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KMID : 0350519960490010477
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Journal of Catholic Medical College
1996 Volume.49 No. 1 p.477 ~ p.485
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Characteristics on Secluded Psychiatric Inpatients
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Abstract
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The use of seclusion rooms in psychiatric setting has been an accepted modality of treatment. However, the controversy whether it is justified or is not existing up to the present. In order to evaluate the warranty of seclusion for treatment, the
clinical factors affecting the use seclusion room have more to be defined.
This study was designed to investigate the validity of using seclusion room among 100 psychiatric inpatients admitted to Kangnam St. Mary's Hospital from September 1994 until June 1995. The subjects consisted of 50 secluded patients and 50
non-secluded
patients as control group. Clinical features were assessed by using Nurse's Observation scale for Inpatient Evaluation, a behavioral rating scale designed for the evaluation of the behavioral characteristics. Clinical variables observed were
compared
between seclusion group and control group.
@ES The results were as follows;
@EN 1. Behavioral characteristics evaluated with Nurse's Observation Scale for Inpatients Evaluation (NOSIE).
The average scores of NOSIE were significantly higher in the seclusion group (1.86±0.32) than in the control group (1.29±0.19) (t=2.77, P=0.0005). Among the factors of NOSIE, significant differences were shown in irritability (t=10.97,
P=0.0001),
psychosis (t=6.52, P=0.0001), neatness (t=2.39, P=0.0189), self-care competence(t=5.28, P=0.0001) and depression (t=4.26, P=0.0001).
2. Discriminant variables classifying seclusion group and control group
The variable most effectively discriminating seclusion group from control group was total NOSIE score (F=7.40), P=0.0077). Other discriminant variables were social interest (F=2.80, P=0.0976), neatness (F=2.69, P=0.1040) and educational level
(F=3.59,
P=0.0611).
3. Clinical characteristics of the seclusion group
1) The needs of seclusion room for 37 patients were determined by doctors-in-charge patients (92.5%), for 2 patients (5.0%) by nurses and for 1 patient by other patient (2.5%).
2) Frequencies of the seclusion of psychotic patients according to the time of the day were 21 (52.5%) from 2 p.m. to 10 p.m., 15(37.5%) from 6 a.m. to 2 p.m., and 4 (10.0%) from 10p.m. to 6 a.m., respectively.
3) The common reasons for seclusion in psychotic patients were inability to control their own behaviors associated with excitement (13.32.5%), un-cooperativeness (11, 27.5%), and violent behaviors (5, 12.5%). The frequent reasons for seclusion
in
nonpsychotic patients were inability to control their own behaviors associated with excitement (5, 50.5%) and behavioral modification (2, 20.0%), consecutively.
4) persons victimized by psychotic patients before the seclusion were 19 other patients (47.7%), 6 nurese(15.0%), 5 caregivers (12.5%) and 4 doctors (10.0%), consecutively. The persons victimized by nonpsychotic patients before the seclusion
were
5
patients (50.0%). 2 self-mutilation(20.0%), and 1 caregiver, 1 nurse, 1 doctor.
5) As for the duration of seclusion 29 (72.5%) psychotic patients stayed for over 24 hours, 8 (20.0%) for 12 to 24 hours, and 3 (7.5%) for 4 to 12 hours. Among the nonpsychotic patients, 6 (60.0%) were secluded for over 24 hours, 3 (30.0%) for
12
to 24
hours.
6) During seclusion, medication and close observation were performed in 24(60.0%) of psychotic patients and in 6 (60.0%) of nonpsychotic patients. Physical restraints were used for 15 (37.5%) of psychotic patients and for 4 (40.0%) of
nonpsychotic
patients.
7) Frequencies of the use of seclusion room according to the hospital days were 29 (42.0%) on the first day, 15 (20.6%) from 4th to 7th day, 10 (14.7%) on the 3dr day, 8 (11.8%) in the 2nd week, and 4 (5.9%) in the 3rd week of admission.
To conclude, the seclusion of psychiatric inpatients can be determined by the used of Nurse's Observation Scale for Inpatient Evaluation.
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