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Joanna Collins
NUR 3208
February 4, 2017
There is a growing rate of violence among patients in psychiatric facilities across the
United States and the need to reduce the use of seclusion and restraint is a pressing concern.
While there are many ways to decrease the need for seclusion and restraints, (Gaynes, Brown, &
Lux, 2016) encourages the use of risk assessment intervention and protocols to decrease
aggression. (Gaynes et al., 2016) states that there is limited evidence for de-escalating
aggressive behavior and that further research is needed. In addition, using flashpoints per
events or social circumstances that are most likely to trigger a conflict or containment event in
the very short term. The purpose of this paper is to discuss the need for further research into
earl intervention protocols to prevent the use of seclusion and restraints in psychiatric facilities.
Discussion
Currently, there are early intervention techniques used by mental health workers to de-
escalate patients and prevent more restrictive alternatives. The Safewards Model, provided by
(Bowers, 2014) depicts the use of flashpoints to recognize early triggers that can lead a patient to
have aggressive behavior and ways to modify the flashpoints to prevent further escalation.
Flashpoints, as depicted in this model, can be anything that can affect a patients mood
negatively, bring about a sense a fear, or cause agitation. For example, a flashpoint can be
anything in the patients hospital environment such as, being in a locked facility, a crowded
milieu, and being around other individuals with a negative outlook. They can be outside hospital
influences such as, a patient receiving bad news about a loved one or not having the money to
pay a bill. It is possible to control any of these flashpoints with a trained team that is educated in
de-escalation techniques and milieu management. This is done by using modifiers such as with
trained staff and managing the environment per (Bowers, 2014). However, there is no set
protocol in place that has been researched to effectively decrease seclusion and restraints.
(Gaynes et al., 2016) completed a systematic review of interventions currently being used
to de-escalate patients and prevent seclusion and restraints. The review found that evidence is
acute care settings (Gaynes et al., 2016). In conclusion, the review found that using a risk
assessment on all patients on a psychiatric unit may decrease subsequent aggressive behavior.
Conclusion
early interventions such as, recognizing flashpoints or using a standard risk assessment and
intervention protocol may prove beneficial in the future of psychiatric care. However, there is
lack of research into the effectiveness of any specific early intervention method to decrease the
number of seclusion and restraint episodes in psychiatric units. Seclusion and restraint use can
preventative method can be utilized over the decision for seclusion or restraints it should be.
Further research into ways to prevent the need for seclusion and restraints in psychiatric facilities
needs to be addressed to effectively care for individuals suffering from mental illness and
References
Bowers, L. (2014, February 19). Safewards: A new model of conflict and containment on
psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21, 499-508.
http://dx.doi.org/10.1111/jpm.12129
Gaynes, B. N., Brown, C., & Lux, L. J. (2016). Strategies to de-escalate aggressive behavior in
https://www.ncbi.nlm.nih.gov/books/NBK379399/