Preferred Name
Huma Moez Nayani
Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License
ORCID
0009-0005-7945-6573
Date of Graduation
12-14-2024
Semester of Graduation
Fall
Degree Name
Doctor of Nursing Practice (DNP)
Department
School of Nursing
First Advisor
Erika Sawin
Abstract
Background: Seclusion and restraint (SR) or restrictive intervention in inpatient/ acute psychiatric hospitals, emergency departments, crisis stabilization units, residentials, or group homes is a pressing and an immediate concern in mental health settings, particularly for children and adolescents, for whom SR rates are higher. The Joint Commission and other national organizations have made significant strides in prioritizing the reduction and elimination of SR among children and adolescents due to its negative physical and psychological consequences.
Objective: This DNP project will aim to provide the results of a policy analysis to present evidence-based techniques and a resulting re-envisioned policy recommendation to reduce SR among children and adolescents.
Method: The SR policy was analyzed using the Bardach/ Collins Eightfold Path to Policy Analysis as implemented by Collins (2005) and the Institute for Healthcare Improvement (IHI) Quadruple Aim framework (IHI, 2020). Review of the 2023 Joint Legislative Audit and Review Commission (JLARC) report #584 highlighted SR data which provided a summary on nine state inpatient psychiatric hospitals in the one southeastern state.
Results: According to the 2023 JLARC report, the use of SR in one state in the southeastern United States is significantly higher compared to average national rates. Among all the state hospitals in this southeastern state, the facility for children and adolescents uses restraints and seclusion at a rate that is 20 times higher than the national average.
Conclusion: This health policy analysis postulates that these restrictive practices are associated with trauma and re-traumatization which leads to exacerbation of physical and psychological consequences. Analysis identified that incorporating evidence-based trauma-Informed care de-escalation concepts in the revised ideal policy is necessary to prevent further re-traumatization, promote healing and recuperating, and improve quality of care and life among children and adolescents, a particularly vulnerable population in inpatient psychiatric settings.
Keywords: seclusion, restraint, evidence-based, trauma informed care de-escalation, children and adolescents, vulnerable population, trauma, re-traumatization.
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