Learning Objectives. We Had Problems. APNA 30th Annual Conference Session 2041: October 20, Cratty 1

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1 Use of a Tidal Model Informed Program to Improve Patient Satisfaction and Decrease Chemical Restraints on an Adult Inpatient Psychiatric Unit at a Community Hospital Phyllis Cratty, RN, BSN Brittany Chabak, LCSW, MPH *The speakers have no conflicts of interest to disclose Learning Objectives Identify the components of the Tidal Model utilized in this practice change List the Tidal Model informed methods that clinical nurses used to assist in the development of therapeutic nurse patient relationships and in the reduction of patient violence Identify the role of guided journals in augmenting the recovery process We Had Problems Lack of daily structure for patients Low patient satisfaction scores High utilization of chemical restraints Lack of recovery oriented approach Cratty 1

2 Tidal Model Recovery oriented approach designed for acute inpatient mental health settings 3 main points Importance of therapeutic relationship Healing comes from telling our stories Our lives are ever changing Studies indicated Decrease in patient aggression 1,2,3 Decrease in physical restraints 1,2,3 Increase in patient satisfaction 4 1 Gordon et al., 2005; 2 Lafferty & Davidson, 2006; 3 Berger, 2006; 4 Cook et al., 2005 Image: kusumagraj.html Incorporation of Tidal Model Elements Centrality of the patient s narrative Guided journal Recovery focused 1:1 Emphasis on therapeutic patient staff relationships Types of groups Solutions, Recovery, Information Role of Nurses Recovery focused one to ones Listening to a patient s story; their lived experience Empathizing and understanding Empowering patient to make changes Facilitate medication groups Assist patients in the use of guided journals Enforce unit structure It is the relationship that heals Yalom, 1980 Cratty 2

3 Guided Journals Developed by our staff with feedback from patients Empowers patients by giving them space to tell and own their story Engages patients in treatment outside of groups Main components: Daily thought provoking questions Recovery plan Daily goals Medications Resources Outcome Measures Patient satisfaction scores Highly agree The group discussions were helpful Patient Aggression Records Agree Neutral Disagree Highly disagree Date Time Patient Information Medication Diagnosis Hadol Bipolar Disorder Ativan Psychotic Disorder Place Sticker Here Thorazine Schizophrenia Other Dementia IDD/MR Personality D/O Other Outcomes: Patient Satisfaction Data 8 months pre and 10 months post implementation 2 post months were outliers and excluded (N₁ = 8; N₂ = 8) Analysis Independent two sample t test assuming unequal variances Testing H 0 : µ 1 = µ 2 H A : µ 1 µ 2 ; α<0.05 Cratty 3

4 Outcomes: Patient Satisfaction Findings 18% increase in patients marking Highly agree and Agree on surveys P= ; statistically significant suggesting rejection of H 0 Percentage of Positive Patient Satisfaction Ratings Patient Satisfaction Month Pre Post Outcomes: Chemical Restraints Data 5 months pre and 6 months post (N₁ = 5; N₂ = 6) IM/PRN Now medications administered between the hours of 8am 5pm weekdays only Only first 5 PRN/IM medications per patient per admissions counted in data Analysis Independent two sample t test assuming unequal variances Testing: H 0 : µ 1 = µ 2 H A : µ 1 µ 2 α<0.05 Outcomes: Chemical Restraints Findings 40% decrease in IM/PRN Now medications weekdays 8am 5pm P=0.009 Statistically significant suggesting rejection of H 0 Cratty 4

5 Discussion of Findings Logic Model of 2013 for Tidal Model Project Proposed a 15% increase in patient satisfaction ratings Proposed a 20% decrease in IM/PRN Now meds Must also consider other variables Small sample sizes Increased staff patient ratio during day Time of year Can this change be sustained? Recent Program Changes Expansion of group program Evenings and weekends Aides and nurses facilitating more groups Journals in every patient s Welcome Packet Future Implications Additional nursing staff More time to develop relationships with patients Float nurse on evening and night shifts Greater presence on the unit Increase regulation of group topics On going training and assessment of adherence to program components Cratty 5

6 Mental health nurses have great opportunities to impact positively on the health and well being of people they provide care for through using the nurse patient relationship as a therapeutic tool to promote recovery and help people live the lives they want to lead McAndrew et al., 2014 Questions? Cratty 6