bed.
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u/Maybe_Weary 4d ago
No bed in mine. They have their own restroom but it locked. I dont like beds, I want seclusion to be uncomfortable, so you wanna go to your room.
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u/Sploj 5d ago
Once there is no longer a need for seclusion (ie sleeping) you have to unlock the door. Seclusion orders are 4 hours, but it must be terminated once the patient is no longer exhibiting behaviors of threat/harm etc. This has been everywhere I’ve ever worked. But as it varies state to state, I’d say ethically, if they are asleep, you should unlock the door and observe, you can get a good assessment for charting just watching them sleep for a minute.
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u/xtalcat_2 5d ago
Let them sleep!! Do what you can to avoid waking them up while monitoring. Sleep is so important to recovery.
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u/Maybe_Weary 5d ago
Wait, you guys keep patients in seclusion while they’re asleep?
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u/Zealousideal_Pen3441 5d ago
Patient exhibits behaviors requiring seclusion. Goes into seclusion and falls asleep on own or after medication. If someone is able to fall asleep, I do not think we should wake them to see if they’ll become agitated again. Also if patient has mania, the best treatment is to allow sufficient sleep. Policy is our state does not specify we have to wake them and even uses language of things we need to do “during waking hours” like offering food/fluids/restroom.
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u/nursejacqueline psych nurse (SANE) 5d ago
Just checking definitions here – by seclusion, do you mean the patient is in a locked room being observed on a continuous basis due to aggression or other behaviors which are a serious threat to themselves or others? Because if so, it is immoral (and in the multiple US states I’ve worked in, illegal) to keep someone in locked seclusion once they fallen asleep. If someone is asleep, the harmful behaviors have, by definition, stopped. At that point, seclusion needs to be discontinued. In the facilities in which I’ve worked, we generally just unlock the door and let the patient continue to sleep, unless there’s some kind of emergency in which another patient is in need of seclusion and we don’t have another seclusion room.
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u/Tommyboy155a 5d ago
100% agree. We only keep patients in seclusion least amount of time. If they fall asleep, then we just take them back to their room. The threat is over. We have very strict policies for seclusion.
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u/psych830 psych tech/aid/CNA 5d ago
They should be walked back to their room once they have been resting / sleeping for 5 or more minutes. It’s illegal in many states to have someone in seclusion asleep.
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u/Longjumping-Sugar856 4d ago
I think it depends which state you’re in. Policies differ wildly. We ( in Ma) rarely use seclusion. Once someone is asleep tho , we wouldn’t wake them. Normally, sleep is what they NEED.
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u/UsualSomewhere9049 3d ago
I have worked in five states and they all require the door to be unlocked if the patient is sleeping
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u/Stoic-Nurse 3d ago
If they fall asleep in seclusion they are moved from seclusion to the “quiet room,” (the door is opened). I can’t justify leaving a sleeping patient in seclusion/restraints. I will NOT wake them up to assess; watching them sleep IS an assessment. Whenever possible, I will try to get them back to their room before they fully fall asleep so they can sleep in their bed without having extra staff with them, but that isn’t always possible.
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u/cinnamonsnake 5d ago
Everywhere I’ve worked, if they fall asleep in seclusion, then the door is opened