Date on Paper
Coty, Mary Beth
sensory modulation; comfort room; de-escalation; restraint; inpatient psychiatric unit; adolescent female
Background: Epidemiological data suggested high rates of aggressive incidents involving adolescent patients occurred on inpatient psychiatric mental health units. To mitigate these incidents, mental health staff utilized de-escalation techniques to help alleviate distress, yet the data suggested many occurrences resulted in a seclusion or restraint event. Consequently, national healthcare entities and mental health organizations have advocated for eliminating seclusion and restraint practices due to their potential for re-traumatization, injury, or death.
Purpose: This evidence-based project aimed to increase nurses' self-efficacy when utilizing sensory modulation as a de-escalation technique for aggressive behavior to reduce the seclusion/restraint rate.
Methods: Mental health staff on a female adolescent inpatient psychiatric unit participated in an education session that reviewed the benefits of sensory modulation, the policy and procedure for the sensory room/cart, and the appropriate use of the sensory room/cart. A pre-test/post-test design evaluated the impact of the education session upon mental health staff's beliefs regarding sensory modulation and their self-efficacy in de-escalating agitated patients. After using a sensory cart for one month, the participants completed a second evaluation measuring the impact of the intervention on practice change.
Results: A convenience sample of mental health staff (N=22), mental health technicians, nurses, and therapists, participated in the education session and utilization of the sensory cart. A paired samples test evaluated the impact of the education session on participants' scores concerning their beliefs about sensory modulation and their self-efficacy related to de-escalation. The results showed the educational session had a statistically significant impact on staff's beliefs about sensory modulation and de-escalation self-efficacy, as evidenced by the increase in the mean scores on both the sensory beliefs survey and the Clinician Confidence in Coping with Aggression Instrument (CCPAI). Conversely, the follow-up evaluation showed a statistically significant decline in sensory modulation beliefs after one SENSORY MODULATION 4 month of using the intervention. Seclusion/restraint rates declined in the two months following implementation. Discussion: The staff readily adopted the intervention and utilized the sensory cart for de-escalation on average once per day. The results highlighted the importance of providing a thorough education session regarding the benefits of sensory modulation and how to use the sensory cart to increase the self efficacy of staff in using this de-escalation technique. Continued refinement of future educational sessions is needed to address staff concerns about the appropriateness of when to use the sensory cart. Additionally, it is uncertain of the long-term impact on seclusion/restraint rates from one month of data. A more extended evaluation period is needed to fully understand the effect of the intervention on seclusion/restraint rates.
Scott, Heather, "Implementation of sensory modulation for de-escalation on an adolescent, female psychiatric inpatient unit." (2021). Doctor of Nursing Practice Papers. Paper 118.
Retrieved from https://ir.library.louisville.edu/dnp/118