Preferred Name

Karen Dorr

Creative Commons License

Creative Commons License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Date of Graduation


Document Type


Degree Name

Doctor of Nursing Practice (DNP)


School of Nursing


Jeannie Garber

Maria G. DeValpine


The use of seclusion and restraint on psychiatric units can result in physical harm or even death to patients and may inflict further harm on those who have a history of abuse (Valenkamp, Delaney, & Verheij, 2014, p. 170) (Greene, Ablon, & Martin, 2006) (Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Reduction in seclusion and restraint is a basic tenant of trauma informed care. This retrospective review and program evaluation examines the implementation of a new care model on an adolescent psychiatry unit at a large suburban hospital. The new care model incorporated the use of collaborative problem solving, an intervention shown to reduce seclusion and restraint on adolescent psychiatry units (Bonnell et al., 2014) (Ercole-Fricke et al., 2016) (Greene et al., 2006) (Martin et al., 2008) (Pollastri et al., 2016) (Pollastri et al., 2013) (Regan et al., 2017) (Valenkamp et al., 2014) The theoretical framework used was Chen’s theory driven framework for program evaluation (Chen, 2012). This model incorporates an action plan that examines the implementation and a change model that determines success using outcomes measures. The quantitative outcomes measures used to determine the successful implementation of the care model was the use of seclusion and restraint. Seclusion and restraint data was gathered for the new unit and for the years 2009-2011. The hospital did not provide adolescent care from 2012-2018. Quantitative data was analyzed comparing the rates of seclusion/restraint using the new care model compared to the rates using the former care model. Data showed a significant reduction in the use of seclusion using the new care model p-valuep-value=0.618414. Opportunities for improvement in the care model implementation included ongoing training and leadership support. Strengths included the program implementors themselves, the environment for care model implementation, and the culture of professional development at the hospital. The most significant challenge of the implementation was the cultural mismatch between the care model that encouraged flexibility and collaboration and the hospital culture that required strict rule adherence and rigid thinking.

Key words: collaborative-problem-solving, Chen, seclusion, restraint, program evaluation, adolescent psychiatry

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Nursing Commons



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