Assessing Patient Behavior: A Tutorial to Train Health Professions to Evaluate Aggression

Assessing Patient Behavior: A Tutorial to Train Health Professions to Evaluate Aggression

Cynthia L. Phelps, PhD, University of Texas Health Science Center, Maria L. Anderson, Ph.D., RN (Texas Woman's University), Doris Georgiou, Ph.D. (Smilex, Inc.), Lucindra Campbell, M.S.N., RN (Houston Baptist University), Colin B. McKay, Ph.D. (Smilex , Inc.) Houston, Texas, USA

ABSTRACT:

The use of Restraint and Seclusion (R&S) as measures to control behavior is a practice begun in France in 1709 to help protect against aggression. However, studies have shown that these are not effective measures to prevent harm to the patient and often lead to injury and sometimes death. Although defended as indispensable from their inception, the use of restraints has become synonymous with maltreatment and abuse and federal guidelines have been created to attempt to limit the use of R&S (Braun & Lipson, 1993).

Both the Health Care Financing Administration and the Joint Commission on Accreditation of Healthcare Organizations proposed rules and regulations regarding the urgent need to protect patients against the inappropriate use of seclusion and restraints, and to reduce the frequency of use of R&S (HFCA, 1999; JCAHO, 2001).

The need to decrease the use of R&S is particularly pressing since HCFA has recently mandated that institutions receiving Medicare and Medicaid funding recognize specific patient rights, including the right to be free from inappropriate R&S (HCFA, 1999). These guidelines are addressed in the Restraint and Seclusion Standards for Behavioral Health effective January 1, 2001

Our project addresses this problem: Currently in the United States, there is dramatic variability in the R&S training for clinical staff, the interpretation of Federal guidelines, and the methods by which institutions are attempting to lower the need for R&S (Ray & Rappaport, 1995).

Our study has systematically used the research literature, current guidelines and experts in the field to standardize the process of how to recognize risk for R&S. We have used this knowledge model to develop a multimedia application to train health professionals to evaluate patient's aggression and other risk factors for R&S.

We developed a set of six standardized case studies of video patients or patients that were incorporated into the database component of a web-based restraint and seclusion competency-based training program for clinical staff. These case studies are based on prevalent mental and behavioral disorders, and include the patient's pertinent history, current health status, and a short video clip of the patient's risk behavior in the clinical setting.

"Best Practice" literature was used to develop preliminary risk behavior matrices for each of the six video simulations featuring patients at risk for restraint and seclusion. Using an instrument to assess the risk behavior matrices, 10 psychiatric nurse experts evaluated each case study for realism and accuracy of the video simulation, and for patient risk factors including psychopathology and symptoms. There was consensus between experts for each patient risk behavior matrix and with the Best Practice literature. Continuing research should be conducted to further refine, verify, and extend a standardized model per case particularly in relation to identifying risk factors and interventions.

The preliminary standardized patient model constructed from the data demonstrated feasibility, and was successfully integrated into the computer-assisted restraint and seclusion assessment training program.

Funded by the National Institute for Mental Health R43 MH64334-01

BENEFIT TO PARTICIPANTS ATTENDING SESSION:

This presentation will take participants through the process used to design and develop a training program for health professionals. Methods from the field of cognitive science and informatics have been used to create a knowledge model of the content to be taught via the tutorial. This process combines multiple sources of information to produce a standardized training process and uses multimedia to deliver the training.

Cynthia L. Phelps, PhD

University of Texas - Houston

7000 Fannin, Suite 600

Houston, Texas 77030

Phone: 713-500-3926

Fax: 713-500-3929

Email: mailto:Cynthia.L.Phelps@uth.tmc.edu

Website: http://learn.sahs.uth.tmc.edu/clphelps/index.htm

AUTHORS:

Doris Georgiou, Ph.D. and Colin B. McKay, Ph.D.

Smilex, Inc.

3400 Montrose, suite 520