Medicine and Health Sciences Commons^™

A Response Team Approach To Reducing Restraint Use In The Emergency Department, Sarah Place

Doctor of Nursing Practice Scholarly Projects

Assaults on staff are doubling in the healthcare field, and due to the urgent need to secure the environment, the use of restrictive measures is at times, the safest choice. The following project examined the implementation of a Behavioral Emergency Response Team approach in an Emergency Department, and the effects it had, on reducing the use of violent restraints, assaults on staff, and increase confidence of staff in managing difficult situations. An anonymous survey was used to measure staff confidence while handling agitated patients, and an event report was used that identified if de-escalation techniques were employed to assist in …

Acute Agitation Intervention Tool For Reduction Of Polypharmacy, Brooks J. Propst

Dissertations

Introduction: Patients with behavioral health diagnoses are among the highest risk for
aggression. For pediatric patients with behavioral health needs, urgent treatment is
needed for aggressive behavior, due to the potential unwanted outcomes. The purpose of this Quality Improvement (QI) pilot project was to implement an Acute Agitation Intervention Tool that uses the Broset Violence Checklist (BVC) to guide
pharmacological intervention for mild and moderate to severe agitation in pediatric
patients with behavioral health needs ages 8 to 18 to decrease the number of medications that patients are getting per agitation event over a 12-week period.

Methods: This QI included …

Decreasing Restraint Use By Utilization Of Agitation Assessment And Verbal De-Escalation Strategies In An Inpatient Non-Psychiatric Hospital, Kiera Paulo

DNP Qualifying Manuscripts

Background: This paper reviews the literature on ways to decrease the use of restraints in hospitals – specifically the use of agitation assessments and verbal de-escalation to be implemented in healthcare facilities to decrease the number of restraints being used to manage undesirable patient behavior and workplace violence incidents. Problem: Restraints have been shown to impede the nurse-patient relationship and cause emotional and physical trauma to staff and patients. They are no longer considered preferred management and in some circumstances can be considered abuse. Intervention: Agitation assessments and verbal de-escalation have been shown to produce less aggressive behavior and decrease …

Does The Use Of Aromatherapy Massage Reduce Agitation In Elderly Patients With Dementia?, Nicole A. Frinzi

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Does the Use of Aromatherapy Massage Reduce Agitation in Elderly Patients with Dementia?”

Study Design: A systematic review of two randomized controlled trials (RCTs), and one cohort study published between 2010 and 2020.

Data Sources: All studies were discovered using PubMed. The articles were published in English in peer-reviewed journals and selected based on relevance to the clinical question.

Outcome Measured: The outcome measured was a reduction in agitation symptoms. Outcomes were measured through the Cohen-Mansfield Agitation Inventory (CMAI). A similar scale was used among all …

Implementation Of An Agitation Scale In Three Emergency Departments In An Urban Area Of Northern California, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Background. Behavioral health patients in the emergency department are customarily treated without an objective assessment of agitation at presentation and throughout their hospital stay.

Local Problem. Behavioral health patients presenting with agitation in three emergency departments in Northern California are customarily treated with activation of a Code Grey emergency alert, use of physical restraints, or emergent sedation medication administration to manage the situation, prevent escalation, and protect the staff.

Context. Agitation in patients that is not recognized can lead to emergent sedation medication administration, physical restraints placed, and Code Greys activated to support the clinical staff.

Interventions. An evidenced-based agitation …

Behavioral Health Patients And Agitation In The Emergency Department: A Synthesis Of Literature, Adam Pelzl

Doctor of Nursing Practice (DNP) Projects

Abstract

Introduction: Patient agitation is a phenomenon that presents itself to the emergency department (ED) on a daily basis. Agitation can manifest from an array of physical or psychological complaints. Behavioral health patients presenting with agitation is a growing subset of the total agitation population within EDs. A better understanding of behavioral health patient agitation in the ED setting is needed to guide best practices in treating this fragile population with therapeutic, patient-centered care.

Methods: A review of literature was conducted on agitation and behavioral health in ED settings, using the search terms emergency department, agitation, restraints, sedation, and behavioral …

A Model Of Agitated Behavioral Symptoms In Persons With Alzheimer Disease, Katherine Kero

Wayne State University Dissertations

Background: Worldwide population trends are shifting with the population of Elders expected to dramatically increase in absolute and relative numbers in coming years. Alzheimer Disease (AD) is a common and costly disease of aging with agitation being the most poorly managed and detrimental behavioral symptom of the condition. The Nursing Theory of Unpleasant Symptoms provides a conceptual basis for understanding agitated behavioral symptoms associated with AD in the context of its antecedent causes and outcomes of the symptoms.

Purpose: The purpose of this dissertation was to model the predictors and outcomes of agitated behavioral symptoms in persons with AD. The …

The Impact Of Depakote On Agitation And Short-Term Memory In Nursing Home Dementia Residents, Kristin E. Fazzolari-Pleace

Walden Dissertations and Doctoral Studies

Researchers have linked dementia to common psychiatric symptoms such as agitation and aggression, known as behavioral and psychological symptoms of dementia (BPSD). To treat residents manifesting BPSD, nursing homes (NHs) use psychoactive medications. However, research is limited and inconsistent regarding the impact of Depakote treatment on agitation and short-term memory (STM) in NH residents who have dementia. The purpose of this nonexperimental quantitative study was to evaluate for 1 year the impact of Depakote treatment on agitation and STM in NH residents as measured by each resident's Minimum Data Set (MDS). Moncrieff and Cohen's drug-centered theory served as the theoretical …

The Correlation Of Size Of Core Network And Frequency Of Contacts With Agitation And Positive Affect In Elderly With Dementia, Amal Ali Al Ghassani

Theses and Dissertations

In the country of Oman, care needs of older adults are primarily provided by family members in the home. The study was guided by socioemotional selectivity theory, the environmental vulnerability hypothesis, and the need-driven dementia-compromised behavior theories. The central premise was that the size of the person’s activities of daily living (ADL) core network and frequency of contact with the ADL core network would predict agitation and affect. A smaller core network with a higher frequency of contact may be better at identifying and treating the person’s unmet needs. A secondary premise was that the emotional closeness of the core …

Using Music Intervention To Reduce Anxiety And Agitation For Dementia Residents In Long Term Setting, Sonia Brown

Walden Dissertations and Doctoral Studies

Abstract

Dementia is one of the degenerative conditions that present in old age with a decline in cognitive function resulting in changes in personality and the ability to carry out activities of daily living and social functions. Dementia is usually associated with behavioral disturbances that include anxiety and agitation that pose a challenge for family members or caregivers in an alternate home or care-related facility. The purpose of this project was to design and implement a quality improvement program to evaluate music therapy intervention for residents in a long-term care who have dementia. The aim was to evaluate if music …

The Effect Of Music Listening On Anxiety And Agitation In Adult Mechanically Ventilated Patients: A Systematic Review, Kristen M. Trowbridge, Hailee N. Horstman

Williams Honors College, Honors Research Projects

Mechanical ventilation causes anxiety and agitation in patients in intensive care units, which increases risk for complications and prolonged hospital stays. Since pharmacological interventions have adverse effects and are not always effective at reducing anxiety and agitation, nonpharmacological interventions, such as music listening, could be considered. The purpose of this systematic review is to identify, review, and critically appraise the evidence from studies that examined the effect of music listening, compared with standard care, on anxiety and agitation in mechanically ventilated patients in the intensive care unit (ICU). Using search engines, data bases, key words, and criteria, twenty studies are …

Patient Discomfort In The Icu: Ett Movement Effects, Virginia Hamilton

Theses and Dissertations

Critically ill patients who require MV are at risk for a number of complications, including the development of ventilator-associated events (VAE) and agitation that may require the use of sedation. Patients experience anxiety and discomfort during mechanical ventilation from a variety of sources including unfamiliar breathing assistance and an inability to communicate anxiety and pain verbally, but a primary cause of discomfort identified by these patients is the simply the presence of the endotracheal tube (ETT). Discomfort often leads to agitation and may be exacerbated by ETT movement. Management of agitation typically involves the use of sedative therapy and has …

De Concentv Amisso Qvaerendo: An Investigation Into The Relative Benefits Of Three Different Types Of Ambient Music On The Observed Agitated Behaviour And Quality Of Life Of Dementia Sufferers In Residential Aged Care Facilities, Peter Wilkinson

Theses: Doctorates and Masters

There is an increasing body of research evidence to support the use of music as a therapeutic modality in reducing the agitated behaviour frequently associated with late-stage dementia. Although much of this evidence suggests that music interventions are most effective when they are “individualized”, this type of intervention is often difficult to implement in large, busy, aged care facilities where residents may be located together in communal areas during the day. The challenge therefore is to try and identify a particular musical genre which, when played as “ambient” or “background” music, demonstrates a consistent capacity to reduce agitated behaviour in …

Predictors Of Agitation In The Critically Ill, Ruth Burk

Theses and Dissertations

BACKGROUND: Agitation is a common complication in the intensive care unit (ICU) manifested in behavior and actions that range from simple apprehension or anxiety to frankly combative behavior.5 Agitation is associated with significant adverse outcomes.1-3 Studies report up to 71% of ICU patients have some degree of agitation during their ICU stay and that agitation is observed 32% of the time.3;4 Potential causes of agitation in critically ill patients are numerous; however, data about factors that predict agitation are limited. OBJECTIVE: The specific aim of this study was to identify predictors of agitation on admission to the ICU as well …

Familiar Physical Activity To Familiar Music: The Effects On Apathy, Agitation, Eating Ability, And Dietary Intake In Institutionalized Older Adults With Dementia, Janet Ruth Moore

Open Access Dissertations

Background: Many older adults with dementia residing in nursing homes or assisted living facilities exhibit behavioral disturbances such as agitation and apathy. In addition they lose their ability to feed themselves and often suffer serious malnutrition as their dietary intake decreases. Music has been linked to decreased agitation in this population and physical activity to music linked to a slower decline in eating ability. Purpose: The purpose of this study was to examine whether a familiar physical activity to familiar music would reduce apathy and agitation and increase eating ability and dietary intake among institutionalized older adults with dementia. Method: …