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Reply to the discussions.

1.There is a gap between new developments, increasing attention to reducing restraints in hospitals, and a lack of evidence-based practice for using restraints. Describing a problem question is essential as all subsequent actions and decisions build on the clarity and accuracy of the problem statement (Dang et al., 2021).

Restraints in psychiatric facilities refer to the practice of restricting the body movement of patients to prevent them from causing harm to themselves or others (Oh, 2021). They should be utilized as a last resort when no other least restrictive alternative exists. Aggressive and violent behaviors resulting from psychiatric and mental illness can be challenging to manage, resulting in patients being restrained physically or chemically.

 Many researchers and advocates for human rights continue to fight this practice. They have indicated that the role of mental health professionals is not just to implement physical restraint to meet legal standards strictly. Mental health professionals should care for patients as holistic human beings promote their physical and psychological well-being before and after the restraint decision in the entire process of physical restraint, and consider ethical issues related to physical restraint as advocates and moral agents (Oh, 2021).

  Preventing aggressive situations and reducing restrictive practices are crucial global healthcare issues, and it is vital to understand what causes challenging behavior (Tolli et al., 2020).

Recent reviews have demonstrated a research gap in patient safety and patients’ perceptions of staff competence in managing challenging behavior. The research questions were as follows: 1. What kind of patient behaviors did former psychiatric patients think were viewed as challenging by nursing staff? 2. What reasons did former patients suggest caused their own and/or co‐patients challenging behavior? 3. What experiences did former patients have of how their own and/or co‐patients’ challenging behavior was managed, and what patient safety issues did these experiences and the video vignettes raise? 4. How did former patients view the competence of staff to manage challenging behavior, and how should that management be improved? (Tolli et al., 2020).

The conclusion was that seclusion and mechanical restraints should only be used as a last resort to minimize the traumatizing effect of nursing interventions. Former patients provided important information on staff competence that can be used when training nursing staff and evaluating the management of challenging behavior (Tolli et al., 2020).

 The application of restraints has been found to have negative psychological effects on patients; according to (de Bruijn et al., 2020), restraints are not effective in preventing the harmful situations they were indicated for.

Many researchers have raised concerns about the utilization of restrictive practices. Such practices continue to be used in healthcare without therapeutic support (Leif et al., 2023). Implementing evidence-based practice in the healthcare system to reduce restraints requires organizational collaboration. The stakeholders need to educate staff on interventions and strategies aimed at reducing aggressive behaviors among patients, continued supervision of staff, peer support and debriefing, and development of tools aimed at reducing restraints.

A study by Lykke and others examined the predictors, prevalence, and patterns of mechanical restraints in an inpatient dual-diagnosis population. Data was collected from patients with mental illness and substance use disorders. In a sample of 1698 hospitalizations, mechanical restraints ranged from 1% to 4% per year. Practice implications indicated that specialized interventions may reduce restraints and improve treatment outcomes (Lykke et al., 2020). A variety of factors have been proposed to reduce the use of restraint in psychiatric inpatient wards, including improving patient–staff relationships/communication, better staff training, use of clear guidelines, open ward procedures, balancing diagnosis composition, and a range of psychological and psychotherapeutic approaches (Lykke et al., 2020).

Based on my synthesis, there is excellent but conflicting evidence regarding restraints in hospital settings. Currently, there is no indication of practice change; there is a need for further research and investigation for new evidence.

2. In all areas of healthcare, non-adherence to a patient’s prescribed medication regimen is a problem, but in psychiatry, it is particularly problematic. Hospitalization and relapse rates rise as a result, leading to subpar patient outcomes (Sajatovic et al. 2010).  In cases of severe mental illness, noncompliance can approach 60%. Approximately 30% of patients discontinue taking antidepressants after one month, and up to 60% do so after three months. This exacerbates the problems for the clients and makes it more difficult for them to successfully manage their mental health condition.

                                                                                Critical Question: How can we promote compliance with medication in psychiatry?

Synthesis of Articles            

Article One: “Measurement of psychiatric treatment adherence.” By Sajatovic, et.al. 2010.

             This article looks at the objective and subjective information that can be gathered to determine whether or not a patient has not been taking their medication as prescribed. Metrics for objective adherence consist of pill counts, technology tracking, and refill logs. Self-reporting or physician-measured adherence are examples of objective data. A variety of scales are available to gauge clients’ attitudes and actions regarding their medication.

Article Two: “Barriers and Facilitating Factors of Adherence to Antidepressant Treatments: An Exploratory Qualitative Study with Patients and Psychiatrists.” By González de León, et. al. 2022.

                This article explores the aspirations and experiences of antidepressant users as well as potential contributing factors to drug non-compliance. Previous research has consistently shown that side effects are a major factor in treatment discontinuation and that collaborative decision-making is necessary to improve adherence. Utilizing a shared decision-making paradigm is another way to encourage adherence. This study delves into the hopes and experiences of clients who take antidepressants and factors that can contribute to non-compliance to medications. There is uniformity from previous studies that recognized side effects as one of the main causes of treatment termination and the need for shared decision-making to increase compliance. A shared decision-making model can be utilized to promote adherence as well.

Article Three: “The Association Between Religious Belief and Treatment Adherence Among Those with Mental Illnesses.”  Kavak Budak, et. al. 2021.

                 People’s lives are greatly influenced by their religion, and this study looked at the relationship between treatment compliance and religion. Using the Morisky Medication Adherence Scale and the Systems of Belief Inventory, no association was discovered. That may be the case, yet medication compliance was poor among individuals with low religious beliefs and moderate in those with high religious beliefs.

Article Four: “Predicting outpatient’s attitude of compliance on medication in a psychiatric setting.” By Sim, 2006.

This study focuses on variables that could affect drug compliance. It confirmed the finding that patients with severe mental illnesses who were stable for an extended length of time were more likely to adhere to their prescribed regimen because they could recognize side effects sooner and decide whether a medication was right for them sooner rather than later.

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