Paper
Sunday, November 4, 2007
319
Restraints and Alternatives Resource Team: Challenging Practice through Interprofessional Collaboration
Ann Pottinger, RN, MN, Nursing Practice and Professional Services, Centre for Addiction & Mental Health, Toronto, ON, Canada, Rani Hajela Srivastava, RN, MScN, Nursing Practice & Professional Services, Centre for Addiction & Mental Health, Toronto, ON, Canada, Athina Perivolaris, RN, MN, Geriatrics Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada, and Jane Paterson, BA, MSW, Nursing Practice and Professional Services, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| Learning Objective #1: Examine the complexities of restraint use in psychiatric settings, including factors within the client, environment, and the interprofessional team |
| Learning Objective #2: Describe the key challenges as well as opportunities in developing an interprofessional team to initiate and support a major practice change initiative. |
This presentation describes our experience with development of an interprofessional resource team to address a challenging practice issue, the use of restraints in a psychiatric setting. Many factors including legislation, associated risks and a commitment to client-centered care have contributed to scrutiny and increased focus on reducing seclusion and mechanical restraint use in inpatient psychiatric settings. Strategies such as least restraint policies and staff education have been implemented, however, the effectiveness of such approaches is questionable. The questions remain: what are best practices related to aggression management/restraint use or non-use? What are effective ways to implement these best practices in a culture that involves vulnerable clients; has a long history of restraint use; and one in which staff and care recipients often experience aggression and its management differently? One approach is to develop capacity through development of a resource team that provides dedicated support and resources at the point of care in a timely manner.
Restraint use in psychiatric settings is a complex clinical issue influenced by factors within the clients as well as the health care team. Although there is growing recognition that collaborative interprofessional practice is essential to providing quality care that improves client outcomes, in reality care often reflects a multi-disciplinary approach where each professional brings an expertise to client care with little opportunity for effective collaboration. In order to achieve a collaborative approach and develop collective wisdom it is essential to address issues of team dynamics, including power and segregated expertise. Thus the resource team members needed to develop expertise in the clinical issue of restraints as well as in effective interprofesssional collaboration in order to challenge and transform practice. The presentation will present highlights and lessons learned with respect to clinical care as well as interprofessional collaboration and developing communities of practice.