Practice Experience: Quality Improvement Storyboard

Excessive or Unnecessary Use of Restraints and Seclusion of Mentally Ill Children

In mental health inpatient facilities, mentally ill children die, get injured and psychologically traumatized by unnecessary seclusion and restraint practices (De Hert et al., 2011). In my practice setting, Aida Bugg, a nurse practitioner says that the use of noncoercive de-escalation where the patient is calmed down when agitated helps gain their cooperation and hence makes it easier to evaluate and treat the patient.

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Proposed Action Steps

To improve mental health care for children, action steps can be taken to improve mental health care for children through:

Influencing cultural change in mental health issues regarding restraint and seclusion by researching children’s personal experiences of seclusion and restraint, understanding the impact trauma has on children and then sustaining change by involving the patients and the staff (Matte & Collin, 2020). Assessing the risk of violence among secluded children, any medical risk factors and past traumas can be used to develop better safety plans.

Trauma informed care of children with mental health issues shifts tradition from what is wrong with the child to what has happened to the patient. This way, health practitioners can understand that mental health issues are related to traumatic experiences and hence it doesn’t help to inflict more trauma on patients. This action step would be effective with the use of accurate data about how serious the issue is, how effective interventions for the issue will be and alternatives when these interventions don’t work (Raveesh et al., 2019).

Conducting a movement against restraint and seclusion and the effect it has on children who are mentally ill by involving family members and other relevant advocates for inpatient care. This movement can be used to debrief those concerned about policy, procedures and practices that can be used to minimize the future use of restraints and seclusion (Roy et al., 2020). The movement can also be an avenue to address any adverse or traumatic events of restraint and seclusion.

Partnerships and collaborations with both private and public sectors can be used to further influence cultural change, prevent and reduce the use of restraints and seclusion. Partners and stakeholders can be consulted to take an active role in developing new alternatives and taking role in the change process while ensuring accountability.

Potential Challenges

Implementation of the project can be compromised by lack of proper communication among stakeholders involved. Inadequate finances and resources can deter the project from running effectively and efficiently especially when mobilising new partners or conducting movement (Roy et al., 2020). Also lack of proper stakeholder engagement and cooperation when stakeholders are disinterested or do not give open feedback.


The resources that would be needed to implement the project include health care practitioners such as nurses, managers, researchers, material resources and computer software for proper communication with stakeholders and partners (Raveesh et al., 2019). The resources will be cost effective because taking steps to find alternatives or prevent seclusion and restraints will improve the mental health of these children and encourage health seeking behaviour which in turn reduces admissions.


De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011). Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. European child & adolescent psychiatry, 20(5), 221-230.

Matte-Landry, A., & Collin-Vézina, D. (2020). Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis. Child Abuse & Neglect, 109, 104702.

Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693.

Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693.

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