N6052 EBP W1.docx - Restraint use in a Behavioral Unit...

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Unformatted text preview: Restraint use in a Behavioral Unit Psychiatric-mental health nursing has a century history of caring for persons in psychiatric facilities. Currently, nurses serve as direct care providers as well as unit-based and executive level administrators in virtually every organization providing inpatient psychiatric treatment. Organizations such as the American Psychiatric Nurses Association (APNA) recognizes that the ultimate responsibility for maintaining the safety of both individuals and staff in the treatment environment and for maintaining standards of care in the day-to-day treatment of individuals rests with nursing and the organizational leadership that supports care settings. APNA supports a sustained commitment to the reduction and ultimate elimination of seclusion and restraint and advocates for continued research to support evidence-based practice for the prevention and management of behavioral emergencies. Restraining a patient should be considered a last resort. There are three types of restraints: physical, chemical, and seclusion. The use of restraints can be a dangerous intervention if not done properly and by qualified staff. Improper use of restraints can cause death and serious injury (Use & Falls, 2011). Evidence-based medicine “is an approach that integrates the use of the synthesis of the best current evidence from research, clinician expertise, and the individualization of the intervention as a basis for evidence-based clinical decision making,” (Mallory, 2010). On a basic level, evidence-based practice begins with background questions. These are general questions regarding a disease, and answers may be found in textbooks (Polit & Beck, 2017). PICOT Question P: Population/patient- Behavioral health inpatient population I: Intervention/indicator- Use of restraints C: Comparison/control- Patients that are not restrained O: Outcome- Treatment Length and success T: Time- Treatment In the behavioral health inpatient population (P), what is the positive or negative effects of restraints (I) on treatment length and success (O) compared to patients that are not restrained (C) during treatment (T)? Considering the common perception of restraining aggressive patients, many staff assume that restraint occur more frequently than it does. “By far the most disturbing finding of this study was that three of the six patient participants reported that being restrained brought back traumatic memories of previous incidents of abuse and violence” (G. 2002, p. 471, para 10) When I became a psychiatric nurse, our hospital required us to go through training courses to learn and to be educated about special techniques for restraints, most importantly, the rules and regulations about how and how often we can utilize restraints, per institution’s protocol, for violent and aggressive patient behaviors. Observed and recorded how many times restraints happen in the unit each month for a year. They compared this data against the national averages and work to improve the process. Another tool that is used when treating patients on my unit is reviewing the patient for differing protocols including aggression. Jacob (2016) stated, “Since aggression is the foremost cause of ordering restraints for a patient (in our study as well as in prior literature), an individualized treatment plan based on the physiologic, psychosocial, behavioral and environmental needs of the patient may serve to reduce many of the patients’ trigger points of aggression.” Various approved treatment approaches based on information data formulated by the treatment team are utilized within my unit. Barriers and Obstacles of Implementation Implementation of evidence-based practice and experiences can have a lot of short comings and stumbling blocks. These includes, lack of accessible alternatives to restraints and/or seclusions, adverse interpersonal environment which leads to use restraints, unfavorable physical environment contributing to violence and aggression, and practice environment, such as low staff to patient ratios. These factors greatly influence and affect a patient’s length of stay which may highly cause a patient’s behavior to change. The barriers that predetermine the length of stay make it near impossible in some instances to determine if there is a link in extended or long-term increase in the need of patients that have been restrained during their stay. The treatment team can relay the message to rules and lawmakers of our hospital and take steps to identify specific responses to treatment of the patients post restraint. It is difficult to treat many behavioral health patients due to specific individual needs, and to constitute the search for effects of restraints seem to have hidden impacts throughout the treatment process. References American Psychiatric Nurses Association. (2012). Janssen Scholars Seclusion & Restraint Workgroup Report. Retrieved from ? pageid=4950 Jacob, T., Sahu, G., Frankel, V., Homel, P., Berman, B., & McAfee, S. (2016). Patterns of restraint utilization in a community hospital’s psychiatric inpatient units. Psychiatric Quarterly, 87(1), 31-48. doi:10.1007/s11126-015-9353-7 Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Philadelphia, PA: Wolters Kluwer. Use, R., & Falls, P. P. (2011). Joint Commission Resources Quality & Safety Network. ...
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