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Milieu Improvement in Psychiatry Using Evidence-Based Practices: The Long and Winding Road of Culture Change

2014; Elsevier BV; Volume: 29; Issue: 4 Linguagem: Inglês

10.1016/j.apnu.2014.08.004

1532-8228

Linda Espinosa, Beth Perret Harris, Joyce Frank, Julie Armstrong-Muth, Ellen Brous, Janet Moran, Judi Giorgi-Cipriano,

Mental Health Treatment and Access

Background Shorter inpatient stays have resulted in greater patient acuity, making it difficult for patients to heal and challenging for staff to manage. Objective To improve the milieu for psychiatric inpatients using evidence-based practices. Design A thorough literature review suggested 18 basic principles to improve patient outcomes while reducing violence, seclusion, restraint, and 1:1 observation. Interventions were multiple, including intensive multi-modal staff education based on the literature review and starting in orientation, introduction of comfort rooms, changes in debriefing practices, careful review of all seclusion and restraint episodes, introduction of integrative modalities, and careful review of all 1:1 observation and review of unit structure. Results Multiple interventions resulted in favorable outcomes in the following: rates of seclusion and restraints; time devoted to 1:1 observation, patient and staff satisfaction; violent incidents; and staff and patient injury. Conclusions Long-term culture change toward a more therapeutic milieu can occur as a result implementing evidence-based practices.