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Dissertation/Thesis Abstract

Reducing the Use of Physical and Chemical Restraints Through Enhanced De-Escalation Training in Adult Inpatient Psychiatry
by Orlick, Alec, D.N.P., Wilkes University, 2020, 117; 28088013
Abstract (Summary)

To mitigate patient aggression and ensure safety, providers employ coercive methods such as restraints and seclusion (R/S) and involuntary intramuscular psychotropic medication (IIPM). This quantitative quality improvement project investigated whether training in deescalation techniques would reduce R/S and IIPM usage 20% over four weeks. Provider attitudes and confidence were also assessed using the Confidence in Coping with Patient Aggression Instrument (CCPAI) and the Staff Attitude to Coercion Scale (SACS, Husum et al., 2008; Thackrey, 1987). De-escalation training included Safewards and Project BETA (Bowers, 2014; Richmond et al., 2012; Safewards, 2019). Thirty-two registered nurses (RNs) and 18 Personal Care Technicians (PCTs) working on an urban inpatient psychiatric unit participated in a one-hour training (n = 50). Electronic health record data was collected 28 days pre- and 20 days post-intervention. CCPAI results reflected statistically significant (p = 0.28) increases in provider confidence. PCTs were more likely to view coercion as a viable treatment option preand post-training (p < 0.0005, SACS Subscale 3). Participants with more education were less likely to view coercion as favorable pre- (ρ = -.513) and post-survey (ρ = -.324). Behavioral health emergencies, including IIPM usage, dropped 50.1% (p < 0.01, z = 2.7) post-intervention. Results did not reflect a direct correlation between de-escalation training and a reduction in R/S, however training did increase provider confidence and positively shape attitudes away from coercive methods. De-escalation may support a reduction in IIPM, though more research is needed to refine data collection.

Indexing (document details)
Advisor: Loftus, Toni Ann, Frankle, William Gordon
School: Wilkes University
Department: Public Health
School Location: United States -- Pennsylvania
Source: DAI-B 82/2(E), Dissertation Abstracts International
Subjects: Mental health, Nursing, Medicine
Keywords: Coercion, De-escalation, Patient aggression, Restraints, Seclusion, Training
Publication Number: 28088013
ISBN: 9798664739039
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