Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s

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Practice Experience: Quality Improvement Storyboard

Storyboard Instructions

The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The storyboard highlights key aspects of a quality improvement effort by documenting the Practice Experience Project from beginning to end.

The course template uses a PowerPoint format to complete this assignment. You only need to provide two slides, no more. The first slide is the summary of your project; the second slide is the reference page. You will need to choose the most pertinent information from your practice experience and Capstone Paper to complete the Storyboard. No voiceover is required.

The completed storyboard is submitted for grading. Optional: You may submit your storyboard to the group discussion area and share your presentation with your classmates and instructor.

Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
Excessive use of restraints and seclusion in mental health children and adolescents Introduction Physical constraint can be defined as using force to prevent and restrict the natural movement of any part of a patient’s body. On the other hand, seclusion is socially isolating patients from other people. Restrictive strategies such as excessive restraints and seclusion have been used in the mental healthcare industry for a long time as a reactive intervention to aggressive behaviors among patients, especially children, and adolescents. Many experts agree that physical restraints often cause significant bodily injury to the patients, but the psychological effects of the practice are often ignored. Despite the knowledge that physical restraint often causes physical injuries among mental health patients, the technique is widely practiced in many mental healthcare facilities. Impact of physical restraint and seclusion This practice causes a deep mistrust between mental health care patients and their caregivers, significantly hindering the success of the treatment plans. Mental healthcare practitioners argue that the practice is essential in ensuring the safety of all stakeholders in the facility. The procedure is deemed necessary to prevent the children and adolescents from hurting themselves or the people around them. However, with the dawn of the Age of information, more people are informed about their rights and liberties as patients. Thus, mental healthcare practitioners who use this practice face severe legal, ethical, and moral challenges.  The physicians must carefully assess their reaction to their patients’ violent behaviors. They should consider the rights and freedoms of all patients. This includes the rights to self-determination, dignity, security, and physical integrity. Research into the use of physical restraint and seclusion Researchers have established that physically restraining patients negatively affects their mental health (Department of Health, 2017). Restrained patients are likely to develop other mental complications such as mood disorders. However, some violent and aggressive behaviors such as kicking others, spitting on people, damaging property, hurting oneself, or other people may necessitate the use of physical restraint and seclusion among mental health care patients. Nevertheless, the physicians enforcing these techniques should understand their impact on the patient’s psychological and physical well-being. Researchers have also established that executing these techniques has a negative psychological effect on the staff. (Tölli, 2017). The healthcare facility’s staff may experience ugly emotions such as unnecessary anger, fear, and anxiety due to the consistent implementation of these practices (Mérineau‐Côté, 2014). This contributes to increased staff turnover in the facility, which is very costly (Department of Health, 2017). A local example In my practice setting which also is my place of employment, I  investigate the prevalence of this practice. The facility’s COO ( Chief Operating Officer) Paula Roberts RN, agreed to talk to me about the practice. According to the COO, the practice is necessary in controlling violent and aggressive behaviors in the facility. However, the COO acknowledges that the practice negatively impacts the experience of patients in the facility. Internal research in the facility found that many young people associated physical restraint and seclusion with punishment. The study also established that a section of the facility’s staff used the practice as a threat to coerce patients to follow their instructions. The study recommended that physical restraints be used only in emergency situations and called for the abolition of seclusion of patients. Conclusion As seen above, excessive physical restraint and seclusion have negative physical and psychological impacts on children and adolescents. Therefore, mental healthcare facilities should adopt better and efficient strategies to manage violent behaviors among patients. This includes personnel to anticipate violent activities and prevent them from happening. Caregivers should adopt non-aggressive communication strategies to prevent and respond to violent and aggressive behaviors. They can also use other treatment plans such as behavioral therapy.   References Department of Health (2017) Reducing the Need for Restraint and Restrictive Intervention. London: Department of Health Publications. Mérineau‐Côté, J., & Morin, D. (2014). Restraint and seclusion: The perspective of service users and staff members. Journal of Applied Research in Intellectual Disabilities, 27(5), 447-457. Tölli, S., Partanen, P., Kontio, R., & Häggman‐Laitila, A. (2017). A quantitative systematic review of the effects of training interventions on enhancing the competence of nursing staff in managing challenging patient behaviour. Journal of Advanced Nursing, 73(12), 2817-2831.
Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
Cumberland hospital was averaging between 110 to 130 restrictive interventions a month. In the time range of 3qtr 2020 to 1st qtr. 2021 Cumberland Hospital was able to drop their restrictive intervention rate by 25% by using the following.   1.       Completing Camera reviews for each restrictive intervention. a.       This assisted in seeing patient and staff interaction and if the restrictive intervention was justified (i.e. was their immediate risk of harm to self and others) . b.       If the restraint was complete per policy and procedure (excessive force was not used) 2.       If excessive force or unneeded restrictive interventions we used we would do the following a.       The staff member would be reported to the correct regulator agency – this occurred for 20% of restrictive interventions in the 4th QTR b.       After the report was made an investigation would occur  for all reported incidents – Of those incidents 13% were found to be excessive or unneeded to the point that led to termination. c.       The remaining 12% lead to retraining, reeducation, and corrective action. .
Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
I realized I had no references attached, also I still used FOCUS as my Quality Improvement Model but changed my steps to the following if allowed Steps to decrease the excessive or unnecessary use of restraints/seclusion in mental and behavioral health hospital F-find a process that needs improvement. Define the beginning and end of the process, and determine who will benefit from the improvement The process that needs improvement is the excessive or unnecessary use of restraints/seclusion in mental and behavioral health hospital. Coercive measures such as excessive restraints and seclusion are employed to limit the freedom of movement among psychiatry patients, usually to contain aggressive behaviors.  Seclusion and restraint are being often used a scrisis intervention techniques in mental health facilities especially when patients are aggressive and violent. However, these coercive raises ethics and legal concerns as they cause harm to patients which is tantamount to the abuse of human rights.   O-organize a team of people knowledgeable about the process, this team should include employees from various levels of the organization. This knowledgeable people to be involved in solving the problem are the health workers (doctors, nurses and support staff) and other stakeholders such as the management and board of the hospital.   C- clarify the current process of using excessive or unnecessary restraints/seclusion in the mental and behavioral health hospital and the changes that are needed to make improvements. The effects of using excessive restraints and seclusion include: Occurrence of pain and deep vein thrombosis caused by restraint Incidence of post traumatic stress disorder Psychological trauma Hallucinations may occur during seclusion Restraints and seclusion may cause agitation, self-harm, suicide attempt or self-harm, fracture, or death. U-understand the causes of variation by measuring performance at various steps in the process There are different kinds of physical restraint that are used on mental health patients. The restraints could be either mechanical such as devices are used to immobilize patients or manual restraints when the patient is held down by hospital staff. Seclusion is the confinement of a patient in a locked room from which the patient cannot make an exit on his/her own. These measures are used to curtail aggressive behaviour in mental health patients   S- select actions needed to improve the change process such as: Use of Data to promote evidence-based practice—Collection of accurate data is used to assess the scope of the issue, and the harmful effects of excessive restraint and seclusion. Nursing interventions – Nursing staff should always be available for regular conv Workforce training and development—Ensure that staff members receive training and continuous mentoring on prevention and intervention skills that avoid the use of physical struggles with patients that may lead to excessive restraint.ersations with the patients to calm down the patients and reduce the incidents of aggression. Effective leadership—Leaders should promote the use of alternatives to seclusion and restraint, develop clearly articulated plan, take an active lead role in the process of reducing the use of seclusion and restraint and hold staff members accountable as well. Use of preventive measures—Staff should assess the risk for violence among patients, identify the medical risk factors and past traumatic histories of patients, and develop safety plans in collaboration with the patient and family/caregivers. A creative and serene environment such calming rooms may be used to prevent violent behavior and de-escalate aggressive behavior. Increased support and advocacy for patients-This implies the promotion of advocacy for inpatients in mental health hospitals. This should involve youths, family members/caregivers of patients, and advocates in a variety of settings to curb the use of excessive restraint and seclusion. Multi-professional collaborative care involving patients – Collaborative care that involve physicians, nurses, and the patients about their medications, drug dosage, challenges in the ward, and the established criteria for restraint and seclusion will encourage the patient to participate in the treatment process and be less aggressive. Debriefing measures—There should be continuous debriefing to inform policy, procedures, and practices that reduce the use of restraint and seclusion as well as addressing the adverse effects of the excessive restraint and seclusion.   Explanation: References Chieze M., Hurst, S., Kaiser S., & Sentissi O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in psychiatry, 10, 491. https://doi.org/10.3389/fpsyt.2019.00491   Gowda G., Lepping P., Noorthoorn E. et. al (2018) Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian J Psychiatr. 2018;36:10-6.   Raveesh B., Gowda G., & Gowda M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693-S697. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_104_19
Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
Excessive or Unnecessary Use of Restraints and Seclusion of Mentally Ill Children In mental health inpatient facilities, mentally ill children die, get injured and psychologically traumatized by unnecessary seclusion and restraint practices (De Hert et al., 2011). In my practice setting, Aida Bugg, a nurse practitioner says that the use of noncoercive de-escalation where the patient is calmed down when agitated helps gain their cooperation and hence makes it easier to evaluate and treat the patient. Proposed Action Steps To improve mental health care for children, action steps can be taken to improve mental health care for children through: Influencing cultural change in mental health issues regarding restraint and seclusion by researching children’s personal experiences of seclusion and restraint, understanding the impact trauma has on children and then sustaining change by involving the patients and the staff (Matte & Collin, 2020). Assessing the risk of violence among secluded children, any medical risk factors and past traumas can be used to develop better safety plans. Trauma informed care of children with mental health issues shifts tradition from what is wrong with the child to what has happened to the patient. This way, health practitioners can understand that mental health issues are related to traumatic experiences and hence it doesn’t help to inflict more trauma on patients. This action step would be effective with the use of accurate data about how serious the issue is, how effective interventions for the issue will be and alternatives when these interventions don’t work (Raveesh et al., 2019). Conducting a movement against restraint and seclusion and the effect it has on children who are mentally ill by involving family members and other relevant advocates for inpatient care. This movement can be used to debrief those concerned about policy, procedures and practices that can be used to minimize the future use of restraints and seclusion (Roy et al., 2020). The movement can also be an avenue to address any adverse or traumatic events of restraint and seclusion. Partnerships and collaborations with both private and public sectors can be used to further influence cultural change, prevent and reduce the use of restraints and seclusion. Partners and stakeholders can be consulted to take an active role in developing new alternatives and taking role in the change process while ensuring accountability. Potential Challenges Implementation of the project can be compromised by lack of proper communication among stakeholders involved. Inadequate finances and resources can deter the project from running effectively and efficiently especially when mobilising new partners or conducting movement (Roy et al., 2020). Also lack of proper stakeholder engagement and cooperation when stakeholders are disinterested or do not give open feedback. Resources The resources that would be needed to implement the project include health care practitioners such as nurses, managers, researchers, material resources and computer software for proper communication with stakeholders and partners (Raveesh et al., 2019). The resources will be cost effective because taking steps to find alternatives or prevent seclusion and restraints will improve the mental health of these children and encourage health seeking behaviour which in turn reduces admissions.             References De Hert, M., Dirix, N., Demunter, H., & Correll, C. U. (2011). Prevalence and correlates of seclusion and restraint use in children and adolescents: a systematic review. European child & adolescent psychiatry, 20(5), 221-230. Matte-Landry, A., & Collin-Vézina, D. (2020). Restraint, seclusion and time-out among children and youth in group homes and residential treatment centers: a latent profile analysis. Child Abuse & Neglect, 109, 104702. Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693. Raveesh, B. N., Gowda, G. S., & Gowda, M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693.
Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
Practice Experience: Applying Key Interventions to a Practice Problem Restraint and seclusion are utilized to prevent injury and alleviate agitation, as it is hard to administer a program for mentally challenged individuals without utilizing some restrictive intervention (Nielson et al., 2021). Children are subjected to restraint because they are reported to be excessively violent. Retraining is being conducted to decrease the occurrence of risky behavior such as irritation, threat, and assaulting personnel. However, secluding and retraining mentally disabled children has medical and psychological consequences, including developmental issues, psychotic and externalizing diseases, mood and depression, and anxiety (Nielson et al., 2021). Additionally, S/R is contentious since it impinges on patient autonomy and liberty. Huckshorn Six Strategies According to Hammervold et al. (2019), the Huckshorn six strategies is a successful planning tool that leads the creation of seclusion and retraining (S/R) reduction plans by combining a prevention strategy.  Huckshorn six strategies in the care setting include work development, thorough debriefing, leadership in organizational changes, data-driven practice, use of seclusion and restraining techniques, and full engagement of patients and families are among the strategies. According to Hammervold et al. (2019), these measures can significantly reduce isolation and restrain mental healthcare. The first phase is to establish leadership in response to organizational challenges. Senior leadership is involved in the techniques chosen to reduce seclusion and to restrain (S/R) use. The leadership measures include creating a vision, values, and philosophy for S/R, as well as preparing a performance improvement strategy. The vision is critical because it outlines the desired future state and what is expected to be accomplished in the future. In contrast, the improvement action plan directs employees on accomplishing S/R reduction (Perers et al., 2021). The second step entails data collection to inform practice. The purpose of the data collection is to establish a facility’s S/R baseline and collect data on the usage unit, shift, individual staff members participating, consumer demographics, and injuries linked with S/R. The third phase is to establish a workforce. Policies, procedures should guide the treatment environment and practices founded on recovery knowledge and principles and the characteristics of trauma-informed care. The initiatives are carried out with the assistance of extensive and continuing staff training and education. The training will emphasize S/R application training and vendor selection, and the provision of sufficient therapy activities that provide patients with options (Perers et al., 2021). Providers will be educated on sickness and emotional self-management of symptoms and personal triggers that contribute to patient loss of control. The training will further emphasize on educating providers on how to construct customized person-centered treatment plans tailored to each individual’s needs. The team will get instruction on the impact of traumatic experiences on developmental learning, emotional development, recovery, resiliency, and overall health. This will ensure that staff members understand what to do and act professionally to avoid inflicting traumatic experiences on the patient (Perers et al., 2021). Thirdly, isolation and restraining preventative measures are used. The facility’s policies and procedures and each client’s recovery plan incorporate various tools and assessments. The evaluation tools are used to ascertain a child’s risk of violence and his or her history of S/R. Additionally, the universal trauma assessment instruments are used to identify children who are in danger of death or serious harm. Another intervention that is integrated into the individual consumer recovery plan is a de-escalation survey or assessment tool for safety planning to determine individual triggers. The instruments are effective in determining which interventions are most beneficial for emotional self-management. Environmental modifications such as comfort and sensory rooms, sensory modulation interventions, and other therapeutic activities included to teach children self-management skills (Perers et al., 2021). The aggressiveness control behavior scale supports staff in classifying patients who exhibit agitated, disruptive, dangerous, or fatal conduct, thereby avoiding unnecessary restraining and confinement. The fifth phase comprises of performing consumer tasks in a hospital setting. This technique is critical in the S/R treatment plans since it entails the consumer, children, relatives, and external advocates all playing roles in assisting with seclusion and restraint reductions. Consumer assistance includes oversight and monitoring to ensure that seclusion and restraining are conducted in accordance with fundamental human rights, that ensures patient integrity and dignity are preserved, and that patients are treated with care and respect (Perers et al., 2021). Providers conduct debriefing sessions to determine what they could have done differently and make short-term goals to avoid repeated restraint use. The debriefing will aid in elucidating both parties’ behavior concerning prior restraining use. Peer support is also required to guarantee that the patient obtains the critical support necessary for their rehabilitation plan. The final step of seclusion and restraining(S/R) reduction involves employing a debriefing strategy. Debriefing is critical for lowering S/R use since it aids in collecting necessary knowledge that informs policy, procedures, and practice. The treatment team conducts a debriefing in two sections. The first is an immediate post-event acute analysis, and the second is formal problem analysis. Multiple hold debriefings are conducted with children, and staff members involved in treatment events are recognized for instruction on adjusting the treatment plan. Debriefing encompasses all consumer stakeholders, including family, peer support, advocates, and providers.       References Hammervold, U. E., Norvoll, R., Aas, R. W., & Sagvaag, H. (2019). Post-incident review after restraint in mental health care-a a potential for knowledge development, recovery promotion, and restraint prevention. A scoping review. BMC health services research, 19(1), 1-13. Perers, C., Bäckström, B., Johansson, B. A., & Rask, O. (2021). Methods and strategies for reducing seclusion and restraint in child and adolescent psychiatric inpatient care. Psychiatric quarterly, 1-30. Nielson, S., Bray, L., Carter, B., & Kiernan, J. (2021). Physical restraint of children and adolescents in mental health inpatient services: A systematic review and narrative synthesis. Journal of Child Health Care, 25(3), 342–367. https://doi.org/10.1177/1367493520937152    
Practice Experience: Quality Improvement Storyboard Storyboard Instructions The Practice Experience Project Storyboard is a brief, visual summary of a completed quality improvement initiative. The s
Name: NURS_4220_Week6_Assignment_Rubric Grid View List View   Excellent Proficient Basic Needs Improvement Briefly paraphrases and summarizes: Quality Improvement problem 18 (12%) – 20 (13.33%) Student provided a fully developed quality improvement problem with insightful analysis of concepts and related issues. 16 (10.67%) – 17 (11.33%) Student provided a developed quality improvement problem with reasonable analysis of concepts and related issues. 14 (9.33%) – 15 (10%) 14 to 15 points Student provided a minimally developed quality improvement problem with limited analysis of concepts and related issues. 0 (0%) – 13 (8.67%) Student provided an under-developed quality improvement problem with little or no analysis of concepts and related issues. Briefly paraphrases and summarizes: Data to support the problem 27 (18%) – 30 (20%) Student provided a fully developed discussion of data used to support the problem with insightful analysis of concepts and related issues. 23 (15.33%) – 26 (17.33%) Student provided a developed discussion of data used to support the problem with reasonable analysis of concepts and related issues. 22 (14.67%) – 25 (16.67%) Student provided a minimally developed discussion of data used to support the problem with limited analysis of concepts and related issues. 0 (0%) – 21 (14%) Student provided an under-developed discussion of data used to support the problem with little or no analysis of concepts and related issues. Briefly paraphrases and summarizes: Evidence 27 (18%) – 30 (20%) Student provided a fully developed analysis of the available evidence with insightful analysis of concepts and related issues. 23 (15.33%) – 26 (17.33%) Student provided a developed analysis of the evidence with reasonable analysis of concepts and related issues. 22 (14.67%) – 25 (16.67%) Student provided a minimally developed analysis of the evidence with limited analysis of concepts and related issues. 0 (0%) – 21 (14%) Student provided an under-developed analysis of the evidence with little or no analysis of concepts and related issues. Briefly paraphrases and summarizes: QI Plan 35 (23.33%) – 40 (26.67%) Student provided a fully developed Quality Improvement plan with insightful analysis of concepts and related issues. 30 (20%) – 34 (22.67%) Student provided a developed Quality Improvement Plan with insightful analysis of concepts and related issues. 25 (16.67%) – 29 (19.33%) Student provided a minimally developed Quality Improvement Plan with limited analysis of concepts and related issues. 0 (0%) – 24 (16%) Student provided an under-developed Quality Improvement Plan with little or no analysis of concepts and related issues. Briefly paraphrases and summarizes: Resources 18 (12%) – 20 (13.33%) Student provided a fully developed use of resources with insightful analysis of concepts and related issues. 16 (10.67%) – 17 (11.33%) Student provided a developed use of resources with reasonable analysis of concepts and related issues. 14 (9.33%) – 15 (10%) Student provided a minimally developed use of resources with limited analysis of concepts and related issues. 0 (0%) – 13 (8.67%) Student provided an under-developed use of resources with little or no analysis of concepts and related issues. References included on last slide.A minimum of five references are required. 9 (6%) – 10 (6.67%) Student provided a fully developed list of at least 5 or more references using accurate APA format. 8 (5.33%) – 8 (5.33%) Student provided a developed list of 5 references with minimal APA formatting errors. 7 (4.67%) – 7 (4.67%) Student provided a minimally developed list of 5 references with several APA formatting errors. 0 (0%) – 6 (4%) Student provided an under-developed list of less than 5 references with little to no use of APA format. Total Points: 150 Name: NURS_4220_Week6_Assignment_Rubric

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