Doctor of Nursing Practice (DNP) Projects

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Degree Program

Doctor of Nursing Practice

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Psychiatric Mental Health Nurse Practitioner (PMHNP)

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Tidal Model, Restraints, Patient Centered Care


Gabrielle P. Abelard, DNP, PMHNP, PMHCNS-BC



Background: Restraint use has been demonstrated to pose a risk of psychological and physical injury to both clients and staff in health care facilities and programs. Evidence from the literature suggests that including patients in the planning of their care has been demonstrated to reduce problem behaviors, violent outbursts, instances of self-harm, and the need for restraint.

Purpose: The aim of this quality improvement project was to promote collaborative care through the attainment of provider knowledge of best practices to prevent and reduce restraint use at three group homes in St. Petersburg, Florida.

Methods: The intervention involved presenting evidence-based information from the literature to group home leadership, counselors and staff regarding the importance of patient involvement in care plans, and the correlation of decreased use of restraints when care is collaborative. Additionally, a tool kit was presented inclusive of best practice guidelines to reduce restraint use applying the Tidal Model framework. Acquisition of the material presented was measured by the DNP student’s analysis of changes in restraint report data, as well as the use of descriptive statistics to assess participant feedback regarding the educational intervention at two month follow-up.

Results: At two month follow-up, restraint use had decreased by 16% across all group homes, and feedback received from the participant questionnaire was largely positive in nature.

Keywords: Phil Barker, Tidal Model, Mental Health, Restraints, Patient Centered Care

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