Title

An Evidence-Based Intervention to Reduce the Use of Physical Restraints in a Female Adolescent Population at an Inpatient Psychiatric Unit

Date of Degree

12-2019

Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)

Program

Nursing

Advisor

Christopher P. Weidlich

Abstract

The use of physical restraints within psychiatric units is problematic since it raises a range of legal, ethical, and clinical questions (American Psychiatric Nurses Association, 2014). The use of physical restraint has become a common practice in many psychiatric units despite the negative effects associated with its use. Selecting strategies such as verbal de-escalation to manage aggressive psychiatric inpatients shows promise with patients when used by providers and staff in mental health facilities. The purpose of this evidence-based project was to introduce and train staff to utilize the Modified Overt Aggression Scale (MOAS) and verbal de-escalation in psychiatric units in a residential psychiatric treatment center with aggressive female inpatients aged 13-17 years. The primary objectives were to reduce the selection of physical restraints and time used to restraint to less than an hour, assess 100% of the target population, educate providers/staff the use of MOAS and verbal de-escalation, and review intervention choices selected by staff. The intervention included implementing MOAS scale, training staff to use verbal de-escalation, and pre/posttest surveys to evaluate the effectiveness of verbal de-escalation techniques. Between January and April 2019, 20 patients met the inclusion criteria. Following the intervention, documented physical restraints decreased by 89%, time spent in restraints decreased to 10 minutes, 100% of the staff was trained, 18 patients were assessed, and 18 intervention choices were reviewed. Results suggest that a combination of MOAS scale along with staff training on verbal de-escalation can influence and reduce the selection of physical restraints in the inpatient psychiatric unit.

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