Proposed Nursing Theory
Restraint and seclusion implemented alongside sedative medication have a traumatic effect on the majority of mental health patients. Such treatment is often deemed unethical due to the fact that doctors and nurses implement the procedure whenever they encounter a patient that does not respond to traditional methods of treatment. One of the emerging alternative solutions for RS involves sensory modulation, which revolves around identifying potential stressors for the patient and preventing or minimizing exposure. Peplau’s theory of interpersonal relationships assists in that goal and is the best framework to inform the use of sensory modulation (Andersen, Kolmos, Andersen, Sippel, & Stenager, 2017).
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Peplau’s theory addresses some of the core questions behind the intervention, as it identifies the patient as an organism that tries to reduce anxiety caused by needs. Mental health patients have a variety of physical, mental, and emotional needs that need to be addressed in order to reduce the symptoms of their diseases (Alligood, 2017). The figure of the nurse plays a therapeutic role in the process, working cooperatively with the patient in order to improve their health and well-being.
This framework works well with sensory modulation, as one of the primary means of reducing anxiety in patients is the close interactive study of the patient in order to identify potential triggers and fears while providing suitable non-invasive interventions (Andersen et al., 2017).
Proposed Implementation Plan
The outline of the proposed intervention is as follows:
- Educate nurses and doctors in the concepts and methods of sensory modulation (SM), urging them to utilize the provided guidelines instead of restraint and seclusion methods;
- Establish a council of experienced clinicians in a mental health setting to give permission for RS, as a means of eliminating unlikely cases and discourage other doctors from unlawful use of such practices;
- Observe and record the use of SM in a nursing setting for a period of 6 to 12 months;
- Compare the number of RS and sedative medication uses before the intervention, during the intervention, and after the intervention with a follow-up period of 1 year.
Potential Barriers to Plan Implementation
Some of the identified barriers to plan implementation are as follows:
- Lack of cooperation. Nurses and doctors may refuse to comply with the proposed alternative measures for handling mental health patients due to internalized biases as well as the implicit message that previously they have been neglecting their duties to patients as healthcare specialists by overusing RS.
- The time lag in decision-making. The decision to utilize restraint and seclusion on a panicky or violent patient often needs to be made quickly, before the situation escalates. Delegating the responsibility to a council of specialists may potentially escalate the situation due to inaction.
- Some patients may be resistant to change. SM relies on identifying triggers and avoiding them, which is not always possible with specific patients.
The potential solutions for these barriers include sharing academic evidence with skeptical nurses, improving commission response times, and tailoring the SM experience to the patient. As all doctors and nurses have been trained to evaluate their own performance critically, it would be possible to overcome bias using evidence-based practice. Response times may be improved by having one or several members of the council present at the ward at all times, in order to make the call for RS. Lastly, the fact that some patients are resistant to SM does not mean it should not be implemented. Reducing the amount of exposure to stressors, even by a modest margin, would have a positive impact on the patient’s health.
Alligood, M. R. (2017). Nursing theorists and their work (6 ed.). New York, NY: Elsevier.
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Andersen, C., Kolmos, A., Andersen, K., Sippel, V., & Stenager, E. (2017). Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint: a case control study. Nordic Journal of Psychiatry, 71(7), 525-528.