Working in a mental health facility exposes social workers to various challenges which can affect them personally and professionally. Continued interaction with individuals suffering from mental health issues could undermine one’s safety or optimal functioning at the workplace. More often than not, mental health patients might experience outburst thereby demanding the use of seclusion and restraint (S/R) as measures to control the patients’ behavior. There are increasing concerns that the use of S/R is likely to promote negative physical and psychological outcomes in patients thereby leading to decreased satisfaction. Additionally, cases of morbidity and mortality are also evidenced which puts to question the effectiveness of S/R in managing the behavior of mental health patients. For that reason, there is a need to consider other measures of dealing with patients. The proposed intervention approach involves reducing seclusion and restraints of mental health patients to promote better health outcomes.
Flammer and Steinert (2015) stated that S/R are associated with giving patients medicine involuntarily which is highly controversial. The experiences of mental health professionals cannot be understated as they operate in environments where they suffer the risk of being attacked by patients. However, that should not be the catalyst of using coercive measures such as involuntary medicine which is administered as a patient has been secluded and restrained. Based on such an understanding, the goal of the intervention plan is to push for other alternatives to S/R. For instance, Oster, Gerace, Thomson and Muir-Cochrane (2016) explained that strategies such as reviewing repeat events and debriefing, structured short-term risk assessment tools could help tailor interventions such that coercive measures such as S/R are avoided. Therefore, the intervention plan in question emphasizes the input of both mental health professionals and patients. The idea is to determine a patient’s ability to contain their behavior thereby not being a threat to workers as well as fellow patients.
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Discussion
Advocacy
Nurses can play a critical role in promoting a change in mental health facilities such as Anoka Metro Regional Treatment Center (AMRTC). The institution serves patients in a campus-based setting which means that S/R could be used as a method to moderate the behavior of patients who are a threat to others. One of the goals of the intervention plan is to take note of events and keep a record such that nurses, for instance, are able to determine the frequency of a particular patient’s outbursts. Oster, Gerace, Thomson and Muir-Cochrane (2016) explained that nurses could use short-term risk assessment tools which can help in evaluating risks associated with both seclusion and aggression. The idea is to reduce the number of hours a patient spends in seclusion. Nurses are in constant interaction with patients which places them at a unique position of knowing and evaluating certain behaviors which could be indicators of risk.
Kaucic (2017) stated that a dominating theme involving S/R is that a majority of nurses do not believe that there are alternatives while they believe that the practice in question is an ethical dilemma. However, as nurses are in constant contact with patients, they can leverage their experiences to advocate for more relaxed but effective measures of dealing with patients. Kaucic (2017) explained that nurses can listen to patients’ concerns, keep them informed of changes in treatment plans alongside the rationale for chosen interventions. Such an approach is intended to allow nurses uses their positions to communicate to the management and patients as well, their understanding of patients’ experiences. Nurses can offer suggestions on measures that can be adopted which can promote adoption of less coercive interventions such as S/R.
The intervention plan implies that nurses will be required to acquire extra skills, for instance, in carrying short-term risk assessment procedures or assessing the frequency of events in mental health patients. The changes in roles might demand participation of other professionals such as health information technology (IT) experts who are more experienced in executing comprehensive assessment of data gathered. Hence, it will be more like an interdisciplinary approach whereby nurses gather information while health IT professionals analyze it to determine the likelihood of events and what indicators are the key triggers. Such an approach is likely to promote effectiveness in the healthcare sector when it comes to addressing the diverse needs of mental health patients.
Future Steps
An organization such as AMRTC focuses on reducing S/R which are to be used as last resort only when the patient Is a danger to self and others. The quality improvement objective for the facility is that S/R will be reduced by at least 25%. Furthermore, patients should not be restrained for more than two hours at a time. For such an organization, there is a need to consider improvement of the proposed intervention plan. For instance, AMRTC houses patients who are have mental illness and are about to face a criminal trial or patients with relatively high levels of behavioral issues. However, Wale, Belkin and Moon (2011) explained that there is need to adopt a more patient-centered approach when dealing with mental health patients. Such an objective can be achieved in various ways. Clinical staff should be exposed to rigorous education about the need for continued culture change in healthcare settings. Hence to improve the project at hand, technology can be leveraged to improve nurse-patient interaction. Fisher and Feigenbaum (2015) cited that informatics can be used to support the acquisition as well as application of evidence to particular clinical situations. In this case, the integration of nursing informatics would provide nurses with a tool to acquire information about events and certain key indicators. Through access to such data, it will be easy to determine measures to adopt to promote a more effective approach when dealing with patients.
Reflection on Leading Change and Improvement
The project in question has impact my ability to lead change in both personal practice and future leadership positions in various ways. For instance, as a nurse, I am now aware that I hold a rather critical position when it comes to understanding patients’ needs. I am the bridge between the patient and the management and therefore should use such a position to advocate for measures that are likely to increase patient satisfaction and compliance to chosen treatment methods. Huckshorn (2014) stated that nurses have the ability to build a shared vision with other staff which is critical towards reducing the rate of use of S/R in mental health facilities. Therefore, the project has exposed me to new information regarding the diverse role that nurses play which is critical to promoting patient satisfaction. The idea is to refrain to extensive use of treatment techniques such as S/R which are likely to cause ethical issues.
Knowledge acquired can be transferred to my personal practice in various ways. As I indicated, AMRTC is a facility that houses mental health patients with diverse issues or cases. That being the case, I can advocate for and apply the patient-centered technique to try and understand patients with their own unique experiences. The idea is to avoid using a generalized treatment approach which would undermine the healthcare needs of some patients thereby leading to dissatisfaction of medical services offered. Therefore, person-centered care is a measure which can help promote quality improvement throughout AMRTC as the approach is context specific. Hence, patients are likely to be administered customized treatment which is in line with their mental health needs.
References
Fisher, C. A., & Feigenbaum, K. (2015). Harnessing technology to promote patient-centered care. Nursing Management (Springhouse),46 (1), 14-15. doi:10.1097/01.numa.0000459044.24554.af
Flammer, E., & Steinert, T. (2015). Involuntary medication, seclusion, and restraint in german psychiatric hospitals after the adoption of legislation in 2013. Frontiers in Psychiatry,6 . doi:10.3389/fpsyt.2015.00153
Huckshorn, K. A. (2014). Reducing seclusion and restraint use in inpatient settings: A phenomenological study of state psychiatric hospital leader and staff experiences. Journal of Psychosocial Nursing and Mental Health Services,52 (11), 40-47. doi:10.3928/02793695-20141006-01
Kaucic, A. (2017). The use of seclusion and restraints in the inpatient psychiatric hospital setting: A systematic review of the literature . The University of Akron.
Oster, C., Gerace, A., Thomson, D., & Muir-Cochrane, E. (2016). Seclusion and restraint use in adult inpatient mental health care: An Australian perspective. Collegian,23 (2), 183-190. doi:10.1016/j.colegn.2015.03.006
Wale, J. B., Belkin, G. S., & Moon, R. (2011). Reducing the use of seclusion and restraint in psychiatric emergency and adult inpatient services- improving patient-centered care. The Permanente journal , 15 (2), 57-62.
