Assignment: Capstone Paper, Part II: Quality Improvement Plan, Resources and Conclusion

Use of Restraints and Seclusion in Children and Adolescents

Shannon R. Pierce

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Bachelor of Science in Nursing, Walden University

NURS 4220: Leadership Competencies in Nursing and Healthcare

April Martin

October 31, 2021

Use of Restraints and Seclusion in Children and Adolescents

A physical constraint can be defined as using force to prevent and restrict the natural movement of any part of a patient’s body. On the other hand, seclusion is socially isolating patients from other people. Restrictive strategies such as excessive restraints and seclusion have been used in the mental healthcare industry for a long time as a reactive intervention to aggressive behaviors among patients, especially children and adolescents (Chieze et al., 2019). Many experts agree that physical restraints often cause significant bodily injury to the patients, but the psychological effects of the practice are often ignored. Despite the knowledge that physical restraint often causes physical injuries among mental health patients, the technique is widely practiced in many mental healthcare facilities, and this requires to be stopped for better health for all.

Research into the use of physical restraint and seclusion

Researchers have established that physically restraining patients negatively affects their mental health (Department of Health, 2017). Restrained patients are likely to develop other mental complications such as mood disorders. However, some violent and aggressive behaviors such as kicking others, spitting on people, damaging property, hurting oneself, or other people may necessitate the use of physical restraint and seclusion among mental health care patients. Nevertheless, the physicians enforcing these techniques should understand their impact on the patient’s psychological and physical well-being. Researchers have also established that executing these techniques has a negative psychological effect on the staff. (Tölli et al., 2017). The healthcare facility’s staff may experience ugly emotions such as unnecessary anger, fear, and anxiety due to the consistent implementation of these practices (Mérineau-Côté & Morin, 2013). This contributes to increased staff turnover in the facility, which is very costly (Department of Health, 2017).

Impact of physical restraint and seclusion

The practice of physical restraint and seclusion causes a deep mistrust between mental health care patients and their caregivers, significantly hindering the success of the treatment plans. Mental healthcare practitioners argue that the practice is essential in ensuring the safety of all stakeholders in the facility. The procedure is deemed necessary to prevent the children and adolescents from hurting themselves or the people around them (Tölli et al., 2018). However, with the dawn of the Age of information, more people are informed about their rights and liberties as patients. Thus, mental healthcare practitioners who use this practice face severe legal, ethical, and moral challenges.  The physicians must carefully assess their reaction to their patients’ violent behaviors. They should consider the rights and freedoms of all patients. This includes the rights to self-determination, dignity, security, and physical integrity.

Addressing the Issue of Physical restraint and Seclusion through CPI (Crisis Preventive Intervention

The Department of Health has issued advice on using positive and proactive techniques to foster a culture where physical interventions are only required as a last option. Several reports have focused on the misuse or abuse of restrictive interventions in health and care services. Restraint reduction aims for schools, hospitals, and human care agencies devoted to properly controlling agitated behavior. In healthcare, the Joint Commission has its Elements of Performance addressing the use of the physical constraint (Gowda et al., 2018). CPI’s training and tools can assist you with constraint reduction in education, healthcare, or human services. Nonviolent Crisis Intervention training from CPI teaches hospital personnel de-escalation methods and various alternatives to restraint. The training programs follow The Joint Commission and CMS requirements (Mérineau-Côté & Morin, 2013). Select personnel can be qualified to teach the curriculum to other professionals on an ongoing basis using the train-the-trainer option. According to the MHA Code of Practice 11, health and care providers must ensure that their staff is adequately educated in the confinement of mentally ill patients. Implementing restrictive measures in community-based health and social care services and non-mental hospital settings is very seldom authorized under the Mental Health Act of 1983 (MHA) 18 ((South et al., 2010). The use of force is only justified in self-defense, defense of others, criminal prevention, property protection, or property protection.

Addressing the Issue of Physical restraint and Seclusion through Reviews of Restrictive Intervention and Effective Administration

Annual reviews of restrictive intervention reduction programs must be conducted, and they must be made available for inspection by the CQC and Monitor. Any service user who has a behavior support plan that recommends restrictive interventions should have clear, proactive strategies in place. The principles of the Programme for British Standards must be followed when providing care (PBS). The Care Quality Commission (CQC) has created a robust registration, regulation, and inspection system that holds businesses and NHS boards accountable for care failures (Mask & Adepoju, 2019). According to the CQC, physical interventions are risky and put both staff and service users at risk of bodily or mental damage. Restriction intervention reduction programs must be implemented in services based on the concepts of effective leadership, data-informed practice, workforce development, and service user empowerment. A yearly assessment of control measures is required to revise and update corporate action plans. Any service user who has a behavior-support plan that recommends restrictive measures should have clearly defined proactive tactics.

Leaders should also promote the use of alternatives to seclusion and restraint, develop a clearly articulated plan, take an active leadership role in reducing the use of seclusion and restraint, and hold staff members accountable. Moreover, there should be increased support and advocacy for patients (Raveesh et al., 2019). This implies the promotion of advocacy for inpatients in mental health hospitals. This should involve youths, family members/caregivers of patients, and advocates in various settings to curb the use of excessive restraint and seclusion.

As discussed in this paper, excessive physical restraint and seclusion have negative physical and psychological impacts on children and adolescents. Therefore, mental healthcare facilities should adopt better and efficient strategies to manage violent behaviors among patients. This includes personnel to anticipate violent activities and prevent them from happening. Caregivers should adopt non-aggressive communication strategies to prevent and respond to violent and aggressive behaviors. They can also use other treatment plans such as behavioral therapy.

References

Chieze M., Hurst, S., Kaiser S., & Sentissi O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in psychiatry10, 491. https://doi.org/10.3389/fpsyt.2019.00491

Department of Health. (2017). Reducing the need for restraint and restrictive intervention. GOV.UK. Retrieved 31 October 2021, from https://www.gov.uk/government/publications/reducing-the-need-for-restraint-and-restrictive-intervention.

Gowda, G., Lepping, P., Noorthoorn, E., Ali, S., Kumar, C., Raveesh, B., & Math, S. (2018). Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian Journal of Psychiatry36, 10-16. https://doi.org/10.1016/j.ajp.2018.05.024

Mask, A., & Adepoju, O. (2019). Relationship between Accountable Care Organization Status and 30-Day Hospital-wide Readmissions: Are All Accountable Care Organizations Created Equal? Journal for Healthcare Quality41(1), 10-16. https://doi.org/10.1097/jhq.0000000000000132

Mérineau-Côté, J., & Morin, D. (2013). Restraint and Seclusion: The Perspective of Service Users and Staff Members. Journal of Applied Research in Intellectual Disabilities27(5), 447-457. https://doi.org/10.1111/jar.12069

 Raveesh B., Gowda G., & Gowda M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry61(Suppl 4), S693-S697. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_104_19

South, J., Darby, F., Bagnall, A., & White, A. (2010). Implementing a community-based self-care training initiative: a process evaluation. Health & Social Care in the Community18(6), 662-670. https://doi.org/10.1111/j.1365-2524.2010.00940.x

Tölli, S., Partanen, P., Kontio, R., & Häggman-Laitila, A. (2017). A quantitative systematic review of the effects of training interventions on enhancing the competence of nursing staff in managing challenging patient behaviour. Journal of Advanced Nursing73(12), 2817-2831. https://doi.org/10.1111/jan.13351

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