2022代码代写医护心理健康essay范文
essay 范文Table of ContentSeclusion and Restraint Prevention in Acute Psychiatric Inpatient Setting…………………………..2Introduction ………………………………………………………………………………………………….. 2Causes of Aggression …………………………………………………………………………………….. 3Prevention of aggression ……………………………………………………………………………………………4Risk Prediction…………………………………………………………………………………………… 4Leadership toward Organizational Change…………………………………………………….. 5Workforce Development……………………………………………………………………………… 5De-escalation Kit ……………………………………………………………………………………….. 7Improve Reporting……………………………………………………………………………………… 8Advanced Crisis Management ……………………………………………………………………… 9Conclusion……………………………………………………………………………………………………………10Reference………………………………………………………………………………………………………..12pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA2essay Seclusion and Restraint Prevention in Acute Psychiatric Inpatient SettingIntroductionAggressive incidents committed by patients are a major concern in mental healthinpatient settings (Maguire & Bryan, 2007). Nurses in mental health services are morelikely to be victims of violence or aggression (Needham et al. 2004). Aggression andviolence can be very traumatizing for the victims. The consequences of staff receivingverbal or physical abuse can result in the staff being no longer able to continue his/her joband requiring counseling (Rew & Ferns, 2004). Rippon (2000) supported that staffexperienced workplace violence may manifest symptoms of post-traumatic stressdisorder including anxiety, impaired work performance and insomnia (cited by Rew &Ferns, 2004). There is a direct relationship between aggression and sick leave, burn outand staff turnover among nurses.A frequent reaction to patient aggression is the implementation of seclusion and physicalrestraint. These practices have recently become the target of intense public criticism andthe focus of scientific scrutiny (Needham et al., 2004).#p#分页标题#e#According to Haimowitz, Urff & Huckshorn (2006), each use of restraint poses aninherent physical and psychological danger to the client and to the staff who administerthem. If the nurses used physical contact intervention as soon as situation arises, nursesshould view it as failure. There is a need for psychiatric nurse to use interventions that aremore therapeutic (Delaney, Cleary, Jordan & Horsfall, 2001).The use of systematic risk assessments to predict aggressive behaviour or alternativemethods to manage aggressive patient have been proposed to achieve this objective(Needham et al., 2004). Supporting and training staff in recognition of conflict situationspdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA3and de-escalation techniques should be a priority in the healthcare service in order tominimize risks to staff and clients with mental health problems.The purpose of this article is not to provide a systematic review on interventions but topropose interventions that may help to decrease seclusion and restraint as well asaggressive incidents in the acute psychiatric ward.Causes of AggressionDuxbury (2002) identified three broad models of causation of violence as the naturepatient aggression is likely multifactorial. The patient risk factor, aggression is mainly caused by the aggressive personsmental illness and/or personality. Davison (2005) supported that inpatients thatare young, having a history of violence and being involuntarily admitted are atrisk of becoming violent.essay The environmental risk factor- the persons physical and social environment is themain cause of aggression. Report from the Royal College of Psychiatristsmentioned that there are three important factors: the physical facilities providedfor the patients, visitors and staffs; the experience, training, supervision andnumber of staff; and the policies in place to manage the clinical environment(cited by Davison, 2005). The situational risk factor- some studies show that staffs with professional mentalhealth training are less likely to be assault whereas others report that experiencedstaffs are at higher risk because they are more likely to be involved in restraint.Staffs who are namely rigid, authoritarian and custodial attitudes and a lack ofrespect towards patients also have higher risk to be a victim (Davison, 2005).pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA#p#分页标题#e#4Prevention of aggressionThe most effective way to manage aggression is to prevent it where possible. There areseveral ways help reduce risks associated with physical restraint, rapid tranquillizationand seclusion.Risk PredictionKey activities of mental health nurses working in acute psychiatric inpatient settings areto attempt to prevent aggressive incidents and to stop such incidents if they occur(Duxbury, Hahn, Needham & Pulsford, 2008). Very often aggression is sudden andunpredicted. Staffs working in clinical area find it very stress because they are not surewho has the higher risk of anger outbreak. Researchers have worked and still working todevelop a reliable tool to predict violence (Beech & Bowyer, 2004). Almvik, Woods &Rasmussen (2000) mentioned that use of short-term predictive instruments and improvingknowledge about aggression allowing early intervention will help to reduce level of stress.Almvik & Woods (1999) have been seeking to develop tools to predict short-termaggression. The growing number of research conducted to identify potential violentindividual in psychiatric setting indicates that the need for predictive tools. With theseaids, valuable resources can be better used, and thus, staff and patients will be lessexposed to violence.There are several assessment tools available. Risk assessment tool like HCR-20 are notdesigned to assess immediate risk of violence and have mainly been validated in forensicpopulations. It can take several hours to complete (Almvik, Woods & Rasmussen, 2000).There is a need to look for a quick, user-friendly instrument to predict risk and it must bepdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA5reliable and valid for the targeting population. Almvik, Woods & Rasmussen (2000) haddone a study to examine the clinical validity and reliability of the The Brøset ViolenceChecklist (BVC), as well as to examine the differences between the violent andnot-violent individuals and to study the effectiveness of the variables in predictingviolence. Almvik, Woods & Rasmussen (2000) conclude that the BVC is useful inpredicting violence within the next 24-hour period. More specifically, it is 63% accuratein predicting that violence will occur within the next 24 hours and 92% accurate inpredicting that violence will not occur (Almvik, Woods & Rasmussen, 2000, p.1292).Leadership toward Organizational ChangeThere are growing evidence supported that many restraint and seclusion events occur dueto the wards rigid policies regarding attendance at activities, wake and sleep times,#p#分页标题#e#smoke breaks, meal times, and other rules designed to keep order but individual needsor the signs and symptoms of mental illness are neglected. Facility leadership needprocedures in place that provide guidance to empowered staff to make decision tosuspend institutional rules and procedures in order to resolve conflicts to avoid the useof restraint and seclusion (Huckshorn, Urff & Huckshorn, 2006).Workforce DevelopmentTraining courses have been conducted to avoid eruptions of anger, to reduce the risk ofinjury, to minimize the need for harsh coercive measures, and to help the patient controlthemselves better (Needham et al. 2004). Staffs working in the ward are handling thepotential aggressive patient directly and it is very important that the nurses must possessthe knowledge and skills that are compatible with the demands of the task. Training givespdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA6the staffs opportunity to develop and practice skills for individualizing treatment planningto help specific high-risk individuals (Haimowitz, Urff & Huckshorn, 2006).Haimowitz et al. (2006) emphasized that staff must be able to understand the experiencesof seclusion and restraint; address the common myths in the use of restraint; introduce therationale and characteristics of trauma informed care; educate on the neurobiological andpsychological effects of trauma; and describe an alternative approach to manageaggressive patient.Bowers, Brennan, Flood, Lipang & Oladapo (2006) suggested that low conflictenvironments are not achieved through high levels of containment, but through betterstaff attitudes and working practices. Bowers identifies staffs positive appreciation ofpatients; staffs ability to regulate their own natural emotional reactions towards patientsand the creation of an effective structure (rules and routine) for ward life as threeimportant factors in staff behaviour for the production of low-conflict, therapeuticpsychiatric wards (cited in Bowers et al. 2006). Bowers et al. (2006) further determinedthat the three factors are dependent upon: (1) the staffs perception on mental illness andtheir role in delivery of care; (2) moral commitments (e.g. non-judgemental, nursingprofessionalism, humanism, honesty); (3) use of cognitive-emotional self-managementmethods; (4) interpersonal skills; (5) Teamwork to achieve cohesion, consistency andmutual support; and (6) clinical supervision and learning opportunities provided by theorganization.pdfMachine – is a pdf writer that produces quality PDF files with ease!#p#分页标题#e#Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA7De-escalation KitCowin et al. (2003) defined de-escalation as the use of verbal and physical expression ofempathy, alliance and non-confrontational limit setting with respect to achieve theresolution of a potentially violent and/or aggressive situation.Regardless of patient acuity, de-escalation is a key to reduce violent incidents on units aswell as seclusion and restraint. Greystone Park Psychiatric Hospital (GPPH) and theSchool of Nursing of the University of Medicine and Dentistry of New Jersey (UMDNJ)implemented the Four S Model (safety, support, structure, and symptom management)with the De-escalation/Alternative to restraint flow sheet as the framework to organizenursing interventions and improve patient care at the hospital. TheDe-escalation/Alternative to Restraint Flowsheet helps staff understand what behavioursto observe are and what interventions should be used.In the 4 S model, safety is defined as interventions that help secure patients physical andemotional well-being (e.g. reduce unpleasant stimulation). Support refers to interventionsthat decrease patients distress or anxiety and increase their experience of beingunderstood. Structure helps restore clients functional levels after stabilization. Anexample of providing structure is helping client set behaviour contract and remind clientexpectations of hospital community life. Symptom management addresses symptoms andprevents negative outcomes. Interventions include stress management, relaxationtechniques, diversionary interventions, grounding techniques, education/review resourcesand medication (Chabora, Judge-gorny & Kim, 2003).Maier mentioned two types of threat that mental health staff may face: threats that arebecause of escalation and threats that are used as part of manipulation and control. ThepdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA8first type of threatening behaviour is defined as hot and the second is cold. To handlethe hot threat, staff must be able to recognize early signs of aggression and try to gainsufficient time for the client to regain control of himself or herself before the situationescalate into an aggressive event. This can be achieved by implementing the interventionsin the 4 S model. However, Maiers suggest that reaction towards client who uses threatto gain control by manipulating staffs is to document all threats and discuss the event#p#分页标题#e#with security experts, such as the police if required. The rationale of such reaction is toencourage patients to take responsibility for their own behaviour (cited by Cowin et al.,2003).Improve ReportingIn IMH, staff nurses are writing most of the reports on patients mental state. Enrollednurses and healthcare attendants who also spend a lot of time with patients but theyusually verbally relate information about patients behavior to staff nurses and others.Nolan & Citrome (2008) supported that if a therapy aid manages an aggressive incident(e.g. verbal aggression) without assistant from other team members, the incident may notbe reported. Therefore, the current problem is some aggressive behaviour are notwitnessed by or reported to staff, those witness most of the aggressive behavior have lessopportunity to report what they see.Treating aggression in clients with mental disorders depend on accurate detection,description, and classification of behaviour. Improved reporting may have theunanticipated effect on reducing physical aggression in the ward, perhaps by promotingearly recognition and intervention in events that might otherwise escalate into moreserious aggression (Nolan & Citrome, 2008).pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA9Nolan & Citrome (2008) conducted a study to determine the effectiveness of improvingreporting in Clinical Research and Evaluation Facility (CREF) at the Nathan KlineInstitute in USA. The therapy aids were required to document patients location, activitiesand signs of aggression in the Patient Monitoring Form (PMF). In order to simplify andencourage report on aggression, codes were added to the form: VA stands for verbalaggression; PO for physical aggression against object; PAP for physical aggressionagainst persons and SAG for self-directed aggression. The researchers used audio andvideo recording to detect the aggressive incidents in the unit. At the end of study period,they compared the detected incidents with the reported incidents in the PMF. There wasan improvement in the reporting of aggressive incidents and decrease in physicalaggression.Advanced Crisis ManagementThe Roadmap to a Restraint-Free Environment developed by the National Association ofConsumer/Survivor Mental Health Administrators (NACSMHA) and published by theSubstance Abuse and Mental Health Services Administration support the use of advancedcrisis management (ACM). The ACM allows a person to specify in advance actions to betaken during times when he or she is unfit to make decisions. ACM is part of the#p#分页标题#e#Wellness Recovery Action Plan (WRAP).The ACM instructs the client to:1. Identify events that might trigger or increase symptoms.2. List things the client can do to relieve symptoms.3. Make a list of early warning signs before crisis.pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA104. Create a list of supporters who can take over responsibility for him/her and makedecisions in his/her behalf.5. Write down the medication that the client prefers to take and reason for choosingthose medications.6. List the treatments that the client would prefer in a crisis.7. Describe what are the actions indicate supporters can stop using this plan.The program believes that individuals naturally occurring crisis management techniquescan be used provided the plan is documented before the crisis occurs. Symptommanagement and self awareness is a central element in the treatment.ConclusionIt is difficult to determine the effectiveness of each intervention separately a lot ofinterventions are implemented at the same time. Emmerson et al. (2007) implemented anaggression management strategy included improve staff communication, new acutepharmacological treatment protocols, mandatory staff aggression management training,personal alarms and aggression risk assessment tools. One year after the introduction ofthe strategy, there was a reduction of 40% in aggressive incidents and a 56% reductionin staff injuries in 2005 compared to 2003 levels (Emmerson et al. 2007, p115).Based on Needham et al. (2004) research outcome, there is significant decrease ofcoercive measures after implementation of risk assessment tool followed by staff training.Bowers et al. (2006) worked on improving staffs attitude and working practices. Nosignificant change in containment method use but there were significant decrease inconflict occurred, with falls in aggression, absconding and self-harm. Further studies arerequired to examine the effectiveness of these interventions in the ward if they arepdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA11implemented locally. In the writers opinion, staff training and leadership are the mostimportant interventions to reduce use of seclusion and restraint in the ward. When themanagers and staffs are motivated to improve the quality of care, the rest of interventionscan be implemented properly.#p#分页标题#e#pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA12ReferencesAkmvik, R. & Woods, P. (1999) Predicting inpatient violence using the Broset ViolenceChecklist (BVC). International Journal of Psychiatric Nursing Research, 4(3),498-505. http://www.ukassignment.org/essayfw/Almvik, R., Woods, P., & Rasmussen, K. (2000). The Broset Violence Checklist:Sensitivity, specificity, and interrater reliability. Journal of Interpersonal Violence,15 (12), 1284-1296.Bowers, L., Brennan, G., Flood, C., Lipang, M. & Oladapo, P. (2006) Preliminaryoutcomes of a trial to reduce conflict and containment on acute psychiatric wards:City Nurses. Journal of Psychiatric and Mental Health Nursing, 13, 165172.Beech, B. & Bowyer, D. (2004). Management of aggression and violence in mentalhealth settings. Mental Health Practice. 7 (7), 31-37.Chabora, N., Judge-gorny, M. & Kim, G. (2003) The four S model in action for deescalation:an innovative state hospital-university collaborative endeavor. Journal ofPsychosocial Nursing. 41(1), 22-28.Davison, S.E. (2005). The management of violence in general psychiatry. Advances inPsychiatric Treatment, 11, 362-370.Delaney, J., Cleary, M., Jordan, R. & Horsfall J. (2001). An exploratory investigationinto the nursing management of aggression in acute psychiatric settings. Journal ofPsychiatric and Mental Health Nursing 8, 77-84.pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA13Duxbury J. (2002). An evaluation of staff and patient views of and strategies employed tomanage inpatient aggression and violence on one mental health unit: a pluralisticdesign. Journal of Psychiatric and Mental Health Nursing 9, 325337.Duxbury, J., Hahn, S., Needham, I. & Pulsford, D. (2008). The Management ofAggression and Violence Attitude Scale (MAVAS): a cross-national comparativestudy. Journal of Advanced Nursing 62(5), 596606.Emmerson, B., Fawcett, L., Ward, W., Catts, S., Ng, A. & Frost, A. (2007) Contemporarymanagement of aggression in an inner city mental health service. AustraliaPsychiatry, 15 (2), 115-119.Haimowitz, S., Urff, J. & Huckshorn, K.A. Restraint and seclusion a risk managementguide (2006). National Association of State Mental Health Program Directors(NASMHPD).Available:Maguire, J. & Ryan, D. (2007). Aggression and violence in mental health services:categorizing the experiences of Irish nurses. Journal of Psychiatric and Mental#p#分页标题#e#Health Nursing 14, 120127.National Institute for Clinical Excellence (2006) Violence: The short-term managementof violent (disturbed) behaviour in adult psychiatric in-patient and accident andemergency settings. London: NICE.pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA14Needham, I., Abderhalden, C., Meer, R., Dassen, T., Haug, H.J., Halfens, R.J.G. &Fischer, J.E. (2004) The effectiveness of two interventions in the management ofpatient violence in acute mental inpatient settings: report on a pilot study. Journal ofPsychiatric and Mental Health Nursing 11, 595-601.Nolan, K.A. & Citrome L. (2008) Reducing inpatient aggression: Does paying attentionpay off? Psychiatr Q 79, 9195.Rew, M. & Ferns, T. (2005) A balanced approach to dealing with violence andaggression at work. British Journal of Nursing,14(4), 227-232.Substance Abuse and Mental Health Services Administration (SAMHSA), Roadmap to aRestraint-Free Environment (2005), available atJanuary 2010).essay pdfMachine – is a pdf writer that produces quality PDF files with ease!Get yours now!“Thank you very much! I can use Acrobat Distiller or the Acrobat PDFWriter but I consider yourproduct a lot easier to use and much preferable to Adobe’s" A.Sarras – USA
