Seclusion is an intervention used in mental health settings, with nurses playing a key role in decisions related to secluding a patient. The purpose of this interpretive description study was to explore the place of ethics in mental health nurses’ clinical judgements on seclusion use. Data collection involved interviews of nine registered psychiatric nurses and eight registered nurses. Nurses described their experiences with seclusion and identified factors that impacted their decision to seclude. Ethical tensions related to seclusion use were outlined. Two themes were identified. The complexity of promoting safety and preventing harm illustrates nurses’ sometimes competing responsibilities to keep people safe, understanding of power differentials and patient vulnerability, and recognition of the various types of harms that can arise with seclusion. The importance of knowing for ethical action with seclusion use highlights the role of knowing oneself, the patient, other team members, and the unit in judgments to seclude.

Seclusion is an intervention used in mental health settings, with nurses playing a key role in decisions related to secluding a patient. The purpose of this interpretive description study was to explore the place of ethics in mental health nurses’ clinical judgements on seclusion use. Data collection involved interviews of nine registered psychiatric nurses and eight registered nurses. Nurses described their experiences with seclusion and identified factors that impacted their decision to seclude. Ethical tensions related to seclusion use were outlined. Two themes were identified. The complexity of promoting safety and preventing harm illustrates nurses’ sometimes competing responsibilities to keep people safe, understanding of power differentials and patient vulnerability, and recognition of the various types of harms that can arise with seclusion. The importance of knowing for ethical action with seclusion use highlights the role of knowing oneself, the patient, other team members, and the unit in judgments to seclude.

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Seclusion is a behavioral management intervention used at the practicum site to manage maladaptive behaviors seen in mentally ill patients. Seclusion is not a voluntary occurrence for patients. The practice-focused question asked: Can development of an evidence-based practice (EBP) guideline help guide health care providers in the development of a multisensory room as an alternative to seclusion for people living with mental health disorders (PLWMHD)? The purpose of this DNP project was to develop the EBP guideline for a multisensory room as an alternative to seclusion for the practicum site. To aid in the development of the EBP guideline, the AGREE II model provided the framework for quality improvement related to better patient outcomes. The sources of evidence for this DNP project were drawn from the systematic review of the literature related to primary, original, and peer-reviewed journals. The electronic databases used for conducting these searches were CINAHL with Plus Full, Medline with full text, PsycINFO, SocINDEX and the Walden University library. The analytical strategy for this DNP project was to conduct a content analysis of research studies for recurrent themes, related to maladaptive behaviors, seclusion, and sensory rooms, in order to develop the draft guideline. Subsequently, 14 experts were selected for review of the resultant draft guideline using the AGREE II tool. Expert input and feedback was incorporated to achieve consensus on the final version. The potential implication for nursing practice is patient safety for a targeted population. The positive social change expected to occur for health care providers at the practicum site is the use of a best-practice tool based on evidence during their provision of care for PLWMHDs.

Magister Artium - MA / The mbopo institution, popularly known as the “fattening room” is a cultural rite of passage for young virgins, who are being prepared for marriage among the Ibibio/Efik people of southern Nigeria. It is a complex cultural institution which marked the change of status from girlhood to nubile womanhood in Ibibio/Efik culture. This study examines the practice of mbopo ritual among the Ibibio/Efik people across the previous century. Through an engaged and detailed visual analysis, the study argues that in the first decade of the 20th century, the mbopo ritual had a degree of vibrancy with an attached sense of secrecy and spiritual mystery. But between 1920 and the present, this vibrancy and spiritual undertone has been subtly but progressively compromised. A buildup of tension on the ritual by modern forces, not only of the outside missionaries, but also indigenous converts set in motion a process that would eventually transform the ritual from a framework of an actual cultural practice into the realms of “cultural reinvention” and re-rendering. Feminist critiques of the 1980s and the 1990s led to the popular awareness of the damaging impact of clitoridectomy, just one core aspect of the ritual. As a direct result, clitoridectomy was outlawed across the country, leaving mbopo to be seen as a morally suspect practice. In recent year, the once vibrant, secret and spiritually grounded rite of seclusion for nubile women has been reimagined and reinvented through the public display in art, painting, cultural dance troupe, music and television shows.

The intent of this study was to determine whether implementation of the Collaborative Problem Solving (CPS) model, that has proven successful in psychiatric settings, was equally effective in reducing restrictive practices in public school settings. Many peer-reviewed, published reports suggest that educators are poorly prepared to manage the extremely challenging behaviors of aggression and non-compliance, which are common in students classified with an emotional disturbance (ED). Too often educators rely on ineffective, potentially harmful interventions such as seclusion and restraint, which adversely impact students as well as staff. The nonrandom sample was comprised of students enrolled in two segregated special education schools located in large communities in northwestern Pennsylvania. The enrollment was 69 students in School A and 26 students in School B. The schools serve students, kindergarten through twelfth grade. All students were evaluated and classified as ED by their referring home school district as per Chapter 14 Regulations of the Pennsylvania Department of Education and received one-hundred percent of their special education program in this restrictive school-based environment. This study used a quasi-experimental, pre-test-post-test research design and used two separate existing electronic data sources to test for relationships between the implementation of the CPS model and identified variables (standardized measures of externalizing maladaptive behaviors, incidents of aggression, noncompliance, and disruption, as well as incidents and duration of seclusion and restraint). The analyses included frequency comparisons, a series of Wilcoxon Signed Rank Tests, a series of dependent samples T-tests, and two-way repeated measures analyses of variance. Implementation of the model reduced the incidents of aggression, noncompliance, and disruption, as well as incidents and duration of seclusion and restraint. However, only one of the schools in the study demonstrated a statistically significant reduction of aggression incidents and the use of restraint procedures. The results suggest that when implemented with fidelity, the research-based CPS model is a promising, preventative behavior approach for students classified with ED in a segregated special education school. / School of Education / Interdisciplinary Doctoral Program for Education Leaders (IDPEL) / EdD / Dissertation

The reason behind this essay has been to study if previous research is relevant for Jehovah’s Witnesses in Sweden and see if secularization has affected the organization or not. The empirical material is made from two qualitative group- interviews and open observations during two meetings in the Kingdom Hall. These studies were performed in Oskarshamn and Mönsterås during the month of February. The reason that these studies have been limited to Oskarshamn and Mönsterås is mainly because they were the only ones willing to do an interview.  According to previous research by James A. Beckfors and Andrew Holden, it has been shown that the Jehovah’s Witnesses hasn’t been affected by secularization, neither by new interpretations nor from the decrease of predicators. In my study, the interviewees have experienced secularization over the last 10-15 years while they are out preaching the religion. The organization of Jehovah’s Witnesses in Sweden has been setting up rules for the members to follow, such as not live together before marriage or not get tattoos. This is rules set up to keep a distance between the members and the society and therefore the organization avoid the secularization.

Master of Music / Department of Music / Julie Yu / This document is focused on three excerpts from a graduate vocal recital, completed in partial fulfillment of the requirements for the Master of Music degree. The recital was held on January 23, 2012 at seven-thirty o’clock in the evening at All Faiths Chapel on the campus of Kansas State University. Selections for this recital were selected upon the theme of Seclusion. The three characters examined further in the document are Alcina in the G. F. Handel opera, Alcina (HWV 34), Gretchen in German Lieder Gretchen am Spinnrade (D. 118) by Franz Schubert, and Lily from the Tony Award-winning Broadway musical, The Secret Garden, by Lucy Simon and Marsha Norman. Each chapter, devoted to a specific work, contains the following: 1) biographical information on the composer, 2) textual analysis, and 3) compositional, stylistic, and technical considerations.

Childhood trauma is the primary reason children and adolescents display behavioral issues that require hospitalization. Implementation of a trauma-€informed care (TIC) program was the intervention chosen at a child and adolescent behavioral health hospital to decrease physical holds and seclusion rates for patients aged 3 to 17 and to reduce the risk of retraumatization of children needing psychiatric care. Six core strategies from the National Association of Mental Health Program Directors was the framework for this project. The number of crisis interventions before and after implementation were 440 and 259, respectively. The number of seclusions before implementation was 215, and total number of restraints was 225. The number of seclusions after implementation was 125, and total number of restraints was 134. Data showed that implementing a TIC program decreased the use of physical holds and seclusions by 26% within 6 months of program implementation. The implications of this project for positive social change include changing the approach to children with high-€risk behaviors by decreasing the risk for retraumatization.

Syfte: Syftet med föreliggande litteraturstudie var att beskriva sjuksköterskors erfarenheter av att utföra tvångsvårdsåtgärder av patienter med psykisk ohälsa samt att granska de valdaartiklarnas urvalsmetod. Metod: Föreliggande litteraturstudie har en deskriptiv design som inkluderar artiklar av bådekvalitativ och kvantitativ ansats, litteraturstudien innefattar totalt tolv artiklar. Resultat: Resultatet visade att sjuksköterskors erfarenheter av utförande av tvångsvårdsåtgärder inkluderar ett brett spektrum av känslor som engagerar bland annat enmotstridighet av känslor då patientens autonomi fråntogs. Resultatet visade skilda erfarenheter hos sjuksköterskor gällande uppfattning om tvångsvårdsåtgärder gynnade patienten i fråga eller inte. Majoriteten av sjuksköterskorna upplevde att utförandet av tvångsåtgärder används för lättvindigt samt att de äventyrar den terapeutiska alliansen med patienten. Sjuksköterskor gemensamma åsikt var att det fanns behov för att få möjlighet att ventilera åtgärdsförfarandet. Slutsats: Resultatet visade att majoriteten av sjuksköterskor ansåg att tvångsvårdsåtgärder medförde negativa erfarenheter. Ett återkommande utslag i samband med tvångsvårdsåtgärder var motstridighet av känslor hos sjuksköterskorna till följd av det etiska dilemmat som uppstod. Gemensamma erfarenheter identifierades, att tvångsvårdsåtgärder användes för lättvindigt. Alternativa åtgärder bör få mer utrymme att implementeras i den kliniska praktiken. Det bör även utvecklas ett ventilationsforum för sjusköterskor som kommer i kontakt med tvångsåtgärder för möjlighet till diskussion samt en förbättring av förfarandet. / Aim: The aim of the present study was to describe nurses' experiences of performing compulsory measures of patients with mental illness and review the selected articles sample method.                                                                                                                           Method: The present literature study has a descriptive design that includes articles of both qualitative and quantitative approach; the literature review includes a total of twelve articles.   Result: The results showed that nurses' experiences of performing compulsory treatment measures include a wide range of emotions that involve, among other things, a conflict of emotions in conjunction with the exclusion of the patient's autonomy. Results showed differing experiences of nurses existing idea of ​​compulsory measures favored the patient in question or not. The majority of nurses felt that the execution of coercive measures was used too casually as well as to undermine the therapeutic alliance with the patient. Nurses’ common view was that there was need for the opportunity to vent action procedure.   Conclusion: The results showed that the majority of nurses felt that compulsory measures implied negative experiences. A recurring verdict associated with compulsory measures was a contradiction of emotions in nurses due to the ethical dilemma that arose. Common experiences were identified, that compulsory measures was used too lightly. Alternative measures should have more room to be implemented in clinical practice. It should also develop a forum for ventilation for the nurses that are in contact with the coercion, an opportunity for discussion and improvement of the procedure.