An inpatient psychiatric unit has been operating at an unusually high acuity level over the past week resulting in numerous incidents of seclusion or restraint

Question

A review of each violent event reveals that appropriate crisis management strategies were implemented and unit policy followed. What action is most appropriate? 1. No action is necessary; the staff is following policy appropriately.
2. Create a rotating schedule to allow staff to leave the unit for frequent brief breaks to alleviate stress.
3. Identify the characteristics of the aggressive clients so that admission criteria can be adjusted to reduce risk of violence.
4. Have an expert speak to staff about seclusion and restraint reduction strategies.

Answer 1

2
Rationale: It is highly likely that staff members are experiencing an increased amount of stress given the high client acuity, so frequent breaks will enable staff to meet personal needs and continue to perform effectively. Taking no action ignores that staff have been operating under conditions that are more stressful than usual and may need supportive measures to cope with the increased job stress. Correct crisis management strategies were followed suggesting that seclusion and restraint interventions were warranted and could not be reduced or prevented. Having an expert speak about reduction at this time could imply that staff did not perform appropriately, which is not the case. Clients with a high risk for violence need treatment, therefore, admission criteria should not be altered to prevent such clients' access to treatment.