Sivak, Kim, Lilly, Mary L., Hermanns, Melinda S., Crawley, Bill, Beebe, Lora H., and Harris, Robin Faust
The use of seclusion and restraint as methods to control acting-out behaviors by individuals with mental illness continues, despite deaths and other negative outcomes to both the clients themselves and the staff members applying these techniques. Additionally, client-to-client and client-to-staff assaults and self-injurious behaviors can lead to injury or possible fatalities to both parties. Thus, there is a need to find alternative approaches to mitigate or even eliminate some of these behaviors. The use of comfort rooms is one such approach. With the institution of comfort rooms, one small, rural, tertiary mental health hospital demonstrated a reduction in seclusion and restraint use and assaultive behaviors of clients. In addition, 92.9% of the clients who used these rooms found them to be helpful when they experienced increasing levels of distress. With the provision of an area for clients to go voluntarily to self-manage their distress, nurses play a role in promoting autonomy and person-centered care, while reducing environmental stress and potential negative outcomes. A simulated wrist-cutting suicide attempt scenario was developed and implemented, with the goal of integrating the concepts of psychiatric emergency care, contraband, environmental assessment, and personal safety. Faculty also wanted to convey and provide care and support for participants throughout the visually and emotionally stimulating activity. The underlying premise was that providing readings and lecture material on these topics was insufficient to the level of learning and performance needed by nursing students and novice nurses. However, actual student clinical episodes integrating these concepts were also infrequent, unpredictable, and often not conducive to student learning. Therefore, faculty implemented a simulation teaching modality to deliver the concepts in a vivid and memorable format. A standardized rating scale on perceived learning and care from faculty during the course of the simulation was administered immediately following participation in the activity. Participants were overwhelmingly positive in their assessment of the activity, reporting an enhanced appreciation for safety in the conduct of inpatient psychiatric nursing care. Further, the faculty member's observation and post-simulation processing of the activity noted cognitive, behavioral, and emotional responses at the individual and group levels related to communication, observation and assessment, decision making, and interpersonal support. Identification of procedures to document physical activity is critical to developing interventions to improve physical health. The purpose of this pilot study was to describe the feasibility and acceptability of pedometers to document physical activity in patients with schizophrenia spectrum disorders (SSDs). Twenty-four outpatients were provided with extended-wear pedometers and instructed to wear them daily for 1 week without altering their usual activities. All participants completed the 1-week data collection period. Twenty-one (87.5%) participants wore their pedometer at least 6 of the 7 days. Difficulties with the pedometers were few and minor. These preliminary findings indicate that a majority of individuals with SSDs are willing to wear pedometers for activity monitoring and can do so with few problems. Possible barriers to the use of extended-wear pedometers in this group include cognitive and memory deficits. Future investigations should test concurrent validity by examining the correlations between pedometer data and self-reported activity level. [ABSTRACT FROM AUTHOR]