Psychiatric and Mental Health Nursing Commons^™

Reducing Restraints In Adolescent Psychiatric Inpatient Units Through Trauma-Informed Care, Alanna G. Mejia

Doctor of Nursing Practice Final Project Abstract

Purpose: This Doctor of Nursing Practice project explores the impact of implementing trauma-informed care (TIC) training and screening interventions within an inpatient adolescent psychiatric unit. The goal is to reduce physical restraint use and improve patient care by fostering a more compassionate and effective treatment approach.

Background: Adolescents in psychiatric settings often experience restraints, which can cause trauma and harm therapeutic relationships. Implementing TIC strategies equips staff with de-escalation techniques and structured trauma screenings, creating safer environments and improving patient outcomes.

Methodology: The Plan-Do-Study-Act (PDSA) cycle was chosen to guide improvements, aligning with best practices in quality improvement by allowing …

Increasing The Frequency Of Behavior Assessment To Reduce Physical Restraint, Breanne N. Ford

Doctor of Nursing Practice Final Project Abstract

Purpose: The purpose of this quality improvement (QI) project was to implement a system that routinely assesses for behavior changes in psychiatric patients presenting to the emergency department to improve staff intervention of escalating behaviors and decrease physical restraint use.

Background: The project was implemented in a 45-bed emergency department in a community-based hospital affiliated with a large hospital system in Houston, Texas.

Methodology: The project utilizes the Behavioral Activity Rating Scale (BARS) to assess patients' behaviors at routine intervals throughout shifts and a comfort cart that houses several non-pharmacological intervention items to use to de-escalate adverse behaviors. The staff …

Improving Mental Health Outcomes For Amputees, Zachary Elmore

Dissertations

Problem: depression, anxiety, and other mental health disorders are more commonly diagnosed in the amputee population related to changes in mobility, activities of daily living, and quality of life (Turner et al., 2020.) As the amputation population is projected to reach over 3 million Americans in the next 25 years, additional screening is imperative to identify patients at high-risk for mental health deterioration (Ziegler-Graham et al., 2018).

Methods: this was a project that included screening all patients with the Personal Health Questionnaire for Depression (PHQ-8) meeting the inclusion criteria of being admitted to 7500 Vascular Surgery at Barnes-Jewish …

Nursing Interventions For Psychosis And Other Mental Health Crises: A Hermeneutical Phenomenological Study Of Nurses’ Experiences, Christopher Jasensky

Dissertations

The nursing profession experiences caring for patients suffering psychosis and managing crises events in a way that is unique to all other healthcare providers. A gap in research and literature exists related to this phenomenon. The purpose of this study was to examine the lived experiences of nurses caring for patients experiencing psychosis or some other severe mental health issue. By analyzing the common expressions and behaviors of nurses in situations involving care of psychosis, the meaning of the care giving experience and thus, an understanding of the interactions involved with caregivers in psychosis was revealed. Participants provided experiential, firsthand …

Medication Adherence Via A Smartphone Application, Robert B. Marsh

Seton Hall University Dissertations and Theses (ETDs)

Medication adherence among the mentally ill is critical.

Increasing Colorectal Cancer Screening Rates In The Psychiatric Inpatient Unit, Diane R. Ventura

Master's Projects and Capstones

Increasing Colorectal Cancer Screening Rates in the Psychiatric Inpatient Unit

Abstract

Problem: Colorectal cancer is one of the leading cancer deaths in the United States. The Psychiatric Inpatient Unit has a colorectal cancer screening compliance rate of 40% compared to the statewide average of 80%.

Context: The Psychiatric Inpatient Unit is a 58-bed inpatient intermediate care facility mental health program in Northern California. Upon review of the EMR, most PIU nurses give verbal instructions and patient education on colorectal cancer screenings when due. Still, no printed handout was provided to the patients upon review of the EMR.

Intervention: Review of …

Evaluation Of A Dirfloortime® Program For Autism Spectrum Disorder, Jennifer L. Pipitone

Dissertations

Problem. Parents with children who have neurodevelopmental disorders, such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) experience high levels of parenting stress. The prevalence of ASD is on the rise in the United States. As a result, there has been an increase in the use of treatment modalities, in effort to better understand which modalities have the most positive impact on children and their parents. DIRFloortime® is a developmental treatment modality used to help strengthen the parent-child bond and used to decrease parental-child stress. The Autism Parenting Stress Index (APSI) measures the impact of an intervention …

The Effectiveness Of Mixed Personality Trait Analysis With Multiple Stress Education Model In Coping With Stress Among International Students In American, Xiaoyang Mei

DNP Research Projects

No abstract provided.

Decreasing Psychiatric Readmissions In A Nonprofit Behavioral Health Hospital, John Schreiber

Doctoral Dissertations and Projects

This scholarly project aimed to decrease adult readmission rates of psychiatric patients in a Nonprofit Behavioral Health Hospital (NBHH). The project aims to decrease the number of readmissions to an NBHH by 25% using specific interventions that have been revealed through a literature review of evidence-based practices (EBPs). A literature review revealed focused EBP interventions that could decrease readmissions. The PICOT question for this project was, "In adult mentally ill patients who are in an NBHH, what is the effect of focused interventions compared with usual care on readmission rates in 2 months?" Reducing the number of psychiatric readmissions is …

Psychiatric Patients’ Perception Of Involvement In The Plan Of Care, Jaspal Kaur Gill

Dissertations

Background: There is an increased need to actively engage and involve patients in their care planning in healthcare facilities including psychiatric facilities (Wills, Riefer, Schauer, & del Vecchio, 2011). There has been a growing interest in patient-centered care and patients’ involvement in their plan of care as it leads to positive healthcare outcomes and increased patient satisfaction. However, there is a lack of research on how psychiatric patients perceive their involvement in the care planning while they are admitted to an inpatient psychiatric facility.

Aim: The aim of this qualitative phenomenological research study was to explore patients’ perception …

Reexamining Overuse Of Frequent Observation For New Admissions On Psychiatric Units To Increase Nurse/Patient Engagement, Samuel Novela

Master's Theses

People in California who suffer from mental health conditions are often admitted involuntarily to hospitals on 72 hour psychiatric evaluation holds if they are deemed imminently dangerous to themselves, or others, or are gravely disabled. Observational patient safety checks are performed and based on patient acuity and hospital standards. Variations exist among different clinical settings with regard to best practices and the patient subpopulations that may warrant less frequent safety checks. Nurses experience different levels of satisfaction with regard to frequency of safety checks because there is no national consensus on which subsets of patients may require them. A senior …

Evaluation Of A Youth Emergency Room Enhancement Program For Behavioral Health, Anne Thatcher

Dissertations

Problem. Pediatric mental health complaints and subsequent hospitalizations have been steadily increasing. The Behavioral Health Network (BHN) developed an intensive outreach case management program aimed at reducing youth mental health emergency department (ED) visits and inpatient psychiatric admissions. The Youth Emergency Room Enhancement (YERE) program was a process improvement initiative to provide immediate case management to youth and caregivers for mental health care.

Methods. A Plan-Do-Study-Act (PDSA) method utilizing a retrospective case record review occurred over a six-month period. A convenience sample of youth aged 6-20 years presenting to one of eight healthcare facilities for either ED or inpatient hospitalization …

Metabolic Syndrome Screening Among Inpatient Psychiatric Patients, Susan Magorno

Doctor of Nursing Practice Final Manuscripts

Background: More than 50% of patients with severe mental illness carry undiagnosed Metabolic Syndrome (MetS) comorbidities of hypertension, hyperlipidemia, or diabetes. These patients are three times more likely to die of cardiovascular-related causes; however, this population is not routinely assessed for MetS and frequently lack appropriate treatment.

Objective: The objective is to implement a screening tool designed to identify risk for MetS and trigger appropriate treatment.

Design: The screening tool triggers the provider to address positive criteria through interventions such as further evaluation, medical and/or diabetes educator consultation.

Results: Although overall rates of screening improved significantly, follow-up interventions were …

Identification Strategies For The Very High Fall Risk Patient In An Acute Inpatient Psychiatric Unit, P6 Inpatient Geri-Med Psychiatry, Haley Pelletier, Suneela Nayak, Stephen Tyzik, Ruth Hanselman

MaineHealth Maine Medical Center

Patients falling as a result of geriatric and psychiatric impairments are at a much higher risk than the average patient population. An acute care inpatient psychiatric team used baseline metrics to demonstrate increasing fall rates per month that surpassed the unit’s target number. As a result, a quality improvement project around falls was felt to be warranted.

The overall goal of this study was to improve patient safety by reducing falls for their very high risk fall population. A root cause analysis determined that this population was not being properly identified and several tools were developed and employed to better …

The Use Of Seclusion And Restraints In The Inpatient Psychiatric Hospital Setting: A Systematic Review Of The Literature, Angela M. Kaucic

Williams Honors College, Honors Research Projects

The use of seclusion and restraint (S/R) is a practice that has been shown to be potentially harmful to patients on a physical and emotional level. This review examines 20 research publications in order to address the attitudes of staff and service users regarding use of this intervention, as well as to explore how use of alternative behavioral and environmental modification interventions compares to standard nursing care in terms of S/R prevalence. The review found that there are many viable interventions alternative to S/R that are more palatable to patients and nurses. Variability of interventions addressed in the included studies …

Evaluation Outcomes Of Delirium And Abrupt Discontinuation Of Psychiatric Medications Of The Adult Acute Care Patient, Latoya Lee

DNP Projects

PURPOSE: Delirium remains a common consequence of critical illness and is known to cause negative patient outcomes during an intensive care unit (ICU) stay. Hence, the purpose of this project is to evaluate the outcomes of patients taking psychiatric medications whose medications are abruptly discontinued upon admission to an ICU. Specifically, the outcomes of interest will be altered mental status, length of hospital stay, restraint use and mortality.

METHODS: A correlational analysis using a retrospective chart audit was conducted on 602 patients admitted to the Neurological/ Neurosurgical ICUs at the University of Kentucky Chandler Hospital from January 2015 to December …

Developing Psychiatric Nursing Competencies On An In-Patient Hospital-Based Psychiatric Unit, Beverly J. Sedlacek

Doctor of Nursing Practice Projects

Problem Statement

Offering staff development training for psychiatric nurses has not kept pace with the advances in psychiatric knowledge and skills in nursing. Purpose: The purpose of this quality improvement doctor of nursing (DNP) project was to implement a competency-based staff development program on a community hospital-based inpatient psychiatric unit to determine if the psychiatric/mental health nursing knowledge, nurse patient relational skills, and attitudes of the nurses would improve or change.

Methods

A mixed method of quasi-experimental, non-randomized pre-test/post-test and semi-structured interview design was used, which utilized a convenience sampling approach. Data were collected in two phases. Three domains of …

Improving Quality And Efficient Communication Between Providers And Nursing - A Psychiatric Sbar Tool (Psych), Karen Lee Richards

Master's Projects and Capstones

IMPROVING QUALITY AND EFFICIENT COMMUNICATION BETWEEN

PROVIDERS AND NURSING - A PSYCHIATRIC SBAR TOOL (PSYCH)

Karen Richards

University of San Francisco

Abstract

Effective communication is the cornerstone of providing safety and quality healthcare. However, nursing and providers often share information inequitably, as these disciplines are trained differently regarding communication. Providers are taught to be brief, accurate and focused while nurses are taught to be descriptive and holistic. These differences have led to disparity in the sharing of valuable patient information, subsequently leading to increased frustration, inefficiency, and medical errors. Multiple studies provide evidence that poor communication is a major contributor …

Recovery-Oriented Care And Inpatient Psychiatric Nursing Practice, Julia M. Mclaughlin

Master's Projects and Capstones

For the past 15 years, major organizations such as the World Health Organization (WHO), Substance Abuse and Mental Health Services Administration (SAMHSA), and U.S. federal government have been committed to shifting mental health services from the medical model of care to the recovery-oriented model of care (Moller & McLoughlin, 2013). However, not all identified recovery-oriented practices have been fully implemented throughout mental health services, specifically in acute care settings. In 2015, San Mateo Medical Center’s acute psychiatric nursing staff completed McLoughlin’s (2005) Recovery Self-Assessment- Registered Nurse (RSA-RN). Data showed that 34% of nursing staff did not believe that the nurses …

Implementing An Intervention To Reduce Seclusion And Restraints In An Inpatient Psychiatric Hospital, Amanda B. Lykins

Doctor of Nursing Practice Projects

The need to enhance nursing staff’s knowledge, perceptions and attitudes around alternatives to seclusion and restraint has been well validated in the literature. Seclusion and restraint use in the inpatient psychiatric setting are highly dangerous physical interventions, used to control the behavior of a mentally ill patient who is a danger to self or others. Seclusion and restraint events have the potential to cause emotional trauma, physical injury to patients or staff and the possibility of patient death. The purpose of the capstone project was to implement an evidence-based education program to, improve nursing staff’s (RN, LPN, MHA and SRNA) …