KnE Life Sciences | The 1st Payung Negeri International Health Conference | pages: 47–56

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1. Introduction

Mental disorder is a condition where a person experience a breakdown of mind, mood and behavior which is signed by behavioral irregularities [2,5,15]. The mental disorder client is a person who has the high risk to do self-harming behavior, harming others and environment [1,14,16].

According to the Director of the Tampan Asylum in Pekanbaru, Mursal Amir, in 2007, at least 5,000 people in Riau are indicated to have mental disorder which is divided into several classifications from mild to severe. Mental disorders consist of three types, they are schizophrenia, manic-depressive disorder and acute psychosis. The most common disorder is schizophrenia. Schizophrenic clients with violent behavior based on the history of violence behavior, both as victims or witnesses as much as 62.5% of the 72 respondents which is examined [12].

Violent behavior is a behavior of harming and injuring oneself, others and the environment both in verbal and non-verbal. Violent behavior fluctuates from low to high levels, which shows hostility from low level to serious and dangerous level [6].

There are three strategies in treating the client with violent behavior that is preventive, anticipation and restrain and seclusion crucial management [9,14]. Restrain is a treatment to bind a person by using physical or tool, while seclusion is a treatment where a person is being treated in a caged room in the morning, daytime until night in a room with no chance of escaping [4,11].

The result of the research shows that 67 out of 1000 clients in the asylum in United States are given seclusion, while 29% or 42.7 out of 1000 are given restrain every day [3]. In Australia experienced an increase in the number of restrain and seclusion from 9% in 1998 to 31% in 2005, with 33 times each day and 12,000 per year. Its shows that the number of clients in restrain is quite high every day in the asylum by the reason that the client is in an uncontrollable situation for security such as endangering self, others and the environment [7].

Surakarta asylum, in February 2014, is found that 13 clients are secluded for the average duration of caging of 6 hours. The number of clients who are given restrain and seclusion in Tampan asylum in 2014, especially in PICU room as many as 444 clients with the average duration of restrain of 6 hours. This amount is considered high, and the duration of restrain is not suitable with the proper standards, restrain and seclusion to the client must be checked every one hour [10].

According to observation result, nurse secludes client who does not show endangering behavior, nurse does the restrain not properly as the SOP, nurse is not able to maintain emotion which makes them do verbal and non verbal client violence to the client. By the interview result of 10 nurses, they say their reason on why they do restrain and seclusion, it is because they want to work peacefully, bored with the client noises, exit the room for personal matter, working alone, feeling insecure and fear. According to the nursing head commitee and the chairperson of PICU room, there are treatments SOP of restrain in each room but still under the revision due to the death case of the client. For the seclusion SOP which is not yet existed, it is due to the need of suitable room.

Beside the client, nurse also becomes a victim when the client has got wounded during the restrain and seclusion. Nurse as custodian, which has the longest time with the client, is one of the health worker who does restrain and seclusion with various reason or motivation. Based on the explanation above, the writer is to conduct a research related to the nurse motivation in doing restrain and seclusion to the mental disorder client in Tampan Asylum in Pekanbaru.

2. Methodology

This was a quantitative analytic descriptive research with cross sectional design. The research analyzed the factors that had the relation with the nurse motivation in doing restrain and seclusion to the client with mental disorder in Tampan Asylum in Pekanbaru. The sample of this research was the nurse who worked in 5 intermediate room and 1 PICU room which had the number of 84 nurses.

3. Research Result

Table 1

Frequency Distribution Based on Nurse Age in Tampan Asylum in Pekanbaru 2015.


Variable Mean SD Min-Max 95% CI
Age 34,9 7,57 22 – 53 33,34 -36,63

The analysis result in table 1 has the average age of the nurse of 34,99 years old.

Table 2

Nurse Frequency Distribution Based on Gender, Education and Experience in Tampan Asylum in Pekanbaru 2015.


No Nurse Characteristics (f) (%)
1 Gender
A. Male 25 29,8
B. Female 59 70,2
2 Education
A. Diploma 57 67,9
B. Bachelor 27 32,1
3 Experience
A. 1 – 3 Years 13 15,5
B. 4 – 6 Years 22 26,2
A. > 7 Years 49 58,3
Total 84 100

The analysis result of table 2, most of the gender are female (70,2%), most of the nurse education are diploma (67,9%), most of the working experience are > 7 years (58,3%).

Table 3

Motivation Frequency Distribution and Factors of the Nurse in Doing Restrain and Seclusion in Tampan Asylum in Pekanbaru 2015.


No Factor Variables (f) (%)
1 Motivation
1. High 44 52,4
2. Low 40 47,6
2 Physiological Integrity
1. Satisfied 28 33,3
2. Unsatisfied 56 66,6
3 The Integrity of Feeling of Safety
1. Satisfied 42 50
2. Unsatisfied 42 50
4 Affection Integrity
1. Satisfied 26 30,9
2. Unsatisfied 58 69
5 Pride Integrity
1. Satisfied 23 19,3
2. Unsatisfied 61 72,6
6 Actualization Integrity
1. Satisfied 21 25
2. Unsatisfied 63 75
Total 84 100

The analysis result of table 3 shows that the nurse motivation is high (52,4%) in doing restrain and seclusion. The factors which is related to the nurse motivation in doing the restrain and seclusion is consisted of: the factor of physiological fulfillment mostly in the state of unsatisfied (66,6%), security in the state of satisfied (50%) and unsatisfied (50%), the care needs mostly in the state of unsatisfied (69 %), pride needs mostly in the state of unsatisfied (72,6%) and the factor of self-actualization is mostly in the state of unsatisfied (75,0%).

Table 4

The Relation of Physiological Fulfillment with Nurse Motivation in Doing Restrain and Seclusion in Tampan Asylum in Pekanbaru Tahun 2015.


Variable Nurse Motivation Total P OR
Physiology High Low
f % f % F %
Satisfied 7 25,0 21 75,0 28 100 0,007 0,232
Unsatisfied 33 58,9 23 41,1 56 100
Total 40 47,6 44 52,4 84 100

The analysis result of table 4 can be known the low nurse motivation proportion in doing restrain and seclusion, the nurse is more satisfied with the physiological need (75,0%) than the nurse who does not satisfied physiologically (41,1%). The statistic test result shows the p value = 0,007, then, it can be concluded that there is a significant relation between physiological fulfillment with the nurse motivation in doing restrain and seclusion treatment.

Table 5

The Relation of Security Needs with the Nurse Motivation in Doing Restrain and Seclusion in Tampan Asylum in Pekanbaru 2015.


Varia ble Nurse Motivation Total P OR
Feeling of Safety High Low
f % F % F %
Satisfied 12 28,6 30 71,4 42 100 0,001 0,200
Unsatisfied 28 66,7 14 33,3 42 100
Total 40 47,6 44 52,4 84 100

The analysis result of table 5 can be seen the low nurse motivation proportion in doing restrain and seclusion, there is more unsatisfied nurse toward the need of security (71,4%) than the nurse who is unsatisfied (33,3%). The statistic test result shows the p value = 0,001, then, it can be concluded that there is a significant relation between the security need with the nurse motivation in doing the restrain and seclusion.

Table 6

The Relation of Care Need with the Nurse Motivation in Doing Restrain anf Seclusion in Tampan Asylum in Pekanbaru 2015.


Variable Nurse Motivation Total P OR
Affection High Low
f % F % f %
Satisfied 9 34,6 17 65,4 26 100 0,173 0,461
Unsatisfied 31 53,4 27 46,6 58 100
Total 40 52,4 40 47,6 84 100

The analysis result of table 6 can be known that the low nurse motivation proportion in doing restrain and seclusion is mostly found the satisfied nurse in the care need (65,4%) than the nurse who is unsatisfied (46,6%). The statistic test result shows the p value = 0,173, then, it can be concluded that there is no significant relation between the need of care to the nurse motivation in doing restrain and seclusion.

Table 7

The Relation of Pride Fulfillment with the Nurse Motivation in Doing Restrain and Seclusion in Tampan Asylum in Pekanbaru 2015.


Varia ble Nurse Motivation Total P OR
Self-Pride High Low
F % F % F %
Satisfied 6 26,1 17 73,9 23 100 0,029 0,280
Unsatisfied 34 55,7 27 44,3 61 100
Total 40 47,6 44 52,4 84 100

The analysis result of table 7 can be known that the low nurse motivation proportion in doing restrain and seclusion which is mostly found the satisfied nurse of the pride fulfillment (73,9%) than the nurse who is unsatisfied (44,3%). The statistic test result shows that the p value = 0,029, then, it can be concluded that there is a significant relation between the pride fulfillment need with the nurse motivation in doing restrain and seclusion.

Table 8

The Relation of Self-Actualization Need with the Nurse Motivation in Doing Restrain and Seclusion in Tampan Asylum Pekanbaru 2015.


Variable Nurse Motivation Total P OR
Self Actualization High Low
f % f % f %
Satisfied 6 28,6 15 71,4 21 100 0,077 0,341
Unsatisfied 34 54,0 29 46,0 63 100
Total 44 52,4 40 47,6 84 100

The analysis result of table 8 can be known the low nurse motivation proportion in doing restrain and seclusion which is mostly found the satisfied nurse to the self-actualization need (71,4%) than the unsatisfied nurse (46,0%). The statistic test result shows the p value = 0,077, then, it can be concluded that there is no significant relation between the need of self-actualization with the nurse motivation in doing restrain and seclusion.

4. Discussion

Humans are motivated to fulfill their needs, these needs have levels or hierarchies, starting from the lowest to the highest level separation of needs does not mean that each works exclusively, but the needs are overlapping, so, sometimes a person is motivated by two or more needs. There are no two people whose basic needs are 100% satisfied. Maslow estimates the average person is physiologically satisfied of 85%, security of 70%, be taken care and care of 50%, pride of 40% and actualization of 10%. If someone's needs are very strong, then it will motivate him to do behavior that lead to satisfy those needs. Some need that has not been satisfied creates "tension" which later creates a certain impulse in a person. To get rid of the tension they do certain effort, in other words, the greater the effort a person has, the higher the level of tension is [15]

In line with the statement of Poerwadarminto [13] which said that motivation is a tendency that arises in a person consciously or unconsciously in taking action with a specific goal or effort, which drives a person to do something because of the wants to achieve the desired goal.

The result of the research shows that some of the nurses have a high motivation in doing restrain and seclusion (52.4%). The high nurse motivation in this research does not mean that an action which is performed by the nurse is good but it is an action that is harming the client, it is because there is a goal to satisfy the need so the nurse does the restrain and seclusion and the action is considered as not an achievement for the nurse.

Some of the causal factors that can be analyzed from the high nurse motivation in the implementation of restrain and seclusion in this research is the age factor after seen in the average age of nurses which is in the range of middle adolescence age (34.99 years), as explained in Maslow's theory which, at that age, the need for care, appreciation and self-actualization become important along with the maturity of a person. So the tendency to fulfill the satisfaction of the need has a greater chance. Then in the working time factor, most of the nurses (58,%) have worked over 7 years. This is also the causal for the high nurse motivation in doing restrain and seclusion treatment, the rising of boredom at work makes the nurse to act outside the procedure. Beside that, it is also caused by two or more need at the same time which motivated the nurse to meet those needs.

The statistic test result shows the p value = 0.007, it can be concluded that there is a significant relation between physiological needs with the nurse motivation in doing restrain and seclusion treatment. According to researchers, the nurse who works in mental nursing services is indeed a profession with full pressure, emotional fatigue, depersonalization and even a decrease in personal performance due to emotional tension due to the working extensively with mentally disturbed humans, which make the nurse need time to calm some pressure by resting. Rest is included physiological needs, so, if the rest need is not satisfied, the nurse will show a various negative behaviors such as acting not based on the procedure and the result is harming and disrupt the quality of care. This matter actually contradicts the nurse's responsibility as a service provider that prioritizes the client's interests and needs rather than personal interest and need.

The statistic test result shows the p value = 0.001, it can be concluded that there is a significant relation between the need for security and the nurse motivation in doing restrain and seclusion treatment. The researcher concluded that security need is the main indicator in doing a nursing action, especially in the treatment of restrain and seclusion. Nurses must understand what is expected of others / clients to be safe and psychologically secure, including family members and health care professionals themselves. Therefore, the supervisor or assistant in doing restrain and seclusion must pay close attention to the security aspects of both the client and the nurse in the process of performing this treatment. It is become a recommendation of the researcher to do evaluation from various parties in the hospital environment such as leader as policy maker to give more attention to the safety and security of client and nurse continuously.

The statistic test result shows the p value = 0.173, then, it can be concluded that there is no significant relation between care need and the nurse motivation in doing restrain and seclusion. The researcher concluded that in performing restrain and seclusion treatment for client with mental disorders, especially those who experience violence, nurses must be prepared in the implementation which means the nurse must avoid mental and social burdens where nurses feel the need for attention and care, and also social need is fulfilled well. When it is fulfilled, the nurse cares more about the client so, in doing restrain and secretion treatment for a mental disorder patient is avoided by an action that is outside the implementation procedure.

The statistic test result shows the p value = 0.029, it can be concluded that there is a significant relation between pride need and the nurse motivation in doing restrain and seclusion. The researcher conclude that pride will affect a person's behavior in the need for pride or appreciation in giving work satisfaction even though the level of satisfaction is dynamic and develops in accordance with the environment demand. Life satisfaction and happiness have a correlation with pride. Pride is achieved by the nurse who has well adaptation also avoiding anxiety, fear and doubt when working. When the nurse experiences these things in prolonged, it is necessary to look for counseling services, so the problem can be resolved properly. Nurse's job satisfaction is believed in determining the client's satisfaction that has a major impact in the quality of nursing services, especially mental nursing services.

The statistic test result shows the p value = 0.077, it can be concluded that there is no significant relation between actualization needs and nurse motivation in doing restrain and seclusion. The writer concludes that not all nurses can achieve self-actualization need, because this need are on the top of needs, each person will be different in prioritizing which needs must be fulfilled first. Not all people can actualize themselves because of the potency that is met can only fulfill the other need. Although the fulfillment of the need is different, the nurse must receive satisfaction from the needs that they fulfills, so in working as a nurse is not dominated by conflicts that exist within themselves, thus the health services which is provided will become a guaranteed quality.

5. Conclusion

The research result shows that the average nurse age is 34.99, by female gender, diploma degree and working experience > 7 years. The results shows that of the 5 need factors, there are 3 need factors which are related to the nurse motivation in doing restrain and sectional treatment, they are physiological fulfillment, security and pride need while those that are not related are care needs and self-actualization. It is recommended for Tampan Asylum in Pekanbaru to arrange the policy of alertness nursing standard, SOP and competence standard in performing the procedure for doing restrain and sectional treatment. Nurses who already have a training certificate in doing restrain and seclusion should transfer the knowledge to other nurses. Preparing forum and counseling services to help nurses in discussing various problems which is faced while working in serving the client with mental disorders. It must be done the measuring and evaluating the nurse motivation continuously to assess the ability in doing restrain and seclusion treatment. For the development of nursing science, it is a consideration in the curriculum development and mental nursing courses in the nursery education. For the further research, the researcher must try to use a different design, which is qualitative, in order to validate the information that is obtained in this research.

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