Acute Psychiatric Care: PICOT Statement


In spite of the wide use, restraint and seclusion (RS) remain a controversial medical procedure in psychiatric care. While the method is useful for controlling a patient’s dangerous behavior, it implies numerous emotional and ethical issues among the staff and patients. While the practice may be acceptable if all else fails, in most cases, it is unacceptable as it is an offense to human autonomy. The present paper offers a nursing intervention to minimize RS use in acute psychiatric care.

Evidence-Based Solution and Nursing Intervention

RS is an acceptable method of handling aggressive behavior in psychiatric nursing practice. Recent evidence demonstrates some counter-therapeutic effects associated with the practice, which has created a tendency of minimizing RS use (Hernandez, Riahi, Stuckey, Mildon, & Klassen, 2017). There are many strategies that can be implemented to reduce the number of RS misuse that can be implemented by the hospital authorities. However, one of the most efficient methods of handling the situation is the increased number of recovery rounds by nurse educators and managers.

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Due to increased workload and understaffing, nurses experience an excessive amount of stress. This leads to exhaustion and inability to reassess if a patient still needs to be immobilized and isolated because of time deficit (Korkeila, Koivisto, Paavilainen, & Kylmä, 2016). To decrease the number of RS misuse cases, Hernandez et al. (2017) introduced an intervention that was based upon elaborating a five-item recovery rounds checklist and offering psychiatric nursing staff to answer the question on the list systematically. The research shows that the proposed method is an efficient solution for reducing the total hours of RS and the average hours per case.

The study described above can be transformed into a nursing intervention that will be examined in the present research project. The practice will include creating a questionnaire that psychiatric nurses will have to fill up daily in regard to every isolated and restrained patient. The survey will consist of the following questions, which are based on the study of Hernandez et al. (2017):

  1. Why does the patient still require restraint and seclusion?
  2. What does the patient think he needs to return to full privileges?
  3. What are the plans for today?
  4. When do you think it would be appropriate to stop RS?

Even though the proposed procedure creates an additional workload for nurses, it is an efficient way of minimizing RS.

Patient Care, Healthcare Agency, and Nursing Practice

The proposed intervention has the potential to make a positive impact on patient care and nursing practice in psychiatric care facilities. The questionnaire will allow nurses to take time and reevaluate every patient’s condition, which can result in a growth of personal assessment skills promoting evidence-based practice. Moreover, according to Hernandez et al. (2017), the change can reduce RS misuse, which can result in better patient outcomes. As for the agencies, the intervention has a universal design allowing its implementation in any psychiatric facility worldwide. In short, the proposition of the present paper aims at delivering patient-centered, evidence-based medical care.

PICOT Question

  • P: Adult population in psychiatric care;
  • I: The introduction of daily RS questionnaire;
  • C: Units without the daily survey;
  • O: The reduced number of RS utilization;
  • T: 6 months.

Conclusion

Limitation and detachment are closely associated with psychological traumas and are often reported as unpleasant or harmful experiences. One of the methods to minimize the number of RS misuse cases is to introduce a daily practice of filling out questionnaires. The proposed intervention has the potential to enhance psychiatric care in a limited timeframe.

References

Hernandez, A., Riahi, S., Stuckey, M., Mildon, B., & Klassen, P. (2017). A multidimensional approach to restraint minimization: The journey of a specialized mental health organization. International Journal of Mental Health Nursing, 26(5), 482-490. Web.

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Korkeila, H., Koivisto, A., Paavilainen, E., & Kylmä, J. (2016). Psychiatric nurses’ emotional and ethical experiences regarding seclusion and restraint. Issues in Mental Health Nursing, 37(7), 464-475. Web.

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