DEVELOPING IMPLEMENTATION

Developing Implementation
Elise DAgostino
Grand Canyon University
Professional Capstone Project
11/1/15

developing implementation

This paper will describe the ethics regarding restraints and seclusion. Included will be the
benefits of becoming a restraint free facility and the therapeutic interventions that could be used
in place of them. The implementations of change will be described and how the staff can make a
change and receive the correct training that will help them become a more attentive nurse caring
more on a therapeutic level. The use of restraints in a psychiatric setting is a rising concern
among health care. Patient aggression in psychiatric settings continues to be an issue which is
why some facilities still use restraints as a measure to control an aggressive patient (Nursing
Times, 2011). The question is would patients have a better attitude towards treatment knowing
that they will not have to be restrained. Some of the things that cause aggression is
overcrowding, staff that is unexperienced, and poor staff retention. It takes a specially trained
health care provider to care for patients in a mental health facility. Staff can be at fault for the
escalation of a patient if their communication skills are used in a provoking style. While
restraints are used in violent scenerios there has been a report of restraints being misused and
causing harm or even death for patients. Nursing Times lists 5 key points on the topic of
restraints.
There are no statutes or regulations against the use of restraints and seclusion. The first
thing I would do to try and gain the necessary approval of support against the use of seclusion
and restraints is to show all the pros and cons from the use and the different studies that were
done. The use of restraints and seclusion can be an effective measure used in the appropriate way
but can also cause controversy among the health care community. In hospitals that still use

developing implementation

restraints and seclusion, they must uphold the policies and training that is involved therefore
ensuring patients safety. For the hospitals that refrain from restraints and seclusion, they must use
a therapeutic approach in calming down and deescalating patient preventing aggressive behavior.
The overall effort must focus on improving the quality of treatment to increase the safety of
patients and staff, while protecting individual liberty and autonomy.
There are currently no regulations, but there are guidelines put into place on the correct
regulations and approval to use restrains and seclusion. One of the main reason why restraints
and seclusion are used in a psychiatric setting is for the protection of the patient and/or health
care providers. This method is only used after all medication and verbal therapies are unable to
control a potentially dangerous patient. The restraint of a violent patient provides safety for the
health care providers to provide psychotherapeutic tasks that are ordered to prevent or avoid

further escalation. Some patients fear the abuse of restraints and view it as a violation of
human rights (AJOL,2014).
The use of restraints in a psychiatric setting is a rising concern among health care. Patient
aggression in psychiatric settings continues to be an issue which is why some facilities still use
restraints as a measure to control an aggressive patient (Nursing Times, 2011). The question is
would patients have a better attitude towards treatment knowing that they will not have to be
restrained. Some of the things that cause aggression is overcrowding, staff that is unexperienced,
and poor staff retention. It takes a specially trained health care provider to care for patients in a
mental health facility. Staff can be at fault for the escalation of a patient if their communication
skills are used in a provoking style. While restraints are used in violent scenerios there has been a

developing implementation

report of restraints being misused and causing harm or even death for patients. Nursing Times
lists 5 key points on the topic of restraints
The rational for choosing this purposed solution is due to injuries and for the simple fact
that patient respect is very important and the need to be partners instead of adversaries. The use
of restraints in a mental health facility bring forth many safety precautions in itself. Therapeutic
interventions are proven to be a beneficial approach for patients and safer. At Aurora Behavioral
Hospital in Arizona they have a policy that only chemical and physical holds are allowed, not
mechanical restraints. Through many patient surveys patients felt a calmer accepting stance on
receiving treatment knowing that they wouldnt have to deal with the use of mechanical holds.
Communication and support should also be exercised among the staff and the patient involved
following a debriefing to discuss the reasons that this took place. There may be a time when
restraining a patient may seem like the only option in caring for a violent patient but therapeutic
interventions should always be the first line of care. There should always be a plan in place to go
over the resources that may be effective for a patient.
The evidence from the literature used in this research helped provide evidenced based
practice against the use of restraints and seclusion. Each article provided different resources and
cases in mental health facilities that showed how the use of restraints may not always be
necessary. Many cases involved where injury and or death occurred were studied and the benefits
of therapeutic interventions far out-weigh the use of restraints. Each article brought more
evidence and data in regards to the benefits of providing a restraint free health care environment.
There were several articles that did talk about the need for restraints in some situations. There
may be a patient that may be displaying violent behavior and could become aggressive towards
staff. The safety of the staff is a big issue and is one of the reasons that restraints and seclusion
are being used to this day. Some health care staff have stated that they do not feel safe in a

developing implementation

restraint free environment. The use of restraints and seclusion can be an effective measure used
in the appropriate way but can also cause controversy among the health care community. In
hospitals that still use restraints and seclusion, they must uphold the policies and training that is
involved therefore ensuring patients safety. For the hospitals that refrain from restraints and
seclusion, they must use a therapeutic approach in calming down and deescalating patient
preventing aggressive behavior. The overall effort must focus on improving the quality of
treatment to increase the safety of patients and staff, while protecting individual liberty and
autonomy.
I feel the Director of nursing could make the step to form a power point showing the pros
of having a restraint free environment. A survey could be passed out to a handful of patients as to
how they view being restrained. Also research can be done to see if after a patient is restrained
how the outcome is, are they more aggressive what behaviors do they display. According to some
of the articles a patient may be less likely to show aggressive behavior knowing that they will not
be mechanically restrained. Then after displaying this proposal to some of the higher ups a
meeting could be help between the nursing managers about how to come up with a plan to
educate and train the staff on therapeutic interventions that should be the first line of defense
when deescalating a aggressive patient. The information that may be needed while trying to
enforce the need of a restraint free facility is a flyer that could be passed out at huddle. This flyer
could include different types of therapeutic coping mechanisms such as journal writing, music
therapy, exercise, and group therapy. This flyer could also be handed out to the patients
educating them on the different therapeutic interventions that are offered to them. The staff could
give all the patients a survey about how they feel they are treated by staff and what makes them
calm in a time of stress.
There are several states that have initiated the restraint free law in their health care
facilities. As more studies are done and more patients are interviewed the need for a restraint free

developing implementation

environment will become more of a need in health care. There are always going to be those few
times when staff will not be able to use just a therapeutic approach to ensure their safety.
Eliminating restraints may not be possible but the need to have stronger guidelines is a must.
Staff must be trained that mechanical, chemical, and physical restraints should only be used as a
last resort and only when the staff or the patients safety our at risk. Together we can work
together to provide therapeutic treatment for patients treating them with the dignity they deserve.

References
American Journals Online (AJOL). 2014. The Use of Restraints in Psychiatric Patients.
Retrieved from http://www.ajol.info/index.php/sajpsyc/article/viewFile/50432/39115
Nursing Times. (2011). Should Nurses Restrain Violent and Aggressive Patients?.
Retrieved from http://www.nursingtimes.net/Journals/2013/01/18/l/w/g/080311Should-nursesrestrain-violent-and-aggressive-patients_NEW.pdf
Journal of the American Academy of Psychiatry and the Law Online. (2011). Restraint
and Seclusion in Psychiatric Treatment Settings: Regulation, Case Law, and Risk Management.
Retrieved from http://www.jaapl.org/content/39/4/465.full