A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit

Haefner, Judy; Dunn, Ifeoma; McFarland, Marilyn

doi:10.1080/01612840.2020.1789784

Cited by 12 publications

(11 citation statements)

References 19 publications

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“…Seclusion use was associated with nurse education level ( r = .465) in one study (Khalil et al, 2017) while Newman et al (2018) found that seclusion use decreased following a nursing education intervention. In three other studies (Doedens et al, 2017; Haefner et al, 2020; Janssen et al, 2007), no relationship was found between nurse education and seclusion.…”

Section: Resultsmentioning

confidence: 85%

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

Ngune

Myers

Cole

et al. 2023

Journal of Clinical Nursing

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BackgroundWhile nurse‐sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings.AimTo assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care.MethodsDatabases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta‐analysis was not possible because of the large number of variables and measurement inconsistencies.ResultsA total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non‐significant relationship between nurse variables and patient outcomes. Seven outcomes—aggression, seclusion, restraint, absconding, pro‐re‐nata medications, special observations and self‐harm—were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self‐harm, absconding, pro‐re‐nata medications and special observations.ConclusionAll the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high‐quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience.Patient and Public ContributionPatient or public contribution was not possible because of the type of the variables being explored.

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Section: Resultsmentioning

confidence: 85%

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

Ngune

Myers

Cole

et al. 2023

Journal of Clinical Nursing

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“…Two pre-post studies (Forster et al, 1999;Haefner et al, 2021) and one study with a concurrent comparison (Bowers et al, 2008)…”

Section: Staff Education/trainingmentioning

confidence: 99%

Protocols to reduce seclusion in inpatient mental health units

Quinn,

Jutkowitz,

Primack

et al. 2024

Int J Mental Health Nurs

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The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty‐eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi‐component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders.

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“…The committee found research supported a multicomponent approach to addressing WPV, and many of the recommended components had already begun implementation throughout the system (systems for reporting, Code Gray procedures, security services; Somani et al, 2021). Prior studies and quality improvement projects offering WPV prevention education interventions have found positive outcomes of WPV prevention education including increased staff confidence and reduced restraint utilization (de la Fuente et al, 2019; Haefner et al, 2021; Krull et al, 2019; Story et al, 2020; Ye et al, 2021). The committee identified a gap regarding evidence-based WPV prevention education on providing care for patients with behavioral health concerns and their family members after reviewing all available WPV in the organization.…”

Section: Purposementioning

confidence: 99%

Implementing Evidence-Based Workplace Violence Prevention Education to Support Frontline Staff at Risk for Workplace Violence

Varty,

Mines,

DelMonte

et al. 2023

J Nurses Prof Dev

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Prior studies assessing workplace violence educational interventions have found positive outcomes including increased frontline staff confidence and reduced restraint utilization. An electronic, evidenced-based educational module was provided to frontline staff across a large healthcare system in response to a gap found during analysis of workplace violence prevention initiatives. This quality improvement project found that education can be feasibly implemented across large healthcare organizations to improve frontline staff vigilance and awareness of workplace violence risks.

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A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit

Cited by 12 publications

References 19 publications

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

Protocols to reduce seclusion in inpatient mental health units

Implementing Evidence-Based Workplace Violence Prevention Education to Support Frontline Staff at Risk for Workplace Violence

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