576335
research-article2015
JAPXXX10.1177/1078390315576335Journal of the American Psychiatric Nurses AssociationDelaney
Letter to the Editor Journal of the American Psychiatric Nurses Association 2015, Vol. 21(2) 114 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390315576335 jap.sagepub.com
To the Editor: I appreciate Dr. Parkes’s thoughtful response to the American Psychiatric Nurses Association (APNA) revision of its Position Statement on the Use of Seclusion and Restraint (APNA, 2014; Parkes, 2014). Similar to the points raised in the Position Statement, Dr. Parkes’s letter summarizes many of the issues nurses balance in their efforts to reduce/eliminate restrictive measures. Dr. Parkes’s main focus was advocating for the use of four criteria to evaluate a restraint incident, that is, safe for patients, safe for staff, effective, and acceptable. He believes that “the proposed four criteria model may also be of assistance in analyzing existing research or influencing the direction of future research and evaluation work” (Parkes, 2014, p. 370). While an interesting idea, I am not exactly clear how the criteria would be used in this way, that is, to influence the direction of future research or analyze existing research. Dr. Parkes’s four criteria assessment seems best suited for a micro-examination of a restraint incident. But it is unclear how this structured debriefing would influence research or enhance its evaluation. Would it be with the debriefing data one could gauge if the restraint event was absolutely unavoidable and preserved safety in an acceptable manner? Successful restraint reduction efforts such as the Six Core Strategies are indeed evaluated by restraint rates, but also assume a comprehensive ecological, team approach to restraint reduction (e.g., Madan et al., 2014; Wieman, Camacho-Gonsalves, Huckshorn, & Leff, 2014). I am not sure how the four criteria model data could be used to evaluate these programs. As noted in the APNA Position Statement, restraint use on inpatient units is best viewed as a complex interplay of ward atmosphere, culture, staffing, unit structure, patient characteristics, and environmental considerations. Noted are promising interventions to prevent aggression and thus reduce restraints. The emphasis of the Position Statement is the key points that nurses should attend to when addressing issues of restraint and aggression. In line with this thinking, the authors do not forward any one restraint reduction approach; rather, “We advocate and support evidence-based practice through research
directed toward examining the variables associated with the prevention of and safe management of behavioral emergencies.” It might be that the four criteria model would be useful in examining whether the management of an emergency restraint was safe. But as with the application of any intervention, it is important to determine the evidence supporting the approach and be clear on implementation. Thus, clarification is needed on data to support the use of the four criteria model and also how one would use the criteria in practice. While it is an intriguing idea to systematically collect data on if the restraint event was acceptable to persons witnessing the incident, I am not sure how one would accomplish this. It is equally unclear how one would judge an incident acceptable to the profession and the wider community. Thus, prior to implementation of debriefing with these criteria the inpatient team would need clarification on the purpose of using them, how to apply the criteria, what information the exercise might yield, and how the resultant data could be utilized. Thank you for the opportunity to respond to Dr. Parkes’s letter. Kathleen R. Delaney, PhD, PMH-NP, FAAN Rush College of Nursing, Chicago, IL, USA References American Psychiatric Nurses Association. (2014). Position statement: The use of seclusion and restraint. Retrieved from http://www.apna.org/files/public/Seclusion_&_ Restraint_Position_Paper.pdf Madan, A., Borckardt, J. J., Grubaugh, A. L., Danielson, C. K., McLeod-Bryant, S., Cooney, H., . . .Frueh, B. C. (2014). Efforts to reduce seclusion and restraint use in a state psychiatric hospital: A ten-year perspective. Psychiatric Services, 65, 1273-1276. Parkes, J. (2014). Letter to the editor. Journal of the American Psychiatric Nurses Association, 20, 369-370. Wieman, D. A., Camacho-Gonsalves, T., Huckshorn, K. A., & Leff, S. (2014). Multisite study of an evidence-based practice to reduce seclusion and restraint in psychiatric inpatient facilities. Psychiatric Services, 65, 345-351.
Downloaded from jap.sagepub.com at PENNSYLVANIA STATE UNIV on November 15, 2015
research-article2015
JAPXXX10.1177/1078390315576335Journal of the American Psychiatric Nurses AssociationDelaney
Letter to the Editor Journal of the American Psychiatric Nurses Association 2015, Vol. 21(2) 114 © The Author(s) 2015 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1078390315576335 jap.sagepub.com
To the Editor: I appreciate Dr. Parkes’s thoughtful response to the American Psychiatric Nurses Association (APNA) revision of its Position Statement on the Use of Seclusion and Restraint (APNA, 2014; Parkes, 2014). Similar to the points raised in the Position Statement, Dr. Parkes’s letter summarizes many of the issues nurses balance in their efforts to reduce/eliminate restrictive measures. Dr. Parkes’s main focus was advocating for the use of four criteria to evaluate a restraint incident, that is, safe for patients, safe for staff, effective, and acceptable. He believes that “the proposed four criteria model may also be of assistance in analyzing existing research or influencing the direction of future research and evaluation work” (Parkes, 2014, p. 370). While an interesting idea, I am not exactly clear how the criteria would be used in this way, that is, to influence the direction of future research or analyze existing research. Dr. Parkes’s four criteria assessment seems best suited for a micro-examination of a restraint incident. But it is unclear how this structured debriefing would influence research or enhance its evaluation. Would it be with the debriefing data one could gauge if the restraint event was absolutely unavoidable and preserved safety in an acceptable manner? Successful restraint reduction efforts such as the Six Core Strategies are indeed evaluated by restraint rates, but also assume a comprehensive ecological, team approach to restraint reduction (e.g., Madan et al., 2014; Wieman, Camacho-Gonsalves, Huckshorn, & Leff, 2014). I am not sure how the four criteria model data could be used to evaluate these programs. As noted in the APNA Position Statement, restraint use on inpatient units is best viewed as a complex interplay of ward atmosphere, culture, staffing, unit structure, patient characteristics, and environmental considerations. Noted are promising interventions to prevent aggression and thus reduce restraints. The emphasis of the Position Statement is the key points that nurses should attend to when addressing issues of restraint and aggression. In line with this thinking, the authors do not forward any one restraint reduction approach; rather, “We advocate and support evidence-based practice through research
directed toward examining the variables associated with the prevention of and safe management of behavioral emergencies.” It might be that the four criteria model would be useful in examining whether the management of an emergency restraint was safe. But as with the application of any intervention, it is important to determine the evidence supporting the approach and be clear on implementation. Thus, clarification is needed on data to support the use of the four criteria model and also how one would use the criteria in practice. While it is an intriguing idea to systematically collect data on if the restraint event was acceptable to persons witnessing the incident, I am not sure how one would accomplish this. It is equally unclear how one would judge an incident acceptable to the profession and the wider community. Thus, prior to implementation of debriefing with these criteria the inpatient team would need clarification on the purpose of using them, how to apply the criteria, what information the exercise might yield, and how the resultant data could be utilized. Thank you for the opportunity to respond to Dr. Parkes’s letter. Kathleen R. Delaney, PhD, PMH-NP, FAAN Rush College of Nursing, Chicago, IL, USA References American Psychiatric Nurses Association. (2014). Position statement: The use of seclusion and restraint. Retrieved from http://www.apna.org/files/public/Seclusion_&_ Restraint_Position_Paper.pdf Madan, A., Borckardt, J. J., Grubaugh, A. L., Danielson, C. K., McLeod-Bryant, S., Cooney, H., . . .Frueh, B. C. (2014). Efforts to reduce seclusion and restraint use in a state psychiatric hospital: A ten-year perspective. Psychiatric Services, 65, 1273-1276. Parkes, J. (2014). Letter to the editor. Journal of the American Psychiatric Nurses Association, 20, 369-370. Wieman, D. A., Camacho-Gonsalves, T., Huckshorn, K. A., & Leff, S. (2014). Multisite study of an evidence-based practice to reduce seclusion and restraint in psychiatric inpatient facilities. Psychiatric Services, 65, 345-351.
Downloaded from jap.sagepub.com at PENNSYLVANIA STATE UNIV on November 15, 2015
