View Position Paper. Seclusion may only be used for the management of violent or self-destructive behavior. The American Psychiatric Nurses Association APNA Position Paper on the Use of Seclusion and Restraint articulates both the vision of eliminating seclusion and restraint as well as the background and principles that support these standards.
The original position statement emphasized prevention and reduction of the use of these restrictive methods and their application only in behavioral emergencies where violent or self-destructive behaviors pose an immediate risk of harm to a person or others.
The foundation for the Standards revision included best practices that have supported successful seclusion and restraint reduction, and in some cases elimination, in settings across the nation. Clinical advances have played a significant role in the emerging best practices. However, in light of the growing realization that hospital characteristics have substantial influence on seclusion and restraint use, the revised standards articulate important characteristics of a work culture that support minimal seclusion and restraint use, and that are necessary to realize the vision of elimination.
The revision validated the fundamental principles and practices set forth previously, with minor changes made to the standards of care during initiation, monitoring and release from seclusion or restraint. Standards revisions were informed by an understanding of the importance of recovery principles and of the need to provide trauma informed care.
It recognizes the need for use of evidence-based tools to predict aggression and measure characteristics of incidents of violence. Such tools can contribute valuable data that will enable nurses to test the effectiveness of clinical interventions designed to prevent the need for the use of seclusion and restraint.
