Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric PDF
Preview Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric
Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2017 Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric Setting Marie Elois Ortiz Walden University Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theNursing Commons, and thePsychiatric and Mental Health Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. Walden University College of Health Sciences Marie Ortiz This is to certify that the doctoral study by has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Marisa Wilson, Committee Chairperson, Nursing Faculty Dr. Murielle Beene, Committee Member, Nursing Faculty Dr. Jonas Nguh, University Reviewer, Nursing Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2017 Abstract Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric Setting by Marie Ortiz MS, Walden University, 2013 BS, Norfolk State University, 2002 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2017 Abstract Nurses working in an acute psychiatric setting within a veterans’ administration hospital must maintain a therapeutic milieu by recognizing and managing aggressive behaviors before violence ensues to reduce injuries to staff nurses and patients. The purpose of this project was to develop an evidence-based and theoretically grounded educational program that will help staff nurses manage escalating aggression, violence, and acting out behaviors to provide a safe environment for patients and staff through high risk identifier recognition and intervention training. During the data and information gathering stage, 23 articles were reviewed, rated, and graded to provide the most significant information used to complete the project. The project is a workshop made up of a 6-module curriculum that will be used to train staff nurses. This workshop will be shared with the partnering organization including the recommendation that it is adopted and implemented at a later date. The educational training program will have the potential to become a practice standard for other acute psychiatric settings within the Veterans Integrated Service Network to provide a tool that will assist the nurses as they care for the patient and maintain safety. Social change will occur through the empowerment of nurses who interact with veterans to bring them better and safer care. Educational Interventions to Improve Aggressive Behavior Recognition for an Acute Psychiatric Setting by Marie Ortiz MS, Walden University, 2013 BS, Norfolk State University, 2002 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University November 2017 Dedication This project is dedicated to mental health nurses who have chosen to work with the unique veteran population. It takes a strong individual to come to work each day knowing that you may be targeted by a cognitively impaired patient who is actively hallucinating and views you as the enemy. Nevertheless, you return and stand steadfastly to provide the necessary care. You are strong when your patient is weak and in need of your strength and guidance. Acknowledgments First and foremost, I would like to thank my faculty committee members, Drs. Marisa Wilson and Murielle Beene. You were there to inspire me and keep me on the right path since the very beginning. I was comforted when I learned that you would continue to see me and my project to the end. You silenced my doubts when I wanted to quit. You motivated me to stay in the game when I grew tired after each inning. It is because of you that I have stayed the course and carried on. Dr. Wilson, there are no words that can possibly explain how you have helped me. Your collaborations kept me centered as I was able to tackle each rewrite. Secondly, to my husband, Jose, you have been a soft place to land. You have been more than understanding when dinner consisted of yet another order of take-out instead of something home cooked. Thank you for being my biggest cheerleader by reassuring me that I could do anything, regardless of the fact that I know I cannot do anything as evidenced by my inability to give you the moon and the stars. You have been my rock. To my sons, I just want you to know that I see you. I know I have had my head in the books for years, but I see you. I want you to know that if I can do it, you certainly can too. I wanted to be your inspiration, just as you have inspired me. Lastly, to my friends, colleagues, my Preceptor, Dr. Clark, and the best boss in the world it has been a great journey. You each kept me grounded in various ways. I appreciate the doses of reality when my head would wander off into the clouds. I am most appreciative to you for always being there. Dr. Clark and Dr. Harris thank you for making it look easy. It is because of you I convinced myself that this was something I could do. Table of Contents List of Figures .................................................................................................................... iv Section 1: Nature of the Project ...........................................................................................1 Introduction ....................................................................................................................1 Problem Statement .........................................................................................................2 Purpose Statement ..........................................................................................................3 Project Objectives ..........................................................................................................4 Significance/Relevance to Practice ................................................................................5 Evidence-Based Project Significance ............................................................................6 Implication for Social Change in Practice .....................................................................7 Definitions of Terms ......................................................................................................7 Assumptions and Limitations ........................................................................................8 Assumptions ............................................................................................................ 8 Limitations .............................................................................................................. 9 Summary ................................................................................................................. 9 Section 2: Review of Literature and Conceptual Framework ............................................11 Review of Literature ....................................................................................................11 Prevention as a Strategy ...............................................................................................11 Impact of Mental Illness ..............................................................................................11 General Literature ........................................................................................................13 Maintaining a Therapeutic Milieu ........................................................................ 14 Contributing Factors ............................................................................................. 15 i Recognizing the Need for Training....................................................................... 17 Theoretical Foundation ................................................................................................18 Project Questions .........................................................................................................22 Summary ......................................................................................................................22 Section 3: Collection and Analysis of Evidence ................................................................24 Introduction ..................................................................................................................24 Practice-Focused Questions .........................................................................................24 Gap in Practice .............................................................................................................27 Policy Impact ...............................................................................................................28 Clinical Practice ...........................................................................................................29 Sources of Evidence .....................................................................................................30 Social Change ..............................................................................................................31 Summary and Conclusion ............................................................................................31 Course Objectives ........................................................................................................32 Course Modules ...........................................................................................................42 Method .........................................................................................................................33 Develop an Implementation Plan .................................................................................51 Assemble a Project Team.............................................................................................61 Initial Project ......................................................................................................... 52 Expanded Implementation .................................................................................... 54 Anticipated Population and Sampling .........................................................................55 Data Collection ............................................................................................................56 ii Instrument ....................................................................................................................56 Review of Pertinent Evidence, Resources, and Literature ...........................................57 Development of High Risk Identifier Training Program .............................................59 Curriculum Development...................................................................................... 59 Educational Delivery Modalities .......................................................................... 59 Development of Evaluation Plan .................................................................................59 Summary ......................................................................................................................63 Section 4: Findings, Discussion and Implications .............................................................65 Introduction ..................................................................................................................65 Findings and Implications ............................................................................................65 Recommendations ........................................................................................................66 Contribution of the Doctoral Project Team .................................................................67 Strength and Limitations of the Project .......................................................................68 Section 5: Dissemination Plan ...........................................................................................70 Poster Board and PowerPoint Presentations ................................................................70 Analysis of Self ............................................................................................................71 Summary ......................................................................................................................72 iii
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