Importance of Evidence-Based Practice for Nursing Care in Mental Health Patients
Evidence-based practice is one of the core nursing responsibilities (Allen et al. 2018). Ensuring evidence-based practice in nursing assures that the care needs of the patients are met, and suitable care outcomes are achieved. It also ensures that the interventions that are applied are in alignment with the existing evidence so that the beneficence of the patient is maintained (Lam and Schubert 2019). For mental health care, it ensures that the best care practices are applied, and holistic care outcomes are achieved for the patients. This paper will explore the evidence based on a developed research question and identify the similarities and differences in the practice. This paper will also outline the limitations of the application of evidence-based practice based on the research done in this assignment.
Patients with severe mental health complications may require extensive care and support (Druss 2020). In certain cases, it is possible that the patients do not comply with the care requirements. Hence, at times, restraint and seclusion based practices are applied in the care. These practices are discouraged in the facilities and are deemed to be applied only in highly specific cases (Oostermeijer et al. 2021). Seclusion and restraint have been associated with poor mental health outcomes in the patients (Cole et al. 2020). Application of restraint for the patients the mental health patients is associated with feelings of fear, humiliation, anger, dehumanization, distress, powerlessness, embarrassment and violation of feelings of integrity and self-respect in the patients (Muir?Cochrane et al. 2018). It also asserts a major impact on the relationship of patient and nurse relationship. It results in a loss of trust between the carer and the patient. The use of restraint is also associated with functional decline in the patients. It may cause emotional suffering in the patient (Hawsawi et al. 2020). Person-centred care helps in providing a more holistic perspective of care and aids in identification of individual care needs of the patient. For mental health patients, it can help in understanding their needs and can ensure delivery of quality care and support. This can thus promote improved care outcomes and patient recovery (Cole et al. 2020).
As a future mental healthcare practitioner, I think this topic is of prime importance. It is possible that, at times, the patients may not be able to comply with the procedures of care and restraint, and seclusion based practice might be needed. However, it is also crucial to have an understanding of alternative practices that can be applied. This research will help in the development of effective practices and assist me in advancing as a competent nurse professional.
PICO format was used for developed the research question. This format was used as it helped in the classification of the key variables associated with the research (Eriksen and Frandsen 2018). P: patients with severe mental health problems, I: use of a patient-centred care, C: restraint and seclusion and, O: patient health improvement. Hence, the PICO question as, “Is patient centred care effective enough to eliminate seclusion and restrain based intervention in patients diagnosed with severe mental disorders such as schizophrenia?”
Use of Restraint and Seclusion in Mental Health Care: Negative Impacts on Patients
The keywords that were used for conducting the study included: “seclusion, restraint, mental health, severe, disorder, holistic, care, patient, nursing, outcomes, alternatives, psychiatry”. The Boolean operators “and” and “or” were used to create search strings.
The use of search strings helps in the identification of the suitable search results using the literature database of PubMed central. Further, the results were filtered out from the database by the inclusion of studies from only the last five years. This ensured that the studies published were recent and coherent with the research problem developed. The articles that were retrieved were then screened manually for relevance and coherence with the research question.
The three articles that were selected for completion of this study included work by Chieze et al. (2019), Raveesh et al. (2019), and Weber et al. (2021). The study by Chieze et al. (2019) was a systematic review. The study asserted that seclusion and restraint have a negative impact on mental health patients and hence, should only be applied as a last resort. The focus should be on building a therapeutic relationship with the patient and focus on care with patient preferences in consideration. The importance of patient-centred care is also highlighted. The second study was by Raveesh et al. (2019) was a review. The study highlights the negative impacts of restraint and seclusion and advocates the use of alternatives such as the humanistic model of care with patient-centred approach for the management of patients with severe mental health problems. The third study was by Weber et al. (2021) that was a systematic review. The study highlights that there exists a major gap in the research that can help in highlighting the impact of the physical environment of the patient on their well-being. The findings suggested that the use of the least restrictive practices and therapeutic care impact patient health and outcomes.
To conduct primary research, it is important to have a focused area of discussion. In this study, a focussed area was defined with a focus on the restraint and seclusion based nursing interventions for mental health patients with severe mental health disorders. In conjunction with the focussed area, the PICO approach is used for research question development. Once the PICO question was developed, the second approach was to develop the search strings using the Boolean operators. The search strings were then applied using with the limiter of the last five years on an open literature database, PubMed central. The search was done using these keywords. The individual articles were screened manually and then three articles were selected based on the question developed. The articles were assessed for quality using the checklist developed by CASP (Critical appraisal skills programme) and were then included in the study.
This section will highlight the level of evidence and the strengths and weaknesses of the individual articles published. The study by Chieze et al. (2019) was a systematic review and thus belonged to level of synopses of synthesis based on hierarchy of evidence. Clearly defined search strategy and inclusion of thirty five articles in the study were the strengths of the study. The limitation of the study included the heterogeneity of the studies included impacted the derivation of direct conclusions. Having a narrower inclusion criterion with only a single type of study could have helped in overcoming this limitation. This study was selected as it provides a summary of existing practices associated with restraint or seclusion based interventions for the care of patients with severe mental health problems. For the second study, by Raveesh et al. (2019), the level of evidence was synthesis. The study elaborates on different types of restraints and their impact on the mental health patients with a wide array of resources to develop its discussion making the study highly evidence-based. This was a primary strength of the paper. The methodology to complete the study was not provided. Hence, the findings of the study cannot be replicated. This emerged as a limitation of this paper. The study was selected as it helped in the identification of different types of restraint based practices in the care facilities and their impact on the patients. The third study was by Weber et al. (2021) that was a systematic review and hence belonged to level of synopses of synthesis. The strength of the study was that based on a systematic review research approach with the use of the PRISMA approach. A total of 26 articles were included in the study. The limitation of the study was that the study concluded that there is a gap in the research, and a more focused analysis is needed. The study also concluded that the seclusion and restriction based practices impact the mental health of the patients. The study was selected as it helped in understanding the alignment of current evidence associated with restraint based care or alternative methods of patient care for severe mental health disorders in the patients.
Alternatives to Restraint and Seclusion: Humanistic Model of Care with Patient-Centred Approach
The major similarity that emerges in the research articles studied in this assessment is that all three articles, Chieze et al. (2019), Raveesh et al. (2019), and Weber et al. (2021), highlight the importance of limiting the use of restraint based practices in the care facility. The same is promoted in our facility, where the focus is on providing holistic care to the patients. The outcomes indicate a common aspect that restraint based practices have a negative impact on the patient and the carer relationship and hence should be avoided in the process of care. Further, inclusion of person-centred care can help in improving the patient outcomes help achieve improved patient well-being.
The studies also highlight that limited evidence is available to develop coherent conclusions. However, in the facility, it is suggested that the restraint based practices are necessarily limited based on the mental healthcare support guidelines. This difference is based on the different research settings and individual codes and practices developed for mental health care policies for patient needs across the countries.
The current mental health practice asserts that seclusion and restriction base d interventions should be discouraged (Power et al. 2020). The current evidence highlights that there is a need to have a more focused research to identify what kind of interventions can be applied as an alternative to restriction and seclusion based interventions. This study also highlights that while restrictive practices impact the relationship between the carer and the patient, they may still be needed in certain cases concerning the safety and well-being of the patient as well. The use of restrictive practices raises a question of violation of the human rights of the patients. The patient-centred care is also regarded as the suitable care approach where the individual care needs of the patient are acknowledged and understood. The ethical principles of nursing assert the importance of patient autonomy (Molina-Mula and Gallo-Estrada 2020). In the case of mental health patients, there may be a possibility that the patient refuses to participate in the process of care and may pose a threat to safety for him or herself or for the carers or any other individual in the vicinity. It is only in such cases that the use of restrictive practices is often defined. It is important to consider that while restrictive practices serve as a temporary resort to the problem, they fail to provide the long term benefits for the patients and also tarnish the relationship between the carer and the patient. However, more focused evidence is needed to develop an alternative strategy for ensuring improved patient outcomes; there is a need to develop a more holistic approach toward mental health patients with severe mental health problems (Paradis?Gagné et al. 2021).
While the application of evidence-based practice is the core responsibility of the healthcare professionals, certain limitations or barriers are also associated with its application in the process of care (Glowacki et al. 2019). One of the primary limitations associated with the application of evidence-based practice is the knowledge of practices. Therefore, lack of knowledge is one of the primary limitations that impacts the application of evidence-based practice. Other limitations also include negative attitudes and poor acknowledgement by the care service providers, along with a lack of motivation and training to the care service providers (Duncombe 2018).
Methodology for Conducting Secondary Research: PICO and Boolean Search Strategy
Evidence-based practice is one of the core skills and responsibilities that is associated with improved care outcomes for the patients and enhanced patient care and support. It is important to overcome these barriers with a systematic action and by the development of suitable interventions to ensure improved patient outcomes and well-being in the care facility (Glowacki et al. 2019).
Mental Health Care And Support For The Patients Require Extensive Care And Support It Is Important That Evidence Based Care Is Provided To Patients To Ensure Improved Patient outcomes. This paper describes a search strategy applied for the identification of the evidence based on a focused PICO question. The focus of the study was identified as to study the difference between the restraint based care and patient-centred care provided to patients with severe mental health problems and its impact on their health. Three articles were retrieved based on the search strategy. The findings of the paper indicated that there is a need to develop more research and evidence to derive a conclusive inference. However, the current findings indicate that the restrictive practices implicate poor healthcare experience for the patients and are discouraged in the facility. This paper also outlines that there are certain limitations in the application of the evidence-based practices. These should be limited to ensure improved care and support to the patients.
References
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Chieze, M., Hurst, S., Kaiser, S. and Sentissi, O., 2019. Effects of seclusion and restraint in adult psychiatry: a systematic review. Frontiers in Psychiatry, p.491.
Cole, C., Vandamme, A., Bermpohl, F., Czernin, K., Wullschleger, A. and Mahler, L., 2020. Correlates of seclusion and restraint of patients admitted to psychiatric inpatient treatment via a German emergency room. Journal of Psychiatric Research, 130, pp.201-206.
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Glowacki, K., Weatherson, K. and Faulkner, G., 2019. Barriers and facilitators to health care providers’ promotion of physical activity for individuals with mental illness: a scoping review. Mental Health and Physical Activity, 16, pp.152-168.
Hawsawi, T., Power, T., Sugai, J. and Jackson, D., 2020. Nurses’ and consumers’ shared experiences of seclusion and restraint: A qualitative literature review. International journal of mental health nursing, 29(5), pp.831-845.
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Muir?Cochrane, E., O’Kane, D. and Oster, C., 2018. Fear and blame in mental health nurses’ accounts of restrictive practices: Implications for the elimination of seclusion and restraint. International journal of mental health nursing, 27(5), pp.1511-1521.
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Power, T., Baker, A. and Jackson, D., 2020. ‘Only ever as a last resort’: Mental health nurses’ experiences of restrictive practices. International Journal of Mental Health Nursing, 29(4), pp.674-684.
Raveesh, B.N., Gowda, G.S. and Gowda, M., 2019. Alternatives to use of restraint: A path toward humanistic care. Indian Journal of Psychiatry, 61(4), p.S693.
Weber, C., Monero Flores, V., Wheeler, T.P., Miedema, E. and White, E.V., 2022. Patients’ health & well-being in inpatient mental healthcare facilities: a systematic review. Frontiers in Psychiatry, p.2446.
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