The Anoka Metro Regional Treatment Center (AMRTC) remains committed to providing mentally-ill patients with high quality services. In an effort to enhance the hospital’s effectiveness, it has been proposed that it should embrace dialectical behavior therapy and accelerated response teams and minimize the use of restraints and seclusions. An intervention and implementation plan was developed to facilitate the adoption of the new interventions. It is hoped that as it incorporates the new interventions into its routine and policies, AMRTC will improve the quality of services that it offers. In order to determine the impact of the intervention plan, an evaluation is necessary so as to provide the hospital with a framework for determining success.
Evaluation of Plan
Researchers have raised concerns about the seclusion and restraining of mentally ill patients. For example, Bell and Gallacher (2016) use their text to caution practitioners that seclusions and restraints have harmful effects on patients. These concerns are echoed in the article by Smith, Ashbridge, Davis and Steinmetz (2015) who report that patients sustain injuries when practitioners employ force in restraining or holding them in seclusion. The research finding that seclusions and restraints have adverse impacts on patients and practitioners informed the main outcomes that the intervention plan was designed to address. One of these outcomes concerns the prevention of injury. It is hoped that the full implementation of the intervention plan will yield a significant and sustained reduction in the number and severity of injuries reported at AMRTC. If this outcome is accomplished, the hospital will have a solid basis to conclude that the intervention has bene successful. On the other hand, if the hospital does not report any declines in injuries among its patients and practitioners, it will be clear that the intervention has failed to deliver the desired outcomes.
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Reducing the use of seclusions and restraints is another outcome that the intervention plan seeks to achieve. AMRTC uses these interventions routinely, particularly in the management of difficult patients who pose a risk to the safety of other patients and practitioners. It is indeed true that the patients’ behavior warrants the use of restraints and seclusions. However, as the hospital has observed and as has been confirmed through research, seclusions and restraints expose patients and their practitioners to the risk of sustaining injury. Furthermore, researchers like Moghadam, Khoshknab and Pazargadi (2014) feel that these techniques strip patients of their dignity and amount to a violation of their rights. Given the harmful effects of seclusions and restraints, the intervention plan is aimed at reducing the frequency with which they are employed. For example, a 25% reduction in the use of restraints is expected to be achieved when the intervention plan is implemented. Furthermore, the amount of time that patients are held in seclusion is to be lowered by at least 1/3.
In order to determine if the outcomes mentioned above have been accomplished, an evaluation plan is needed. This plan will largely rely on feedback from stakeholders. In particular, the views of practitioners regarding the effect of the interventions will be obtained. For example, the nurses attending to the patients will be required to share their thoughts on whether there has been a reduction in the incidences of injury and if restraints and seclusions are being used in fewer cases. If they confirm that restraints and seclusions are being used sparingly and that fewer injuries have been recorded, the hospital will conclude that the new interventions have been effective. Apart from the insights shared by nurses, the evaluation process will also involve an examination of data. It is assumed that AMRTC maintains a record of injuries and the use of restraints and seclusions. This record will be analyzed for indications that the new interventions have led to a drop in injuries and the administration of seclusions and restraints.
Discussion
The focus of this discussion is to examine the function that nurses serve in the change implementation process and to outline the steps that AMRTC should take as it seeks to expand the interventions.
Advocacy
Patient advocacy is one of the key mandates of nursing practitioners (Gerber, 2018). Nurses have the responsibility of staunchly defending the rights and wellbeing of their patients. One of the ways through which they can engage in advocacy is by leading the implementation of change and quality improvement efforts. As stated by such scholars as Thomas, Seifert and Joyner (2016), by adopting innovative solutions, nurses can be in the forefront of change implementation and management. Some of the specific ways through which nurses can lead change and drive improvements is using their familiarity with the work environment to call for action. For example, the nurses working at AMRTC have witnessed firsthand the damaging effects of seclusions and restraints. This places them in a unique position from which they can demand action. Nurses can also leverage their skills to make small but meaningful changes that result in significant quality improvements. For example, by simply choosing to not resist the introduction of the two new interventions, the nurses at AMRTC guarantee the successful implementation of the interventions. Embracing training and recognizing the role that technology plays in quality improvement are other mechanisms through which nurses can participate in change and quality improvement initiatives.
The plan for the implementation of the interventions presents implications for collaboration and promises gains for the healthcare profession. In the plan, it is pointed out that various stakeholders such as patients, their families and AMRTC’s practitioners must join forces for the successful implementation of the plan. The partnership among these stakeholders will foster Interprofessional collaboration. This plan also presents benefits for the healthcare profession because it prescribes the adoption of two approaches that have been shown to have a tremendous impact on patient welfare and practitioner safety. When other institutions implement these approaches, an overall improvement in the quality of care will be witnessed.
Future Steps
The project promises to transform how AMRTC can improve the care that it delivers to its patients. However, this project has some shortcomings which when addressed will enhance the impact of the project. One of the improvements that can be made to the project is extending it beyond the use of restraints and seclusions. For example, the principles and strategies outlined in the project can be applied in the implementation of such other quality improvement initiatives as a program designed to encourage open communication among practitioners. Therefore, this project can be expanded to any other issue in mental health nursing requiring improvement.
Reflection on Leading Change and Improvement
This project has expanded my perspectives on mental healthcare delivery. In particular, it has challenged me to recognize that as a healthcare professional, I am required to participate enthusiastically in quality improvement efforts. In my personal practice and the leadership positions that I hold in the future, I intend to become an effective change agent. I will remain vigilant, keeping an eye out for inefficiencies that can be addressed through the adoption of evidence-based practices and strategies. Furthermore, the project has reminded me that any effective change process requires collaboration. I plan to join forces with my colleagues as we implement reforms that result in enhanced care. While the entire project has opened my mind to the importance of change, I find that the evaluation, intervention and the implementation plans that I have developed have had the most critical effect and I intend to transfer the insights gained from the plans to my practice. For example, all the plans underscore the value of multi-stakeholder approaches and collaboration. Furthermore, the plans highlight the need for adopting technology when implementing change. I plan to incorporate all these lessons into my practice. I encourage other practitioners to embrace technology and collaboration when managing change.
References
Bell, A., & Gallacher, N. (2016). Succeeding in sustained reduction in the use of restraint using the improvement model. BMJ Quality Improvement Reports, 5 (1). DOI: 10.1136/bmjquality.u211050.w4430.
Gerber, L. (2018). Understanding the nurse’s role as a patient advocate. Nursing, 48 (4), 55-8.
Moghadam, M. F., Khoshknab, M. F., & Pazargadi, M. (2014). Psychiatric nurses’ perceptions about physical restraint: a qualitative study. International Journal of Community Based Nursing-Midwifery, 2 (1), 20-30.
Smith, G. M., Ashbridge, D. M., Davis, R. H., & Steinmetz, W. (2015). Correlation between reduction of seclusion and restraint and assaults by patients in Pennsylvania’s state hospitals. Psychiatric Services, 66 (3), 303-9.
Thomas, T. W., Seifert, P. C., & Joyner, J. C. (2016). Registered nurses leading innovative changes. The Online Journal of Issues in Nursing, 21 (3). DOI: 10.3912/OJIN.Vol21No03Man03
