National Nursing Week | 2016

6 WINNIPEG FREE PRESS - SATURDAY, MAY 9, 2015

#NNW2016 MAY 9-15, 2016 NATIONAL NURSING WEEK 2016

HEALTHIER ALTERNATIVES SECLUSION REDUCTION REDUCES TRAUMA FOR STAFF AND PATIENTS

Supporting team: From left, Debbie Frechette, director of Patient Services, Annette McDougall, registered psychiatric nurse, and Lisa Knechtel, manager of Quality and Patient Care. PHOTO BY DARCY FINLEY

By Holli Moncrieff for the Free Press

in introducing the seclusion reduction program to the region. “Some of the units made their bathrooms a little more welcoming, more like a home environment.” Another proactive technique is creating personal safety plans for patients, which involves learning about what makes them feel distressed and what calms them down. “Having that calming strategy in place in advance before a crisis situation occurs is so important,” Knechtel says. “We’re more recovery- and patient-focused now.” A debrief and defusing process helps refine the program and gives both patients and staff the opportunity to discuss what is often a traumatic incident. “Once a patient is settled and able to engage in conversation again, we hold a debrief with the patient and ask what happened,” McDougall says.

An innovative program introduced in Manitoba’s mental health units has greatly reduced the level of trauma experienced by patients and staff. K nown as the Six Core Strategies for Seclusion Reduction, the initiative aims to meet the needs of acute-care mental health patients in the least restrictive way possible. “Confining someone in a locked room was used when a patient had lost control of their behaviour. Seclusion has limited therapeutic value and can be traumatizing,” explains Lisa Knechtel, manager of Quality and Patient Care at Health Sciences Centre. “There’s also the risk of trauma to staff when they have to confine someone in a restrictive space. It can lead to physical and emotional injuries for both patients and staff.” Only a small percentage of mental health patients are aggressive enough to require seclusion, Knechtel says, stressing that it’s not the norm. Often seclusion is more damaging than restorative to a patient’s mental health. “A lot of people with mental health diagnoses have a past history of trauma. When someone is secluded, it becomes a power struggle between staff and the patient,” she says. “Staff have to restrain the patient and escort them to a locked room, which can trigger past memories of abuse for the patient.” The seclusion reduction program builds a more supportive relationship between patients and staff, says Debbie Frechette, Health Sciences Centre director of Patient Services — Mental Health. “We work with staff to teach them tools to deal with people who have a risk of harming themselves or others,” she says. “We try to align those who are already doing this program with people who may need more support or skill-building.” While seclusion was already being used only as a last resort, there is a strong desire among mental health professionals to reduce it further, says Knechtel. “It’s about building a partnership with the patient. When you’re secluding them, it’s seen as us versus them,” she explains. “Seclusion seems more like punishment.” To reduce the need for seclusion, mental health units now provide designated safe places where patients can go and calm themselves when needed. “We’ve added comforting items and comforting rooms to our unit, which has been one of the biggest successes. We added massage chairs, stress balls, soothing music,” says Annette McDougall, a registered psychiatric nurse who has been instrumental

“IT’S ABOUT BUILDING A PARTNERSHIP WITH THE PATIENT. WHEN YOU’RE SECLUDING THEM, IT’S SEEN AS US VERSUS THEM - SECLUSION SEEMS MORE LIKE PUNISHMENT.”

Another debrief is held with staff to discuss the patient’s perspective. Following a successful pilot project at Health Sciences Centre, the seclusion reduction program was implemented in April 2014 at all in-patient mental health units in Winnipeg — at Seven Oaks General Hospital, Health Sciences Centre, Grace Hospital, Victoria Hospital and St. Boniface Hospital. In the first year, mental health units reported a 42% decrease in seclusion incidents, a 45% decrease in the total amount of time patients spent in seclusion, and a 67% decrease in days lost due to staff injuries. “We were really stretching our resources, so to have any success was really good,” says McDougall. “This was a huge team project on so many levels.” ✚