PubMed · 4731797
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L Eisenberg. 1973. Psychiatric intervention.. https://doi.org/10.1038/scientificamerican0973-116
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This article describes the use of rapid response teams to reduce the use of mechanical restraints (i.e., restricting a person's movement through the use of a mechanical device such as a backboard, net, or papoose) in an acute psychiatric care setting. Rapid response teams have proven highly effective for emergent medical patients, but have not typically been used in behavioral health care settings. Utilizing a rapid cycle process improvement approach, a response team was convened following each episode of mechanical restraint in an inpatient psychiatric treatment facility. Initial results, during a 6-week rapid cycle change process, showed that mechanical restraints were reduced by 36.4% when compared with a 6-week baseline and when compared with a 1-year baseline. Changes in hospital census during the implementation process did not appear to account for the reduction in restraints. Rapid response teams and rapid cycle process improvement are discussed as useful change vehicles for behavioral health care organizations.
There are around 350 psychiatric intensive care units but standards vary. Guidelines have been published, bu there is no obligation to follow them. A number of units are inappropriately equipped--for example, 35 per cent lack single-sex facilities. Many PICU beds are blocked by patients who should be treated in low-secure units.
BACKGROUND: The concept of caring is described as intangible, abstract, and invisible in nursing practice. This has translated into a view of caring as a personal choice or natural obligation rather than a deliberate process. While there has been movement to delineate caring within nursing in general, the psychiatric nurse's perspective on caring has been absent from theoretical works and measures constructed to describe nurse's work. OBJECTIVES: To develop a substantive grounded theory of caring from the perspective of Registered Nurses working with patients in three Canadian acute psychiatric hospital settings. DESIGN: The qualitative research design of grounded theory methodology was used to develop a theory of caring. SETTINGS: Three urban, acute psychiatric hospital settings in Canada. Two were general hospitals and one was a psychiatric hospital. PARTICIPANTS: Registered Nurses (N=17) licensed with the College of Nurses of Ontario. METHOD: In-depth interviews with Registered Nurses were conducted using theoretical sampling. The data were analysed using constant comparative analysis. RESULTS: Protective empowering is the basic social psychological process that represents Registered Nurses' caring with patients in acute psychiatric hospital settings. Nurses accomplish protective empowering through six main categories of: (1) respecting the patient; (2) not taking the patient's behaviour personally; (3) keeping the patient safe; (4) encouraging the patient's health; (5) authentic relating; and (6) interactive teaching. The six main categories were accomplished through 27 subcategories. In the theory of protective empowering, the goal is to help patients participate in activities contributing to convalescence, health, and/or quality of life. CONCLUSIONS: The theory of protective empowering provides six main categories and 27 subcategories that can be transferred to funding formulas, patient health record documentation systems, nurse orientation and education programs, nurse role descriptions, and used in guiding discussions about organizational values of patient-centred care within a collaborative multidisciplinary context.