Research Article| Volume 41, P333-340, December 2022

Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers

Published:September 30, 2022DOI:


      • Seclusion use was influenced by the presence of senior nurse positions.
      • Nursing staff to patient ratios did not have a statistically significant influence on seclusion use.
      • Seclusion events increased on shifts with a higher presence of registered nurses.
      • No significant associations were identified between overtime rates per shift and use of seclusion.
      • No statistically significant relationship was found between staff gender and the use of seclusion.



      Research on the influence of nursing staff composition and use of seclusion in the forensic mental health inpatient settings is sparse. Nursing staff composition refers to staffing levels, roles, gender ratio and skill mix of the ward teams. Internationally, the rates of seclusion in some forensic mental health inpatient settings have increased over the past 10 years despite global efforts to reduce and eliminate its use.


      To examine whether the use of seclusion in a forensic mental health inpatient setting can be attributed to staffing composition or to contextual factors such as day of the week, month or other clinical factors.


      Retrospective data collection was conducted using seclusion data, daily ward reports and staff rosters. Data were collected for all shifts in the hospital over a six-month period.


      Three staffing variables were identified as having an influence on the use of seclusion: the number of registered nurses on duty, the presence of the shift coordinator and having a lead nurse on shift.


      Senior nurse oversight and guidance are important factors in assisting staff to identify clinical deterioration and intervene early which may assist services reduce the use of seclusion.

      Implications for practice

      As staffing levels and composition are modifiable, the results of this study may assist nurse leaders to consider workforce improvements to reduce seclusion use.


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