Assessment Solutions | Evidence Based Practice: CNA672

CNA672 Research for Clinical Practice A
Student name:
Student ID:
Evidence-based practice is one of the core nursing responsibilities (Allen …

Preview text

CNA672 Research for Clinical Practice A
Student name:
Student ID:
Evidence-based practice is one of the core nursing responsibilities (Allen et al. 2018).
Ensuring evidence-based practice in nursing assures that the care needs of the patients are
met, and suitable care outcomes are achieved. It also ensures that the interventions that are
applied are in alignment with the existing evidence so that the beneficence of the patient is
maintained (Lam and Schubert 2019) .For mental health care, itensures that the best care
practices are applied, and holistic care outcomes are achieved for the patients. This paper will
explore the evidence based on adeveloped research question and identify the similarities and
differences in the practice. This paper will also outline the limitations of the application of
evidence-based practice based on the research done in this assignment.
Patients with severe mental health complications may require extensive care and support
(Druss 2020) .In certain cases, itis possible that the patients do not comply with the care
requirements. Hence, at times, restraint and seclusion based practices are applied in the care.
These practices are discouraged in the facilities and are deemed to be applied only in highly
specific cases (Oostermeijer et al. 2021) .Seclusion and restraint have been associated with
poor mental health outcomes in the patients (Cole et al. 2020). Application of restraint for the
patients the mental health patients is associated with feelings of fear, humiliation, anger,
dehumanization, distress, powerlessness, embarrassment and violation of feelings of integrity
and self-respect in the patients (Muir ‐Cochrane et al. 2018) .It also asserts amajor impact on
the relationship of patient and nurse relationship. It results in aloss of trust between the carer
and the patient. The use of restraint is also associated with functional decline in the patients.
It may cause emotional suffering in the patient (Hawsawi et al. 2020) .Person-centred care
helps in providing amore holistic perspective of care and aids in identification of individual
care needs of the patient. For mental health patients, itcan help in understanding their needs
and can ensure delivery of quality care and support. This can thus promote improved care
outcomes and patient recovery (Cole et al. 2020).
As afuture mental healthcare practitioner, Ithink this topic is of prime importance. It is
possible that, at times, the patients may not be able to comply with the procedures of care and
restraint, and seclusion based practice might be needed. However, itis also crucial to have an
understanding of alternative practices that can be applied. This research will help in the
development of effective practices and assist me in advancing as acompetent nurse
PICO format was used for developed the research question. This format was used as ithelped
in the classification of the key variables associated with the research (Eriksen and Frandsen
2018) .P: patients with severe mental health problems, I: use of apatient-centred care, C:
restraint and seclusion and, O: patient health improvement. Hence, the PICO question as, “Is
patient centred care effective enough to eliminate seclusion and restrain based intervention
in patients diagnosed with severe mental disorders such as schizophrenia? ”
The keywords that were used for conducting the study included: “seclusion, restraint, mental
health, severe, disorder, holistic, care, patient, nursing, outcomes, alternatives, psychiatry”.
The Boolean operators “and” and “or” were used to create search strings.
The use of search strings helps in the identification of the suitable search results using the
literature database of PubMed central. Further, the results were filtered out from the database
by the inclusion of studies from only the last five years. This ensured that the studies
published were recent and coherent with the research problem developed. The articles that
were retrieved were then screened manually for relevance and coherence with the research
The three articles that were selected for completion of this study included work by Chieze et
al. (2019), Raveesh et al. (2019), and Weber et al. (2021). The study by Chieze et al. (2019)
was asystematic review. The study asserted that seclusion and restraint have anegative
impact on mental health patients and hence, should only be applied as alast resort. The focus
should be on building atherapeutic relationship with the patient and focus on care with
patient preferences in consideration. The importance of patient-centred care is also
highlighted. The second study was by Raveesh et al. (2019) was areview. The study
highlights the negative impacts of restraint and seclusion and advocates the use of
alternatives such as the humanistic model of care with patient-centred approach for the
management of patients with severe mental health problems. The third study was by Weber et
al. (2021) that was asystematic review. The study highlights that there exists amajor gap in
the research that can help in highlighting the impact of the physical environment of the
patient on their well-being. The findings suggested that the use of the least restrictive
practices and therapeutic care impact patient health and outcomes.
To conduct primary research, itis important to have afocused area of discussion. In this
study, afocussed area was defined with afocus on the restraint and seclusion based nursing
interventions for mental health patients with severe mental health disorders. In conjunction
with the focussed area, the PICO approach is used for research question development. Once
the PICO question was developed, the second approach was to develop the search strings
using the Boolean operators. The search strings were then applied using with the limiter of
the last five years on an open literature database, PubMed central. The search was done using
these keywords. The individual articles were screened manually and then three articles were
selected based on the question developed. The articles were assessed for quality using the
checklist developed by CASP (Critical appraisal skills programme) and were then included in
the study.
This section will highlight the level of evidence and the strengths and weaknesses of the
individual articles published. The study by Chieze et al. (2019) was asystematic review and
thus belonged to level of synopses of synthesis based on hierarchy of evidence. Clearly
defined search strategy and inclusion of thirty five articles in the study were the strengths of
the study. The limitation of the study included the heterogeneity of the studies included
impacted the derivation of direct conclusions. Having anarrower inclusion criterion with
only asingle type of study could have helped in overcoming this limitation. This study was
selected as itprovides asummary of existing practices associated with restraint or seclusion
based interventions for the care of patients with severe mental health problems. For the
second study, by Raveesh et al. (2019), the level of evidence was synthesis. The study
elaborates on different types of restraints and their impact on the mental health patients with a
wide array of resources to develop its discussion making the study highly evidence-based.
This was aprimary strength of the paper. The methodology to complete the study was not
provided. Hence, the findings of the study cannot be replicated. This emerged as alimitation
of this paper. The study was selected as ithelped in the identification of different types of
restraint based practices in the care facilities and their impact on the patients. The third study
was by Weber et al. (2021) that was asystematic review and hence belonged to level of
synopses of synthesis. The strength of the study was that based on asystematic review
research approach with the use of the PRISMA approach. A total of 26 articles were included
in the study. The limitation of the study was that the study concluded that there is agap in the
research, and amore focused analysis is needed. The study also concluded that the seclusion
and restriction based practices impact the mental health of the patients. The study was
selected as ithelped in understanding the alignment of current evidence associated with
restraint based care or alternative methods of patient care for severe mental health disorders
in the patients.
The major similarity that emerges in the research articles studied in this assessment is that all
three articles, Chieze et al. (2019), Raveesh et al. (2019), and Weber et al. (2021), highlight
the importance of limiting the use of restraint based practices in the care facility. The same is
promoted in our facility, where the focus is on providing holistic care to the patients. The
outcomes indicate acommon aspect that restraint based practices have anegative impact on
the patient and the carer relationship and hence should be avoided in the process of care.
Further, inclusion of person-centred care can help in improving the patient outcomes help
achieve improved patient well-being.
The studies also highlight that limited evidence is available to develop coherent conclusions.
However, in the facility, itis suggested that the restraint based practices are necessarily
limited based on the mental healthcare support guidelines. This difference is based on the
different research settings and individual codes and practices developed for mental health
care policies for patient needs across the countries.
The current mental health practice asserts that seclusion and restriction base dinterventions
should be discouraged (Power et al. 2020). The current evidence highlights that there is a
need to have amore focused research to identify what kind of interventions can be applied as
an alternative to restriction and seclusion based interventions. This study also highlights that
while restrictive practices impact the relationship between the carer and the patient, they may
still be needed in certain cases concerning the safety and well-being of the patient as well.
The use of restrictive practices raises aquestion of violation of the human rights of the
patients. The patient-centred care is also regarded as the suitable care approach where the
individual care needs of the patient are acknowledged and understood. The ethical principles
of nursing assert the importance of patient autonomy (Molina-Mula and Gallo-Estrada 2020) .
In the case of mental health patients, there may be apossibility that the patient refuses to
participate in the process of care and may pose athreat to safety for him or herself or for the
carers or any other individual in the vicinity. It is only in such cases that the use of restrictive
practices is often defined. It is important to consider that while restrictive practices serve as a
temporary resort to the problem, they fail to provide the long term benefits for the patients
and also tarnish the relationship between the carer and the patient. However, more focused
evidence is needed to develop an alternative strategy for ensuring improved patient outcomes;
there is aneed to develop amore holistic approach toward mental health patients with severe
mental health problems (Paradis ‐Gagn éet al. 2021) .
While the application of evidence-based practice is the core responsibility of the healthcare
professionals, certain limitations or barriers are also associated with its application in the
process of care (Glowacki et al. 2019) .One of the primary limitations associated with the
application of evidence-based practice is the knowledge of practices. Therefore, lack of
knowledge is one of the primary limitations that impacts the application of evidence-based
practice. Other limitations also include negative attitudes and poor acknowledgement by the
care service providers, along with alack of motivation and training to the care service
providers (Duncombe 2018) .
Evidence-based practice is one of the core skills and responsibilities that is associated with
improved care outcomes for the patients and enhanced patient care and support. It is
important to overcome these barriers with asystematic action and by the development of
suitable interventions to ensure improved patient outcomes and well-being in the care facility
(Glowacki et al. 2019) .
Mental health care and support for the patients require extensive care and support. It is
important that evidence-based care is provided to the patients to ensure improved patient
outcomes. This paper describes asearch strategy applied for the identification of the evidence
based on afocused PICO question. The focus of the study was identified as to study the
difference between the restraint based care and patient-centred care provided to patients with
severe mental health problems and its impact on their health. Three articles were retrieved
based on the search strategy. The findings of the paper indicated that there is aneed to
develop more research and evidence to derive aconclusive inference. However, the current
findings indicate that the restrictive practices implicate poor healthcare experience for the
patients and are discouraged in the facility. This paper also outlines that there are certain
limitations in the application of the evidence-based practices. These should be limited to
ensure improved care and support to the patients.
Allen, E., Williams, A., Jennings, D., Stomski, N., Gouache, R., Toye, C., Slatyer, S.,
Clarke, T. and McCullough, K., 2018. Revisiting the Pain Resource Nurse Role in
Sustaining Evidence ‐Based Practice Changes for Pain Assessment and Management.
Worldviews on Evidence ‐Based Nursing ,15 (5), pp.368-376.
Chieze, M., Hurst, S., Kaiser, S. and Sentissi, O., 2019. Effects of seclusion and restraint
in adult psychiatry: asystematic review. Frontiers in Psychiatry ,p.491.
Cole, C., Vandamme, A., Bermpohl, F., Czernin, K., Wullschleger, A. and Mahler, L.,
2020. Correlates of seclusion and restraint of patients admitted to psychiatric inpatient
treatment via aGerman emergency room. Journal of Psychiatric Research ,130 ,pp.201-
Druss, B.G., 2020. Addressing the COVID-19 pandemic in populations with serious
mental illness. JAMA Psychiatry ,77 (9), pp.891-892.
Duncombe, D.C., 2018. A multi ‐institutional study of the perceived barriers and
facilitators to implementing evidence ‐based practice. Journal of Clinical Nursing ,27 (5-6),
Eriksen, M.B. and Frandsen, T.F., 2018. The impact of patient, intervention, comparison,
outcome (PICO) as asearch strategy tool on literature search quality: asystematic review.
Journal of the Medical Library Association: JMLA ,106 (4), p.420.
Glowacki, K., Weatherson, K. and Faulkner, G., 2019. Barriers and facilitators to health
care providers ’promotion of physical activity for individuals with mental illness: a
scoping review. Mental Health and Physical Activity ,16 ,pp.152-168.
Hawsawi, T., Power, T., Sugai, J. and Jackson, D., 2020. Nurses’ and consumers’ shared
experiences of seclusion and restraint: A qualitative literature review. International
journal of mental health nursing ,29 (5), pp.831-845.
Lam, C.K. and Schubert, C., 2019. Evidence ‐based practice competence in nursing
students: An exploratory study with important implications for educators. Worldviews on
Evidence ‐Based Nursing ,16 (2), pp.161-168.
Molina-Mula, J. and Gallo-Estrada, J., 2020. Impact of nurse-patient relationship on
quality of care and patient autonomy in decision-making. International Journal of
Environmental Research and Public Health ,17 (3), p.835.
Muir ‐Cochrane, E., O’Kane, D. and Oster, C., 2018. Fear and blame in mental health
nurses ’accounts of restrictive practices: Implications for the elimination of seclusion and
restraint. International journal of mental health nursing ,27 (5), pp.1511-1521.
Oostermeijer, S., Brasier, C., Harvey, C., Hamilton, B., Roper, C., Martel, A., Fletcher, J.
and Brophy, L., 2021. Design features that reduce the use of seclusion and restraint in
mental health facilities: arapid systematic review. BMJ Open ,11 (7), p.e046647.
Paradis ‐Gagn é,E., Pariseau ‐Legault, P., Goulet, M.H., Jacob, J.D. and
Lessard ‐Desch ênes, C., 2021. Coercion in psychiatric and mental health nursing: A
conceptual analysis. International Journal of Mental Health Nursing ,30 (3), pp.590-609.
Power, T., Baker, A. and Jackson, D., 2020. ‘Only ever as alast resort ’:Mental health
nurses’ experiences of restrictive practices. International Journal of Mental Health
Nursing ,29 (4), pp.674-684.
Raveesh, B.N., Gowda, G.S. and Gowda, M., 2019. Alternatives to use of restraint: A
path toward humanistic care. Indian Journal of Psychiatry ,61 (4), p.S693.
Weber, C., Monero Flores, V., Wheeler, T.P., Miedema, E. and White, E.V., 2022.
Patients’ health & well-being in inpatient mental healthcare facilities: asystematic review.
Frontiers in Psychiatry ,p.2446.
Image of search results
Hierarchy of evidence


Leave a Reply

Your email address will not be published.