- Evidence-Based Solution
- Nursing Intervention
- Patient Care
- Health Care Agency
- Nursing Practice
Restraint and seclusion have been included in the treatment process for a relatively long time. However, the mounting body of evidence suggests that its use does not offer a therapeutic effect and in many scenarios introduces the risk of adverse health effects, undesirable psychological issues, disrupted emotional stability, and, in some cases, increased mortality. In addition, the practice is known to adversely impact the psychological and emotional climate in the setting, especially for nurses who deal with restrained patients on a daily basis (Wieman, Camacho-Gonsalves, Huckshorn, & Leff, 2014). The following paper outlines an evidence-based solution to the issue and describes its positive effect on patient outcomes.
According to the available information, the seclusion and restraint process is associated with insufficient attention to patients’ needs (Kontio et al., 2012). Therefore, it is reasonable to suggest that improved treatment of patients coupled with the use of more humane approaches may lead to a reduction in the need for restraint and seclusion. Understandably, the outlined change needs to be approached on an organizational level in order to achieve systematic improvement. Specifically, in addition to individual changes in behavior exercised by nurses, it would be necessary to organize training that would provide the facility staff with the necessary skills.
The suggested intervention will consist of two principal components. First, it will be necessary to conduct an assessment of characteristics of nurses currently employed in the hospice in order to determine consistency with the required levels of empathy, capacity for the humane treatment of patients, extended interaction between patients and nurses, and the ability to address patient needs. In this way, the role of the suspected factors in the need for restraint and seclusion will be determined. Second, an empathy training program should be developed that would ensure consistent, organization-wide improvement. Based on the information above, the following PICOT question is suggested: In patients of OpusCare of South Florida Hospice (P), does greater staff empathy facilitated through an empathy training program (I) compared to nurses who do not participate in training (C) reduce the need for restraint and seclusion (O) over the period of six months (T)?
The proposed nursing intervention is expected to improve the quality of care in the facility. Specifically, the reduced need for restraint is expected to minimize the risks of physical harm self-inflicted by the patients, included bruises, respiratory complications, impaired muscle strength, decreased endurance, and pressure ulcers (Wieman et al., 2014). By extension, the identified improvements will ensure better patient outcomes. In addition, the adverse psychological effects of restraint will be avoided among patients and their families, strengthening trust, and establishing stronger cooperation.
Health Care Agency
In addition, the proposed intervention is expected to improve the working conditions of the facility staff. Specifically, the reduced need for restraint and seclusion will minimize the traumatic and emotionally challenging element of practice (Muir-Cochrane, Baird, & McCann, 2015). By extension, the nurses will be less vulnerable to burnout and compassion fatigue, both of which are known to compromise the quality of care and increase staff turnover.
The suggested intervention can be introduced independently and without the need for provider prescription. At an individual level, nurses can adjust their behavior through self-management and by keeping records of their daily activities. Self-assessment techniques can be developed to assist individual effort. On the organizational scale, the development and implementation of a training program can be achieved through collaboration with nursing administrators and educators.
Restraint and seclusion are associated with adverse emotional, psychological, and physical effects. The proposed intervention in the form of the empathy training program is expected to address the insufficient attention to patient needs. The intervention will result in improved patient outcomes, increased staff performance, and a more favorable emotional climate in the facility.
Kontio, R., Joffe, G., Putkonen, H., Kuosmanen, L., Hane, K., Holi, M., & Välimäki, M. (2012). Seclusion and restraint in psychiatry: Patients’ experiences and practical suggestions on how to improve practices and use alternatives. Perspectives in Psychiatric Care, 48(1), 16-24.
Muir-Cochrane, E. C., Baird, J., & McCann, T. V. (2015). Nurses’ experiences of restraint and seclusion use in short‐stay acute old age psychiatry inpatient units: A qualitative study. Journal of Psychiatric and Mental Health Nursing, 22(2), 109-115.
Wieman, D. A., Camacho-Gonsalves, T., Huckshorn, K. A., & Leff, S. (2014). Multisite study of an evidence-based practice to reduce seclusion and restraint in psychiatric inpatient facilities. Psychiatric Services, 65(3), 345-351.