Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1

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Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process

The Assignment you will submit this week will combine the work you completed in Week 1 (Introduction) and Week 2 (Analysis of Existing Evidence) and this week’s assignment, the Quality Improvement Process. These three sections, when combined, will complete Part I of your Capstone Paper.

To prepare for this Assignment:

  • Review the Capstone Paper Assignment Guide
  • Locate the most current version of your Week 1 and Week 2 Assignment. You will add this section to that document.
  • Review the Week 3 Assignment Rubric

For the Week 3 Assignment, you will combine your Week 1, 2 and 3 assignments and submit a 3-4-page paper that addresses the following:

  • Practice Problem (Completed in Week 1)
  • Analysis of the Existing Evidence (Completed in Week 2)
  • Quality Improvement Process (Completed this Week) (Approximately 2-3 paragraphs)

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FILES ATTACHED FOR ALL INFORMATION THAT IS TO BE COMPLETED IN ASSIGNMEMNT ALONG WITH CAPSTONE TEMPLATE AND COURSE RUBRIC

Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1
1 Title of the Capstone Student Name Program Name or Degree Name (e.g., Bachelor of Science in Psychology), Walden University COURSE XXX: Title of Course Instructor Name Month XX, 202X Title of the Capstone Do not add any extra spaces between your heading and your text (check Spacing under Format, Paragraph in your word processor, and make sure that it’s set to 0”); just use a standard double space, and indent the first line of each paragraph a full ½ inch (preferably using the tab button). Your introduction should receive no specific heading because it is assumed that your first section is your introduction section. After considering these formatting issues, you will need to construct a thesis statement, which lets readers know the argument you will be supporting and developing in your paper. This statement provides readers with a lens for understanding the evidence you will present in the body of your essay (each paragraph and thus evidence within those paragraphs you include should support and apply to this thesis statement). Once you have established your thesis, begin constructing the introduction. Introductions are usually organized from broad to narrow, with the broadest, general information around your topic going first, then narrowing to provide more specific details until you end with your thesis statement. An easy template for writing an introduction follows: 1. Start with what’s been said/done regarding your topic of interest. 2. Explain the problem with what’s been said or done. 3. Offer your solution, your thesis statement (one that can be supported by the evidence). Level 1 Heading This text will be the beginning of the body of the essay. Even though this section has a new heading, make sure to connect this section to the previous one so readers follow your ideas and evidence. The first sentence in each paragraph should start with a topic sentence, which summarizes the main point in the current paragraph. Make sure each paragraph contains only one topic, which helps establish a clear scope for your paragraph. When you see yourself drifting to another idea, make sure you break into a new paragraph. You can use the MEAL plan as a way to conceptualize and organize your paragraphs. In short, think about our paragraphs in this way: new idea, new paragraph. Level 2 Heading The Level 2 heading designates a subsection of the previous section. Using headings is a great way to organize a paper and increase its readability, so see section 2.27 of APA 7 and the Writing Center’s Heading Levels webpage for details on heading formatting (APA 7 also has a chart detailing heading formatting in the inside front cover). For shorter papers, using one or two levels is all that is needed. You would use Level 1 (centered, bold font with title case) and Level 2 (left aligned, bold, title case). Level 3 Heading The number of headings you need in a particular paper is not set, but for longer papers, you may need another heading level. You would then use Level 3 (left-aligned, bold, italicized, title case). One crucial area in APA is learning how to cite. Make sure to cite source information throughout your paper to avoid plagiarism. This practice is critical: you need to give credit to your sources and avoid copying others’ work. Look at Chapter 8 of APA 7 and the Writing Center’s Plagiarism Prevention Resource Kit for guidelines on citing source information in your writing. Level 1 Heading The conclusion section should recap the major points of your paper. A conclusion can be one paragraph, but it can also be a few paragraphs, depending on the length of your paper. However, perhaps more importantly, the conclusion should also interpret what you have written and what it means in the bigger picture. To help write your conclusion, consider asking yourself these questions: What do you want to happen with the information you have provided? What do you want to change? What is your ultimate goal in using this information? What would it mean if the reader of your paper took and used the suggestions in your paper? References (Note that the following references are intended as examples only. These entries illustrate different types of references but are not cited in the body of this template. In your paper, be sure every reference entry matches a citation, and every citation refers to an item in the reference list. For additional information, examples, and help with reference entries, see Chapter 9 of APA 7 and the Writing Center’s References section of the website, particularly the Common Reference List Examples page.) American Counseling Association. (n.d.). About us. https://www.counseling.org/about-us/about-aca Anderson, M. (2018). Getting consistent with consequences. Educational Leadership, 76(1), 26-33. Bach, D., & Blake, D. J. (2016). Frame or get framed: The critical role of issue framing in nonmarket management. California Management Review, 58(3), 66-87. https://doi.org/10.1525/cmr.2016.58.3.66 Burgess, R. (2019). Rethinking global health: Frameworks of Power. Routledge.​ Herbst-Damm, K. L., & Kulik, J. A. (2005). Volunteer support, marital status, and the survival times of terminally ill patients. Health Psychology, 24(2), 225–229. https://doi.org/10.1037/0278-6133.24.2.225 Johnson, P. (2003). Art: A new history. HarperCollins. https://doi.org/10.1037.0000136-000​ Lindley, L. C., & Slayter, E. M. (2018). Prior trauma exposure and serious illness at end of life: A national study of children in the U.S. foster care system from 2005 to 2015. Journal of Pain and Symptom Management, 56(3), 309–317. https://doi.org/10.1016/j.jpainsymman.2018.06.001 Osman, M. A. (2016, December 15). 5 do’s and don’ts for staying motivated. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/5-dos-and-donts-for-staying-motivated/art-20270835 Sue, D. W., & Sue, D. (2016). Counseling the culturally diverse: Theory and practice (7th ed.). Wiley. Walden University Library. (n.d.). Anatomy of a research article [Video]. https://academicguides.waldenu.edu/library/instructionalmedia/tutorials#s-lg-box-7955524 Walden University Writing Center. (n.d.). Writing literature reviews in your graduate coursework [Webinar]. https://academicguides.waldenu.edu/writingcenter/webinars/graduate#s-lg-box-18447417 World Health Organization. (2018, March). Questions and answers on immunization and vaccine safety. https://www.who.int/features/qa/84/en/
Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1
Name: NURS_4220_Week3_Assignment_Rubric Grid View List View   Excellent Proficient Basic Needs Improvement Required ContentIdentified the quality improvement practice problem in measurable terms that reflect quality indicators. 9 (6%) – 10 (6.67%) Provided a fully developed quality improvement problem in measurable terms that reflect quality indicators with insightful analysis of concepts and related issues. 8 (5.33%) – 8 (5.33%) Provided a developed quality improvement problem in measurable terms that reflect quality indicators with reasonable analysis of concepts and related issues. 7 (4.67%) – 7 (4.67%) Provided a minimally developed quality improvement problem in measurable terms that reflect quality indicators with limited analysis of concepts and related issues. 0 (0%) – 6 (4%) Provided an under-developed quality improvement problem or is not in measurable terms that reflect quality indicators with little or no analysis of concepts and related issues. Required ContentIncluded data that suggests a practice problem exists. 9 (6%) – 10 (6.67%) Provided a fully developed description of data that suggests a practice problem exists with insightful analysis of concepts and related issues. 8 (5.33%) – 8 (5.33%) Provided a developed description of data that suggests a practice problem exists with reasonable analysis of concepts and related issues. 7 (4.67%) – 7 (4.67%) Provided a minimally developed description of data that suggests a practice problem exists with limited analysis of concepts and related issues. 0 (0%) – 6 (4%) Provided an under-developed description of data that suggests a practice problem exists with little or no analysis of concepts and related issues. Required ContentProvided the purpose statement/rationale for selecting the practice problem including the importance of improving patient outcomes. 18 (12%) – 20 (13.33%) Provided a fully developed purpose statement/rationale for the quality improvement problem with insightful analysis of concepts and related issues. 16 (10.67%) – 17 (11.33%) Provided a developed purpose statement/rationale for the quality improvement problem with reasonable analysis of concepts and related issues. 14 (9.33%) – 15 (10%) Provided a minimally developed purpose statement/rationale for the quality improvement problem with limited analysis of concepts and related issues. 0 (0%) – 13 (8.67%) Provided an under-developed purpose statement/rationale for the quality improvement problem with little or no analysis of concepts and related issues. Required ContentSynthesize the findings from the analysis of evidence that support the practice problem and meets all requirements. 36 (24%) – 40 (26.67%) Provided a fully developed synthesis of findings from the analysis of evidence. 32 (21.33%) – 35 (23.33%) Provided a developed synthesis of the findings from the analysis of evidence. 28 (18.67%) – 31 (20.67%) Provided a minimally developed synthesis of the findings with limited analysis of the evidence. 0 (0%) – 27 (18%) Provided an under-developed synthesis with little or no analysis of the evidence. Required ContentApplied a quality improvement process and quality model to the practice problem and explain why they were chosen. 23 (15.33%) – 25 (16.67%) Provided a fully developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues. 20 (13.33%) – 22 (14.67%) Provided a developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with reasonable analysis of concepts and related issues. 18 (12%) – 19 (12.67%) Provided a minimally developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with limited analysis of concepts and related issues. 0 (0%) – 17 (11.33%) Provided an under-developed discussion of the selected quality improvement process and quality model including explanation of why each was selected with little or no analysis of concepts and related issues. Required ContentChose a specific quality improvement tool that will be used throughout the project and explain why it was chosen. 14 (9.33%) – 15 (10%) Provided a fully developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues. 12 (8%) – 13 (8.67%) Provided a developed discussion of the selected quality improvement tool including a justification of its selection with reasonable analysis of concepts and related issues. 11 (7.33%) – 11 (7.33%) Provided a minimally developed discussion of the selected quality improvement tool including a justification of its selection with limited analysis of concepts and related issues. 0 (0%) – 10 (6.67%) Provided an under-developed discussion of the selected quality improvement tool including a justification of its selection with little or no analysis of concepts and related issues. Professional Writing: Clarity, Flow, and Organization 9 (6%) – 10 (6.67%) Content is free from spelling, punctuation, and grammar/syntax errors. Writing demonstrates very well-formed sentence and paragraph structure. Content presented is completely clear, logical, and well-organized. 8 (5.33%) – 8 (5.33%) Content contains minor spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates appropriate sentence and paragraph structure. Content presented is mostly clear, logical, and well-organized. 7 (4.67%) – 7 (4.67%) Content contains moderate spelling, punctuation, and/or grammar/syntax errors. Writing demonstrates adequate sentence and paragraph structure and may require some editing. Content presented is adequately clear, logical, and/or organized, but could benefit from additional editing/revision. 0 (0%) – 6 (4%) Content contains significant spelling, punctuation, and/or grammar/syntax errors. Writing does not demonstrate adequate sentence and paragraph structure and requires additional editing/proofreading. Key sections of presented content lack clarity, logical flow, and/or organization. Professional Writing: Context, Audience, Purpose, and Tone 9 (6%) – 10 (6.67%) Content clearly demonstrates awareness of context, audience, and purpose. Tone is highly professional, scholarly, and free from bias, and style is appropriate for the professional setting/workplace context. 8 (5.33%) – 8 (5.33%) Content demonstrates satisfactory awareness of context, audience, and purpose. Tone is adequately professional, scholarly, and/or free from bias, and style is consistent with the professional setting/workplace context. 7 (4.67%) – 7 (4.67%) Content demonstrates basic awareness of context, audience, and purpose. Tone is somewhat professional, scholarly, and/or free from bias, and style is mostly consistent with the professional setting/workplace context. 0 (0%) – 6 (4%) Content minimally or does not demonstrate awareness of context, audience, and/or purpose. Writing is not reflective of professional/scholarly tone and/or is not free of bias. Style is inconsistent with the professional setting/workplace context and reflects the need for additional editing. Professional Writing: Originality, Source Credibility, and Attribution of Ideas 9 (6%) – 10 (6.67%) Content reflects original thought and writing and proper paraphrasing. Writing demonstrates full adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 8 (5.33%) – 8 (5.33%) Content adequately reflects original writing and paraphrasing. Writing demonstrates adequate adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 7 (4.67%) – 7 (4.67%) Content somewhat reflects original writing and paraphrasing. Writing somewhat demonstrates adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and references. 0 (0%) – 6 (4%) Content does not adequately reflect original writing and/or paraphrasing. Writing demonstrates inconsistent adherence to reference requirements, including the use of credible evidence to support a claim, with appropriate source attribution (when applicable) and reference. Total Points: 150 Name: NURS_4220_Week
Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1
RE: Group B Practice Experience Discussion – Week 1 COLLAPSE Top of Form Excessive use of restraints and seclusion in mental health children and adolescents Introduction Physical constraint can be defined as using force to prevent and restrict the natural movement of any part of a patient’s body. On the other hand, seclusion is socially isolating patients from other people. Restrictive strategies such as excessive restraints and seclusion have been used in the mental healthcare industry for a long time as a reactive intervention to aggressive behaviors among patients, especially children, and adolescents. Many experts agree that physical restraints often cause significant bodily injury to the patients, but the psychological effects of the practice are often ignored. Despite the knowledge that physical restraint often causes physical injuries among mental health patients, the technique is widely practiced in many mental healthcare facilities. Impact of physical restraint and seclusion This practice causes a deep mistrust between mental health care patients and their caregivers, significantly hindering the success of the treatment plans. Mental healthcare practitioners argue that the practice is essential in ensuring the safety of all stakeholders in the facility. The procedure is deemed necessary to prevent the children and adolescents from hurting themselves or the people around them. However, with the dawn of the Age of information, more people are informed about their rights and liberties as patients. Thus, mental healthcare practitioners who use this practice face severe legal, ethical, and moral challenges.  The physicians must carefully assess their reaction to their patients’ violent behaviors. They should consider the rights and freedoms of all patients. This includes the rights to self-determination, dignity, security, and physical integrity. Research into the use of physical restraint and seclusion Researchers have established that physically restraining patients negatively affects their mental health (Department of Health, 2017). Restrained patients are likely to develop other mental complications such as mood disorders. However, some violent and aggressive behaviors such as kicking others, spitting on people, damaging property, hurting oneself, or other people may necessitate the use of physical restraint and seclusion among mental health care patients. Nevertheless, the physicians enforcing these techniques should understand their impact on the patient’s psychological and physical well-being. Researchers have also established that executing these techniques has a negative psychological effect on the staff. (Tölli, 2017). The healthcare facility’s staff may experience ugly emotions such as unnecessary anger, fear, and anxiety due to the consistent implementation of these practices (Mérineau‐Côté, 2014). This contributes to increased staff turnover in the facility, which is very costly (Department of Health, 2017). A local example In my practice setting which also is my place of employment, I  investigate the prevalence of this practice. The facility’s COO ( Chief Operating Officer) Paula Roberts RN, agreed to talk to me about the practice. According to the COO, the practice is necessary in controlling violent and aggressive behaviors in the facility. However, the COO acknowledges that the practice negatively impacts the experience of patients in the facility. Internal research in the facility found that many young people associated physical restraint and seclusion with punishment. The study also established that a section of the facility’s staff used the practice as a threat to coerce patients to follow their instructions. The study recommended that physical restraints be used only in emergency situations and called for the abolition of seclusion of patients. Conclusion As seen above, excessive physical restraint and seclusion have negative physical and psychological impacts on children and adolescents. Therefore, mental healthcare facilities should adopt better and efficient strategies to manage violent behaviors among patients. This includes personnel to anticipate violent activities and prevent them from happening. Caregivers should adopt non-aggressive communication strategies to prevent and respond to violent and aggressive behaviors. They can also use other treatment plans such as behavioral therapy.   References Department of Health (2017) Reducing the Need for Restraint and Restrictive Intervention. London: Department of Health Publications. Mérineau‐Côté, J., & Morin, D. (2014). Restraint and seclusion: The perspective of service users and staff members. Journal of Applied Research in Intellectual Disabilities, 27(5), 447-457. Tölli, S., Partanen, P., Kontio, R., & Häggman‐Laitila, A. (2017). A quantitative systematic review of the effects of training interventions on enhancing the competence of nursing staff in managing challenging patient behaviour. Journal of Advanced Nursing, 73(12), 2817-2831. Bottom of Form
Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1
RE: Group B Practice Experience Discussion – Week 2  COLLAPSE Top of Form Use of Restraints and Seclusion in Children and Adolescents The Department of Health has issued advice on using positive and proactive techniques to foster a culture in which physical interventions are only required as a last option. Several reports have focused on the misuse or abuse of restrictive interventions in health and care services. Restraint reduction aims for schools, hospitals, and human care agencies devoted to properly controlling agitated behavior. In healthcare, The Joint Commission has its Elements of Performance in place addressing the use of the physical constraint. CPI’s training and tools can assist you with constraint reduction in education, healthcare, or human services. Nonviolent Crisis Intervention training from CPI teaches hospital personnel de-escalation methods and various alternatives to restraint. The training programs follow The Joint Commission and CMS requirements. Select personnel can be qualified to teach the curriculum to other professionals on an ongoing basis using the train-the-trainer option. According to the MHA Code of Practice 11, health and care providers must ensure that their staff is adequately educated in the confinement of mentally ill patients. Implementing restrictive measures in community-based health and social care services and non-mental hospital settings is very seldom authorized under the Mental Health Act of 1983 (MHA) 18 (Cummins, 2020). The use of force is only justified in self-defense, defense of others, criminal prevention, property protection, or property protection. In my practice setting, I interviewed Peter Shumaker, Risk Manager who reiterated how we are continually educate staff on the approve Restraint method which is CPI ( Crisis Preventive Intervention). We have  four different trainers who complete the re-education in tandem with the staff educator to ensure interrater reliability. According to Peter, the Risk Manager Department completes a review of each restrictive intervention to ensure that the restrictive intervention is meeting not only Hospital policy but regulatory requirements as well. If that restraint does not meet regulatory or Hospital policy, the staff member responsible is subject to corrective actions up to termination. Transparent rules and governance mechanisms must be developed in England, Wales, and Northern Ireland to guarantee transparency surrounding restrictive treatments for mental health patients. Restrictive interventions may constitute assault or battery (if the individual has the mental capacity to oppose what is offered), intentional neglect or ill-treatment of persons lacking mental capacity (an offense under section 44 of the MCA14), or unlawful loss of liberty. Restrictive interventions should always be the least restrictive alternative available to satisfy the person’s current need. They should be scheduled as far ahead as feasible to be documented in a behavior support plan (or similar) and contain both primary and secondary methods. During any period of restraint, a staff member should assume responsibility for talking with the individual to seek to deescalate the situation constantly. Staff shall not intentionally inflict pain on a patient to coerce compliance with their instructions. There must be no deliberate or purposeful restriction of a person in a prone/face down posture on any surface, not only the floor. People must not be confined on purpose in a way that interferes with their airway, breathing, or circulation. Chief Operation Officer, Paula Roberts, RN was also interviewed and added that on a weekly bases, the Behavioral Committee, meets to discuss “high flyers” and other behavioral issues the patient might be having and use therapeutic supports to help patients and safely avoid the need for a restrictive intervention. Annual reviews of restrictive intervention reduction programs must be conducted, and they must be made available for inspection by the CQC and Monitor. Any service user who has a behavior support plan that recommends restrictive interventions should have clear, proactive strategies in place. The principles of the Programme for British Standards must be followed when providing care (PBS). The Care Quality Commission (CQC) has created a robust registration, regulation, and inspection system that holds businesses and NHS boards accountable for care failures (Smithson et al., 2018). According to the CQC, physical interventions are risky and put both staff and service users at risk of bodily or mental damage. Restriction intervention reduction programs must be implemented in services based on the concepts of effective leadership, data-informed practice, workforce development, and service user empowerment. A yearly assessment of control measures is required to revise and update corporate action plans. Any service user who has a behavior-support plan that recommends restrictive measures should have clearly defined proactive tactics. Bottom of Form measurable data collected After speaking with Risk Manager, Peter Shumaker, this is the information I was given. Peter goes on to say that this is data that would also be shared with Joint Comission Cumberland hospital was averaging between 110 to 130 restrictive interventions a month. In the time range of 3qtr 2020 to 1st qtr. 2021 Cumberland Hospital was able to drop their restrictive intervention rate by 25% by using the following.   1.       Completing Camera reviews for each restrictive intervention. a.       This assisted in seeing patient and staff interaction and if the restrictive intervention was justified (i.e. was their immediate risk of harm to self and others) . b.       If the restraint was complete per policy and procedure (excessive force was not used) 2.       If excessive force or unneeded restrictive interventions we used we would do the following a.       The staff member would be reported to the correct regulator agency – this occurred for 20% of restrictive interventions in the 4th QTR b.       After the report was made an investigation would occur  for all reported incidents – Of those incidents 13% were found to be excessive or unneeded to the point that led to termination.
Assignment: Capstone Paper, Part I: Introduction, Analysis of Existing Evidence, and Quality Improvement Process The Assignment you will submit this week will combine the work you completed in Week 1
Steps to decrease the excessive or unnecessary use of restraints/seclusion in mental and behavioral health hospital F-find a process that needs improvement. Define the beginning and end of the process, and determine who will benefit from the improvement The process that needs improvement is the excessive or unnecessary use of restraints/seclusion in mental and behavioral health hospital. Coercive measures such as excessive restraints and seclusion are employed to limit the freedom of movement among psychiatry patients, usually to contain aggressive behaviors.  Seclusion and restraint are being often used a scrisis intervention techniques in mental health facilities especially when patients are aggressive and violent. However, these coercive raises ethics and legal concerns as they cause harm to patients which is tantamount to the abuse of human rights.   O-organize a team of people knowledgeable about the process, this team should include employees from various levels of the organization. This knowledgeable people to be involved in solving the problem are the health workers (doctors, nurses and support staff) and other stakeholders such as the management and board of the hospital.   C- clarify the current process of using excessive or unnecessary restraints/seclusion in the mental and behavioral health hospital and the changes that are needed to make improvements. The effects of using excessive restraints and seclusion include: Occurrence of pain and deep vein thrombosis caused by restraint Incidence of post traumatic stress disorder Psychological trauma Hallucinations may occur during seclusion Restraints and seclusion may cause agitation, self-harm, suicide attempt or self-harm, fracture, or death. U-understand the causes of variation by measuring performance at various steps in the process There are different kinds of physical restraint that are used on mental health patients. The restraints could be either mechanical such as devices are used to immobilize patients or manual restraints when the patient is held down by hospital staff. Seclusion is the confinement of a patient in a locked room from which the patient cannot make an exit on his/her own. These measures are used to curtail aggressive behaviour in mental health patients   S- select actions needed to improve the change process such as: Use of Data to promote evidence-based practice—Collection of accurate data is used to assess the scope of the issue, and the harmful effects of excessive restraint and seclusion. Nursing interventions – Nursing staff should always be available for regular conv Workforce training and development—Ensure that staff members receive training and continuous mentoring on prevention and intervention skills that avoid the use of physical struggles with patients that may lead to excessive restraint.ersations with the patients to calm down the patients and reduce the incidents of aggression. Effective leadership—Leaders should promote the use of alternatives to seclusion and restraint, develop clearly articulated plan, take an active lead role in the process of reducing the use of seclusion and restraint and hold staff members accountable as well. Use of preventive measures—Staff should assess the risk for violence among patients, identify the medical risk factors and past traumatic histories of patients, and develop safety plans in collaboration with the patient and family/caregivers. A creative and serene environment such calming rooms may be used to prevent violent behavior and de-escalate aggressive behavior. Increased support and advocacy for patients-This implies the promotion of advocacy for inpatients in mental health hospitals. This should involve youths, family members/caregivers of patients, and advocates in a variety of settings to curb the use of excessive restraint and seclusion. Multi-professional collaborative care involving patients – Collaborative care that involve physicians, nurses, and the patients about their medications, drug dosage, challenges in the ward, and the established criteria for restraint and seclusion will encourage the patient to participate in the treatment process and be less aggressive. Debriefing measures—There should be continuous debriefing to inform policy, procedures, and practices that reduce the use of restraint and seclusion as well as addressing the adverse effects of the excessive restraint and seclusion.   Explanation: References Chieze M., Hurst, S., Kaiser S., & Sentissi O. (2019). Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in psychiatry, 10, 491. https://doi.org/10.3389/fpsyt.2019.00491   Gowda G., Lepping P., Noorthoorn E. et. al (2018) Restraint prevalence and perceived coercion among psychiatric inpatients from South India: A prospective study. Asian J Psychiatr. 2018;36:10-6.   Raveesh B., Gowda G., & Gowda M. (2019). Alternatives to use of restraint: A path toward humanistic care. Indian journal of psychiatry, 61(Suppl 4), S693-S697. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_104_19

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