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Journal of Psychosocial Nursing and Mental Health Services, 2018;56(8):16–22
Published Online:https://doi.org/10.3928/02793695-20180305-02Cited by:7

Abstract

Addressing tense and escalating situations with noncoercive measures is an important element of inpatient psychiatric treatment. Although restraint rates are frequently monitored, the use of pro re nata (PRN) intramuscular (IM) injections to address agitation is also an important indicator. In 2015, at the current study site, a significant increase was noted in PRN IM medication use despite unit leadership's efforts to build a culture of trauma-informed care (TIC). The purpose of the current quality improvement project was to educate staff on methods to incorporate TIC into daily practice and the use of brief solution-focused therapy techniques in escalating situations. Measurement of attitudes toward patient aggression and engagement with patients followed two waves of staff education. Upon completion of the project, a decrease in PRN IM medications, improvement in staff attitudes toward patient aggression, and improved sense of staff competency in handling tense situations were noted. [Journal of Psychosocial Nursing and Mental Health Services, 56(8), 16–22.]

  • American Psychiatric Nurses Association. (2014). Position statement: The use of restraint and seclusion. Retrieved from http://www.apna.org/files/public/Seclusion_&_Restraint_Position_Paper.pdf

    > Google Scholar
  • Baker J.A., Lovell K., Harris N. (2007). Mental health professionals' psychotropic pro re nata (p.r.n.) medication practices in acute inpatient mental health care: A qualitative study. General Hospital Psychiatry, 29, 163–168.10.1016/j.genhosppsych.2006.12.005

    > Crossref MedlineGoogle Scholar
  • Bennington-Davis M., Murphy T. (2006). Enhancing engagement reducing coercion. Retrieved from https://www.healthcare.uiowa.edu/icmh/recovery/documents/Maggie_Timslides.pdf

    > Google Scholar
  • Bowers L. (2014). Safewards: A new model of conflict and containment on psychiatric wards. Journal of Psychiatric and Mental Health Nursing, 21, 499–508.10.1111/jpm.12129

    > Crossref MedlineGoogle Scholar
  • Bowers L., Alexander J., Bilgin H., Botha M., Dack C., James K., Stewart D. (2014). Safewards: The empirical basis of the model and a critical appraisal. Journal of Psychiatric and Mental Health Nursing, 21, 354–364.10.1111/jpm.12085

    > Crossref MedlineGoogle Scholar
  • Cruz E.B., Caeiro C., Pereira C. (2014). A narrative reasoning course to promote patient-centered practice in a physiotherapy undergraduate programme: A qualitative study of final year students. Physiotherapy Theory and Practice, 30, 254–260.10.3109/09593985.2013.863415

    > Crossref MedlineGoogle Scholar
  • Delaney K.R., Johnson M.E. (2014). Metasynthesis of research on the role of psychiatric inpatient nurses: What is important to staff?Journal of the American Psychiatric Nurses Association, 20, 125–137.10.1177/1078390314527551

    > Crossref MedlineGoogle Scholar
  • Delaney K.R., Johnson M.E., Fogg L. (2015). Development and testing of the combined assessment of psychiatric environments: A patient-centered quality measure for inpatient psychiatric treatment. Journal of the American Psychiatric Nurses Association, 21, 134–147.10.1177/1078390315581338

    > Crossref MedlineGoogle Scholar
  • Ewington J. (2016). Best practices for reducing the use of coercive measures. In , Vollm B., Nedopil N. (Eds.), The use of coercive measures in forensic psychiatric care: Legal, ethical and practical challenges (pp. 285–314). Cham, Switzerland: Springer International.10.1007/978-3-319-26748-7_16

    > CrossrefGoogle Scholar
  • Ferraz H., Wellman N. (2009). Fostering a culture of engagement: An evaluation of a 2-day training in solution-focused brief therapy for mental health workers. Journal of Psychiatric and Mental Health Nursing, 16, 326–334.10.1111/j.1365-2850.2008.01374.x

    > Crossref MedlineGoogle Scholar
  • Haw C., Wolstencroft L. (2014). A study of the use of sedative PRN medication in patients at a secure hospital. The Journal of Forensic Psychiatry & Psychology, 25, 307–320.10.1080/14789949.2014.911948

    > CrossrefGoogle Scholar
  • Hayes A., Russ M.J. (2016). Discontinuing the use of PRN intramuscular medication for agitation in an acute psychiatric hospital. Psychiatric Quarterly, 87(1), 25–29.10.1007/s11126-015-9359-1

    > Crossref MedlineGoogle Scholar
  • Hilton M.F., Whiteford H.A. (2008). Pro re nata medication for psychiatric inpatients: Time to act. Australian and New Zealand Journal of Psychiatry, 42, 555–564.10.1080/00048670802119804

    > Crossref MedlineGoogle Scholar
  • Hosany Z., Wellman N., Lowe T. (2007). Fostering a culture of engagement: A pilot study of the outcomes of training mental health nurses working in two UK acute admission units in brief solution-focused therapy techniques. Journal of Psychiatric and Mental Health Nursing, 14, 688–695.10.1111/j.1365-2850.2007.01161.x

    > Crossref MedlineGoogle Scholar
  • Kostovich C.T., Clementi P.S. (2014). Nursing presence: Putting the art of nursing back into hospital orientation. Journal for Nurses in Professional Development, 30, 70–75.10.1097/NND.0000000000000045

    > Crossref MedlineGoogle Scholar
  • Lepiesova M., Tomagova M. (2014). Analysis of the MAVAS instrument to assess the management of patient aggression. Central European Journal of Nursing and Midwifery, 5, 127–135.10.15452/CEJNM.2014.05.0007

    > CrossrefGoogle Scholar
  • Lewin T.J., Carr V.J., Conrad A.M., Sly K.A., Tirupati S., Cohen M., Coombs T. (2012). Shift climate profiles and correlates in acute psychiatric inpatient units. Social Psychiatry and Psychiatric Epidemiology, 47, 1429–1440.10.1007/s00127-011-0448-7

    > Crossref MedlineGoogle Scholar
  • McAndrew S., Chambers M., Nolan F., Thomas B., Watts P. (2014). Measuring the evidence: Reviewing the literature of the measurement of therapeutic engagement in acute mental health inpatient wards. International Journal of Mental Health Nursing, 23, 212–220.10.1111/inm.12044

    > Crossref MedlineGoogle Scholar
  • McCrae N. (2014). Protected engagement time in mental health inpatient units. Nursing Management, 21, 28–31.10.7748/nm2014.03.21.1.28.e1179

    > CrossrefGoogle Scholar
  • Mollon D. (2014). Feeling safe during an in-patient hospitalization: A concept analysis. Journal of Advanced Nursing, 70, 1727–1737.10.1111/jan.12348

    > Crossref MedlineGoogle Scholar
  • Morkunas B., Porritt K., Stephenson M. (2016). The experiences of mental health professionals' and patients' use of pro re nata (PRN) medication in acute adult mental health care settings: A systematic review protocol of qualitative evidence. JBI Database of Systematic Reviews and Implementation Reports, 14, 99–107.10.11124/jbisrir-2016-2580

    > Crossref MedlineGoogle Scholar
  • Muskett C. (2014). Trauma-informed care in inpatient mental health settings: A review of the literature. International Journal of Mental Health Nursing, 23, 51–59.10.1111/inm.12012

    > Crossref MedlineGoogle Scholar
  • Papadopoulos C., Bowers L., Quirk A., Khanom H. (2012). Events preceding changes in conflict and containment rates on acute psychiatric wards. Psychiatric Services, 63, 40–47.10.1176/appi.ps.201000480

    > Crossref MedlineGoogle Scholar
  • Polacek M.J., Allen D.E., Damin-Moss R.S., Schwartz A.J.A., Sharp D., Shattell M., Delaney K.R. (2015). Engagement as an element of safe inpatient psychiatric environments. Journal of the American Psychiatric Nurses Association, 21, 181–190.10.1177/1078390315593107

    > Crossref MedlineGoogle Scholar
  • Seed M.S., Torkelson D.J., Alnatour R. (2010). The role of the inpatient psychiatric nurse and its effect on job satisfaction. Issues in Mental Health Nursing, 31, 160–170.10.3109/01612840903168729

    > Crossref MedlineGoogle Scholar
  • Smith G.M., Davis R.H., Altenor A., Tran D.P., Wolfe K.L., Deegan J.A., Bradley J. (2008). Psychiatric use of unscheduled medications in the Pennsylvania state hospital system: Effects of discontinuing the use of PRN orders. Community Mental Health Journal, 44, 261–270.10.1007/s10597-008-9126-y

    > Crossref MedlineGoogle Scholar
  • Stewart D., Robson D., Chaplin R., Quirk A., Bowers L. (2012). Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards. International Journal of Mental Health Nursing, 21, 540–549.10.1111/j.1447-0349.2012.00834.x

    > Crossref MedlineGoogle Scholar
  • Usher K., Baker J.A., Holmes C.A. (2010). Understanding clinical decision making for PRN medication in mental health inpatient facilities. Journal of Psychiatric and Mental Health Nursing, 17, 558–564.10.1111/j.1365-2850.2010.01565.x

    > Crossref MedlineGoogle Scholar
  • Wisdom J.P., Wenger D., Robertson D., Van Bramer J., Sederer L.I. (2015). The New York state office of mental health positive alternatives to restraint and seclusion (PARS) project. Psychiatric Services, 66, 851–856.10.1176/appi.ps.201400279

    > Crossref MedlineGoogle Scholar
  • Yoshida K., Suzuki T., Uchida H., Mimura M. (2013). Absence of evidence that the pro re nata regimen confers benefit: A review of the studies. International Clinical Psychopharmacology, 28, 228–237.10.1097/YIC.0b013e328362db99

    > Crossref MedlineGoogle Scholar

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