Decreasing Patient Agitation Using Individualized Therapeutic Activities

Abstract

Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated "sitters." These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. The authors created a tool that allowed continuous observers to identify a patient's abilities and interests, and then offer such activities to the patient. Data were collected using a scale that measured patient agitation before, during, and after these activities. The authors found that during the activities, 73% of patients had decreased levels of agitation compared with baseline, and 64% remained less agitated for at least one hour afterward.The intervention appeared effective in reducing levels of agitation in selected patients who were receiving continuous observation on nonpsychiatric units at a large, urban level 1 trauma center. Many patients expressed gratitude for the diversion from their health issues. Further investigation into the effectiveness of this intervention and its impact on the use of medications or restraints is warranted.

Monitoring Agitated Behavior After acquired Brain Injury: Onset, Duration, Intensity, and Nursing Shift Variation

“…Furthermore, it should be considered that some agents have the potential to adversely exacerbate agitated behavior (Fleminger et al, 2006). Also, it should be considered whether the therapeutic environment and interventions provided, might have an unintended negative influence on patients' behavior (Becker, 2012;Wazynski et al, 2013). Agitated behavior was assessed in a highly structured environment of alternating rehabilitation therapy, rest, and spare time designed to mirror an everyday environment.…”

“…Furthermore, there is insufficient evidence guiding the pharmacological treatment in the management of agitated behavior, and some agents may even exacerbate agitated behavior (Chew & Zafonte, 2009;Pisa et al, 2014). Patient safety may be maintained by round the clock nurse observation, which places a financial burden on services (Bailey et al, 2009;Duraski, 2011;Wazynski et al, 2013). Based on this, it is necessary to develop strategies aimed at alleviating the condition.…”

Interventions to support recovery following an episode of delirium: A realist synthesis

“…A wide range of activities have been used, including games, puzzles, quizzes, arts and crafts, and discussion groups. Effectiveness appeared to be enhanced where activities reflected personal interests and preferences (Alvarez et al, 2017;Blair, Anderson, & Bateman, 2018;Kolanowski et al, 2016;Waszynski et al, 2013;Woods et al, 2012). Personalised recreationbased cognitive stimulation could also improve psychological wellbeing, being associated with patient satisfaction (Danila et al, 2018) decreased agitation (Waszynski et al, 2013) and reduction in caregiver distress (Farina et al, 2006).…”

“…Effectiveness appeared to be enhanced where activities reflected personal interests and preferences (Alvarez et al, 2017;Blair, Anderson, & Bateman, 2018;Kolanowski et al, 2016;Waszynski et al, 2013;Woods et al, 2012). Personalised recreationbased cognitive stimulation could also improve psychological wellbeing, being associated with patient satisfaction (Danila et al, 2018) decreased agitation (Waszynski et al, 2013) and reduction in caregiver distress (Farina et al, 2006). Kolanowski et al (2010Kolanowski et al ( , 2016 developed and tested a recreation-based cognitive stimulation intervention for patients with DSD informed by cognitive reserve theory which proposes that individuals have differing levels of efficiency in the use of brain networks with some being better able to deploy cognitive strategies to cope with brain pathology.…”

“…Kolanowski et al, 2016;A. M. Kolanowski et al, 2010;Waszynski et al, 2013). Personalised and enjoyable activities were less stressful, less obtrusive, and more easily implementable across care settings (Kolanowski et al, 2016;Kolanowski et al, 2010).…”