A nurse in an acute mental health unit is caring for a group of clients. For which of the following clients is seclusion contraindicated?
A An adolescent client who throws objects at other clients
B An older adult client who is manic and crying due to overstimulation
C A school-age client who attempts to repeatedly bite staff
D An adult client following a suicide attempt
The Correct Answer and Explanation is:
The correct answer is D: An adult client following a suicide attempt.
Explanation:
Seclusion, a restrictive intervention, involves isolating a client in a room or area to prevent them from harming themselves or others. Its use must be carefully considered, particularly in mental health settings, due to its ethical, psychological, and safety implications.
Contraindications for Seclusion: Seclusion is contraindicated in situations where the intervention could worsen the client’s condition or increase the risk of harm. This is particularly true for clients at risk of self-harm or suicide. Placing a client who has attempted suicide in seclusion can exacerbate feelings of isolation, hopelessness, and despair, potentially leading to further self-harm or suicidal behavior. These individuals require close supervision, empathetic support, and therapeutic interventions that help them feel connected rather than isolated.
Specific Considerations for a Client Following a Suicide Attempt: Following a suicide attempt, a client is in a fragile psychological state, requiring continuous monitoring to ensure their safety. Seclusion could reinforce feelings of worthlessness or abandonment, making the client feel cut off from human connection. Instead, a less restrictive environment with frequent interaction and observation by staff is essential to ensure their well-being and provide emotional support. Therapeutic communication, safety checks, and appropriate medication management are part of the standard care for clients with suicidal ideation.
Other Options:
- A: An adolescent client who throws objects at other clients: Seclusion might be necessary to ensure the safety of others, as the adolescent’s behavior poses a physical threat.
- B: An older adult client who is manic and crying due to overstimulation: Seclusion can sometimes be appropriate for a manic client who is overstimulated, but other calming techniques should be tried first.
- C: A school-age client who attempts to repeatedly bite staff: Seclusion may be considered to protect staff from physical harm when other de-escalation methods fail.
Seclusion should only be used as a last resort and always with careful consideration of the client’s needs and safety.