The American Nurses Association (ANA) promotes registered nurse participation in reducing patient restraint and seclusion in health care settings. Restraining or secluding patients either directly or indirectly is viewed as contrary to the fundamental goals and ethical traditions of the nursing profession, which upholds the autonomy and inherent dignity of each patient (ANA 2012). The American Psychological Nurses’ Association (APNA) supports the psychiatric mental health nurses’, critical role in the provision effective treatment and milieu leadership to maximize the individual’s ability to effectively manage potentially dangerous behaviors in the psychiatric setting (APNA 2014). The profession of occupational therapy emerged from some of the earliest restraint and seclusion efforts, realizing the need for more humane and nurturing interventions for people with mental health and rehabilitation needs (AOTA, 2014). Given the safety, ethical, professional, regulatory and legal standards related to reducing restraint, it is imperative that alternative, evidenced based strategies be employed throughout our health care settings. Sensory Modulation teaches patient’s self-regulation skills and improves the rapport between staff and patients by giving them additional opportunities for therapeutic communication, prevention of escalation and aggression, and tangible alternatives to PRN medications.
Trauma informed care is patient strength based approach to care, as a least ninety per cent of public mental health consumers have been exposed to trauma (Felitti V. J. & Anda R. F. 2010). Instead of talk based therapies sensory approaches provide experiential opportunities to help individuals recognize and regulate their unique sensory experiences. By using sensory modulation strategies in combination with a trauma informed approach to care, patients can feel empowered by identifying their own individual preferences and can feel more secure knowing that staff will work with them during times of crisis to prevent seclusion and restraint episodes. Patients can also identify their own signs of escalation and aggression and alternative methods for coping during times of stress which can translate beyond the inpatient setting and can be used at home after discharge. Additionally, is that nursing staff can feel empowered with the knowledge provided by patients and suggest patient identified methods of calming during times of stress instead of blindly offering cookie cutter suggestions and care based on tradition instead of evidenced based care.
A sensory modulation program was developed and implemented on our 18 bed inpatient behavioral health unit. Results suggest that the use of sensory modulation is an effective strategy in decreasing patient agitation and employee workplace violence related injuries. This project will enable nurses to identify the importance of collaboration with other disciplines in finding alternatives to restraint and seclusion. As nurses we often believe that we are the experts in knowing how to help people. It can be challenging to let go of our perceived control but it is actually a multi-modal/multidisciplinary approach to challenges that serves people best. By the end of the presentation nurse will be able to describe how the use of sensory modulation strategies can be applied to numerous areas of nursing care. Sensory Modulation Strategies can be applied to calming a patient in emergency departments, medical floors and post-surgical units through the use of a mobile sensory cart. Additionally the use of sensory modulation strategies being utilized by care givers themselves will be highlighted as part of our professional responsibility for our own self-care.