Literature suggest that Registered Nurses (RN’s) play a vital role in continuously improving the quality and safety of healthcare systems. Evidence of this nursing role, invoked the assembling of organizations and projects such as; Quality and Safety Education for Nurses (QSEN) project. The QSEN project collaboratively defines parameters for quality and safety competencies. In one project, QSEN proposed targets for developing nurses in the pre-Licensure stage. It was designed to prepare their knowledge, skills, and attitudes (KSA’s). One of them included, Evidenced-Base Practice (EBP).
Restraint and Seclusion Use
The Department of Veterans Affairs Maryland Health Care System (VAMHCS) published the VAMHCS POLICY MEMORANDUM 512-11/COS-027 in June of 2011, outlining the use of restraints and seclusion (R/S). The policy elaborates in great detail concerning, definitions, criterion of use, types, alternatives, general guidelines, responsibilities and procedurals. All of these subsections are deduced to the conclusion of a few key points. R/S should only be used at the last resort, emergency situations where safety is at risk and only use the least amount of restraints necessary.
According to March and Caple (2014), who compiled an evidenced based care sheet on the topic, stated “Deaths and serious patient and staff injuries have been linked to R/S” (p. 2). March and Caple (2014) referenced a number of EBP studies, describing the probability of increased violence and agitation after R/S.(p. 1) In turn this increased the risk for injury, both for the staff and the patient related to the patients resistance to implementation. A prominent and coinciding point quickly became evident during the review of these texts. The VAMHCS’s policy & evidenced based practice care sheet both emphasized, the use of seclusion only as a safety intervention of last resort to prevent patients from harming themselves of other.
The VAMHCS R/S policy practically mirrors the current EBP R/S standards. It fulfills QSEN’s knowledge section for EBP. The fulfillment of the knowledge section was accomplished by integrating the best current evidence with clinical expertise and patient/family preferences and values for delivery of optimal health care.
An examination of personal goals and expectations in clinical
As a pre-licensed nurse, a plethora of new experiences and situations are due to arise frequently. The practice of self-reflection of personal beliefs, ethics, past experience and abilities should be kept as a default preparatory practice. The ability to execute the Nursing process, in a safe and effective manner should be kept at the forefront of any goals. It is expected that the pre-licensed nurse will also execute this nursing process in a variety of different health care settings with different, involved frameworks. The goal of mastering safe and effective care will be accomplished by personal competency in the existing EBP’s.
Department of Veterans Affairs Maryland Health Care System. (2011). VAMHCS POLICY MEMORANDUM 512-11/COS-027. Unpublished internal document.
March, P., & Caple, C. (2014). Restraint and Seclusion: Minimizing Use in Psychiatric Facilities. CINAHL Nursing Guide,
Pre-licensure KSAS. (n.d.). Retrieved from http://qsen.org/competencies/pre-licensure-ksas/