{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:40:52Z","timestamp":1792845652816,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T00:00:00Z","timestamp":1774656000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100009271","name":"Canadian Nurses Foundation","doi-asserted-by":"publisher","award":["Melvin Kellie Award"],"award-info":[{"award-number":["Melvin Kellie Award"]}],"id":[{"id":"10.13039\/100009271","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Nurs Ethics"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The use of seclusion and other restraints in forensic mental health settings are intended to be employed as a last resort and for the shortest time possible to achieve therapeutic effect. And yet, in Canadian forensic hospital settings, patients can remain in seclusion for weeks, months, even years. An ambiguous legal framework across Canadian provinces lacks mechanisms to limit or forbid the long-term seclusion of patients, which we define as any continuous confinement lasting 15 days or longer.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research objectives<\/jats:title>\n                    <jats:p>The paper undertakes a critical examination of long-term seclusion practices in forensic hospitals, based on the results of a qualitative study examining nursing practices with \u2018difficult\u2019 patients. Agamben\u2019s concepts of homo sacer and bare life and Guenther\u2019s concept of social death provide the framework for this critical examination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Research design<\/jats:title>\n                    <jats:p>A qualitative research design was employed, utilizing a critical discourse analysis methodology.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants and context<\/jats:title>\n                    <jats:p>7 nurses working in a high security forensic hospital setting in Canada participated in qualitative interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethical considerations<\/jats:title>\n                    <jats:p>The paradox of custody and caring is central to the considerable ethical challenges nurses face with patients in long-term seclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings\/results<\/jats:title>\n                    <jats:p>Integration of study findings with existing (limited) studies of this phenomenon illustrate that, though rare, patients in forensic hospital settings may be subject to lengthy and legally ambiguous periods of seclusion. Nursing practices and interventions are aimed at providing patients temporary reprieve from a state of bare life and to alleviate their social death. However, no mechanisms exist to prevent the use of long-term seclusion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Long-term seclusion represents a regrettable practice in forensic hospital settings aimed at the management of \u2018difficult\u2019 patients but is devoid of therapeutic value or intent. Existing nursing practices can only temporarily relieve patients from this state. More substantive and lasting solutions are proposed, focusing on the role of the nurse.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/09697330261437263","type":"journal-article","created":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T07:58:53Z","timestamp":1774684733000},"page":"1466-1478","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Long-term seclusion in forensic psychiatry: Bare life, social death, and the role of the nurse"],"prefix":"10.1177","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8997-2284","authenticated-orcid":false,"given":"Jim A.","family":"Johansson","sequence":"first","affiliation":[{"name":"University of Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya","family":"Szczepek","sequence":"additional","affiliation":[{"name":"University of Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cindy","family":"Peternelj-Taylor","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Saskatchewan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,3,28]]},"reference":[{"key":"e_1_3_4_2_2","volume-title":"Psychiatric power: lectures at the College de France (1973-1974)","author":"Foucault M","year":"2006","unstructured":"Foucault M. Psychiatric power: lectures at the College de France (1973-1974). Palgrave Macmillan, 2006."},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.160.9.1579"},{"key":"e_1_3_4_4_2","volume-title":"Nursing strategies for working with patients perceived to be challenging and difficult: a discourse analysis","author":"Johansson JA","year":"2020","unstructured":"Johansson JA. Nursing strategies for working with patients perceived to be challenging and difficult: a discourse analysis. Master\u2019s thesis. University of Saskatoon, 2020."},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/nin.70004"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1515\/9780804764025"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.5749\/minnesota\/9780816679584.001.0001"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1017\/cls.2024.25"},{"key":"e_1_3_4_9_2","volume-title":"The review board systems in Canada: an overview of results from mentally disordered accused data collection study [internet]","author":"Latimer J","year":"2006","unstructured":"Latimer J, Lawrence A. The review board systems in Canada: an overview of results from mentally disordered accused data collection study [internet]. Department of Justice Canada, 2006. Available from: https:\/\/www.justice.gc.ca\/eng\/rp-pr\/csj-sjc\/jsp-sjp\/rr06_1\/rr06_1.pdf"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.13002"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/JFN.0000000000000088"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1111\/jpm.12979"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12701"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-1-4899-2969-3_4"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2850.2011.01753.x"},{"key":"e_1_3_4_16_2","volume-title":"A literature review and policy analysis on the practice of restrictive interventions","author":"McKenna B","year":"2014","unstructured":"McKenna B, Furness T, Maguire T. A literature review and policy analysis on the practice of restrictive interventions. State of Victoria Department of Health and Human Services, 2014."},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.12383"},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.1080\/14789949.2022.2122857"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/1039856220946634"},{"key":"e_1_3_4_20_2","first-page":"325","article-title":"Psychiatric effects of solitary confinement","volume":"22","author":"Grassian S","year":"2006","unstructured":"Grassian S. Psychiatric effects of solitary confinement. Wash Univ J Law Pol 2006; 22: 325\u2013384.","journal-title":"Wash Univ J Law Pol"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.1086\/696041"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2020.00840"},{"key":"e_1_3_4_23_2","first-page":"47","article-title":"The psychological effects of 60 days in administrative segregation","volume":"43","author":"Zinger I","year":"2001","unstructured":"Zinger I, Wichmann C, Andrews D. The psychological effects of 60 days in administrative segregation. Can J Criminol 2001; 43: 47\u201383. https:\/\/doi.org\/10.3138\/cjcrim.43.1.47","journal-title":"Can J Criminol"},{"key":"e_1_3_4_24_2","volume-title":"The use of seclusion and restraint in psychiatry [Internet]","author":"Chaimowitz G","year":"2022","unstructured":"Chaimowitz G. The use of seclusion and restraint in psychiatry [Internet]. Canadian Psychiatric Association Position Statement, 2022. Available from: https:\/\/www.cpa-apc.org\/wp-content\/uploads\/2023-CPA-Seclusion-and-Restraints-Position-Statement-ENG-Final-web-1.pdf"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-018-2001-7"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.3928\/0279-3695-19990901-06"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.0031-5990.2005.00007.x"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732304266820"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12113"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.4135\/9780857028020"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.18192\/aporia.v1i4.3017"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1111\/nup.12013"},{"key":"e_1_3_4_33_2","volume-title":"Position statement on workplace violence [internet]","author":"American Nurses Association","year":"2025","unstructured":"American Nurses Association. Position statement on workplace violence [internet]. American Nurses Association, 2025. Available from: https:\/\/www.nursingworld.org\/globalassets\/practiceandpolicy\/nursing-excellence\/workplace-violence--ana-position-statement.pdf"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11126-022-10008-5"},{"issue":"1","key":"e_1_3_4_35_2","first-page":"9","article-title":"Violence, mourning, politics","volume":"4","author":"Butler J","year":"2003","unstructured":"Butler J. Violence, mourning, politics. Stud Gend Sex 2003; 4(1): 9\u201337. https:\/\/doi.org\/10.1080\/15240650409349213","journal-title":"Stud Gend Sex"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1111\/inm.13005"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1111\/jpm.12576"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1111\/nin.12480"}],"container-title":["Nursing Ethics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261437263","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/09697330261437263","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/09697330261437263","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T12:12:02Z","timestamp":1792843922000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/09697330261437263"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,28]]},"references-count":37,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1177\/09697330261437263"],"URL":"https:\/\/doi.org\/10.1177\/09697330261437263","relation":{},"ISSN":["0969-7330","1477-0989"],"issn-type":[{"value":"0969-7330","type":"print"},{"value":"1477-0989","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,28]]}}}