Engagement may provide the foundation for safe, therapeutic, and recovery-oriented treatment. In the future, APNA's ISE plans to build upon this foundation by developing a clinical model of nurse-patient engagement and safety by drawing together emerging research and practice models.

Background: Nurse job satisfaction was identified as an outcome measure for a project to develop and implement a patient care delivery model in an acute psychiatric setting. Method: Seventy registered nurses were surveyed during 3 years, utilizing the Index of Work Satisfaction. Results: Nurse job satisfaction has improved significantly (14%) since model development began. Analysis of variance showed significant (p < .05) increases in all component mean scores in the second and third surveys. Conclusion: The relationship-based nursing model empowers nurses who know the patient best to decide how to provide care. It affirms the values that are the foundation of nursing practice, creating an environment where nurses feel they make a difference.

This 1-year study of seclusion and restraint in an acute inpatient psychiatric hospital revealed a marked difference in reasons and duration for adults, children, and adolescents. Children and adolescents are most often secluded and restrained in response to identifiable patterns of dangerous behavior, and episodes of seclusion and restraint involving children and adolescents are considerably shorter than episodes involving adults. This information is being used to find ways to improve the care and treatment of all patients, especially for children.

Elimination of seclusion and restraint requires support at all levels of an organization, especially from leaders who visibly champion and communicate their vision. Nurses, physicians, educators, and administrators at New Hampshire Hospital, an acute psychiatric inpatient facility, have established a standard meeting time and place for an executive-level review of every episode of seclusion and restraint. The standing meeting demonstrates the organization's commitment to caring for both patients and staff. The daily meetings foster a spirit of interdisciplinary collaboration, where direct care staff have the opportunity to tell their stories and share their ideas and concerns in an environment that is caring, supportive, and devoid of criticism or blame. Narrative descriptions of emergency interventions, including what was learned from debriefings with patients and staff involved, provide data about factors that may contribute to the use of seclusion or restraint. This forum provides visible administrative and clinical support that promotes creative thinking, collaborative problem solving, and the exploration of new ideas recommended by those directly involved in providing patient care. It has fostered exploration and development of strategies that have minimized episodes of aggressive behavior as well as seclusion and restraint.

An educational program for staff in an acute, involuntary inpatient setting has led to positive change by challenging the widely held belief that getting hurt is an expected part of the job in acute psychiatric care settings. The Staying Safe program encouraged staff to think differently about their roles and to explore alternative responses to patient behaviors. Cultural change takes time: Staff have requested that the program be repeated multiple times over the past 5 years, and key concepts have been incorporated into employee orientation and refresher programs. During that same time, staff have learned to call for help more often and to have a plan for such help before physically intervening with patients. The strategies described in this program have resulted in decreased number of assaults on staff, injuries from assaults, and lost work time from those injuries.

Psychiatric mental health nurse practitioners (PMHNPs) are assuming increasing clinical responsibilities in the treatment of individuals with mental illness as the shortage of psychiatrists and their maldistribution continues to persist in the United States. States vary widely in their statutes and administrative rules delineating PMHNP's scope of practice. This column describes the legislative process of incremental changes in New Hampshire statute and rules changes over the past 15 years that have significantly expanded PMHNP's ability to treat individuals with mental illnesses in the state mental health system. PMHNPs have worked closely with physician leaders and policy makers to allow this to occur.

OBJECTIVE: A systematic review was conducted to identify methods used to decrease the application of physical restraints in acute inpatient psychiatric hospitals. METHOD: A literature search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines using key words related to physical restraint. RESULTS: Three data-based studies met eligibility criteria. CONCLUSIONS: Findings suggest that multimodal intervention strategies may reduce the number of hours of physical restraint used in inpatient psychiatric settings, but quality evidence to support specific strategies is lacking. The search highlights the need for more quality research using standardized restraint reporting measures.

No abstract