Practice Experience: Quality Improvement Storyboard

Practice Experience: Applying Key Interventions to a Practice Problem

Restraint and seclusion are utilized to prevent injury and alleviate agitation, as it is hard to administer a program for mentally challenged individuals without utilizing some restrictive intervention (Nielson et al., 2021). Children are subjected to restraint because they are reported to be excessively violent. Retraining is being conducted to decrease the occurrence of risky behavior such as irritation, threat, and assaulting personnel. However, secluding and retraining mentally disabled children has medical and psychological consequences, including developmental issues, psychotic and externalizing diseases, mood and depression, and anxiety (Nielson et al., 2021). Additionally, S/R is contentious since it impinges on patient autonomy and liberty.

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Huckshorn Six Strategies

According to Hammervold et al. (2019), the Huckshorn six strategies is a successful planning tool that leads the creation of seclusion and retraining (S/R) reduction plans by combining a prevention strategy.  Huckshorn six strategies in the care setting include work development, thorough debriefing, leadership in organizational changes, data-driven practice, use of seclusion and restraining techniques, and full engagement of patients and families are among the strategies. According to Hammervold et al. (2019), these measures can significantly reduce isolation and restrain mental healthcare. The first phase is to establish leadership in response to organizational challenges.

Senior leadership is involved in the techniques chosen to reduce seclusion and to restrain (S/R) use. The leadership measures include creating a vision, values, and philosophy for S/R, as well as preparing a performance improvement strategy. The vision is critical because it outlines the desired future state and what is expected to be accomplished in the future. In contrast, the improvement action plan directs employees on accomplishing S/R reduction (Perers et al., 2021). The second step entails data collection to inform practice. The purpose of the data collection is to establish a facility’s S/R baseline and collect data on the usage unit, shift, individual staff members participating, consumer demographics, and injuries linked with S/R.

The third phase is to establish a workforce. Policies, procedures should guide the treatment environment and practices founded on recovery knowledge and principles and the characteristics of trauma-informed care. The initiatives are carried out with the assistance of extensive and continuing staff training and education. The training will emphasize S/R application training and vendor selection, and the provision of sufficient therapy activities that provide patients with options (Perers et al., 2021). Providers will be educated on sickness and emotional self-management of symptoms and personal triggers that contribute to patient loss of control. The training will further emphasize on educating providers on how to construct customized person-centered treatment plans tailored to each individual’s needs.

The team will get instruction on the impact of traumatic experiences on developmental learning, emotional development, recovery, resiliency, and overall health. This will ensure that staff members understand what to do and act professionally to avoid inflicting traumatic experiences on the patient (Perers et al., 2021). Thirdly, isolation and restraining preventative measures are used. The facility’s policies and procedures and each client’s recovery plan incorporate various tools and assessments. The evaluation tools are used to ascertain a child’s risk of violence and his or her history of S/R. Additionally, the universal trauma assessment instruments are used to identify children who are in danger of death or serious harm.

Another intervention that is integrated into the individual consumer recovery plan is a de-escalation survey or assessment tool for safety planning to determine individual triggers. The instruments are effective in determining which interventions are most beneficial for emotional self-management. Environmental modifications such as comfort and sensory rooms, sensory modulation interventions, and other therapeutic activities included to teach children self-management skills (Perers et al., 2021). The aggressiveness control behavior scale supports staff in classifying patients who exhibit agitated, disruptive, dangerous, or fatal conduct, thereby avoiding unnecessary restraining and confinement. The fifth phase comprises of performing consumer tasks in a hospital setting.

This technique is critical in the S/R treatment plans since it entails the consumer, children, relatives, and external advocates all playing roles in assisting with seclusion and restraint reductions. Consumer assistance includes oversight and monitoring to ensure that seclusion and restraining are conducted in accordance with fundamental human rights, that ensures patient integrity and dignity are preserved, and that patients are treated with care and respect (Perers et al., 2021). Providers conduct debriefing sessions to determine what they could have done differently and make short-term goals to avoid repeated restraint use. The debriefing will aid in elucidating both parties’ behavior concerning prior restraining use.

Peer support is also required to guarantee that the patient obtains the critical support necessary for their rehabilitation plan. The final step of seclusion and restraining(S/R) reduction involves employing a debriefing strategy. Debriefing is critical for lowering S/R use since it aids in collecting necessary knowledge that informs policy, procedures, and practice. The treatment team conducts a debriefing in two sections. The first is an immediate post-event acute analysis, and the second is formal problem analysis. Multiple hold debriefings are conducted with children, and staff members involved in treatment events are recognized for instruction on adjusting the treatment plan. Debriefing encompasses all consumer stakeholders, including family, peer support, advocates, and providers.

References

Hammervold, U. E., Norvoll, R., Aas, R. W., & Sagvaag, H. (2019). Post-incident review after restraint in mental health care-a a potential for knowledge development, recovery promotion, and restraint prevention. A scoping review. BMC health services research19(1), 1-13.

Perers, C., Bäckström, B., Johansson, B. A., & Rask, O. (2021). Methods and strategies for reducing seclusion and restraint in child and adolescent psychiatric inpatient care. Psychiatric quarterly, 1-30.

Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care25(3), 342–367. https://doi.org/10.1177/1367493520937152

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