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Making a Difference with using a Diversional Activity CartDenise Rhew, MSN, RN, CEN, Sandra Kueider, MHA, RN,NE-BC, Susan Owens, BSN, CEN & Julie Eastwood, MSN,RN-BC
Annie Penn Hospital 618 S. Main Street Reidsville, NC 27320
To determine if offering a diversional cart for our behavioral health (BH)patients being evaluated in the ED would decrease agitation, the need foradditional sedation medications, and the amount of time the nurse isneeded at the bedside.
This design was a prospective pilot study. The use of an evidence-based practice model guided the Shared Governance team in the ED toimplement this study.
Purpose
Design
Once the patient was seen by the ED provider, the nurse offered the BH patient the opportunity to participate in the study, explained the purpose of the diversional activity cart, and obtained a consent if they agreed to participate. The diversional cart was brought to the patient’s room and they were allowed to choose an item off the cart such as: a crossword puzzle, word search, nature sound maker, playing cards, drawing tablet, and other safe items. The nurse caring for the patient completed an observation tool to determine the patient’s level of anxiety pre and post cart utilization. The nurse also documented on the data collection tool if sedation medication was given during the timeframe of the activity cart and was also asked to tally the number of interactions with the patient during the timeframe the patient utilized the cart.
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Sandra Kueider, RN, MHA, NE-BC, Department DirectorSusan Owens, RN, BSN, CEN, Assistant Director
Annie Penn Hospital T: 336.951.4515618. S. Main Street T: 336.951.4414Reidsville, NC 27320 E: [email protected]
METHODS
Leentjens, A.F. Dujardin, K. Marsh, L. Richard, I.H., Starkstein, S.E., Martinez-Martin, P., (2011). Anxiety rating scales in Parkinson's disease: A validation study of the Hamilton anxiety rating scale, the Beck anxiety inventory, and the hospital anxiety and depression scale. Movement Disorders, 26 (3), 407-415.
Honigfeld, G, Gillis, R.D., Klett C.J. (1965). Nurses' observation scale for inpatient evaluation: A new scale for measuring improvement in chronic schizophrenia. Journal of Clinical Psychology, 21, 65-71
Honigfeld, G., Gillis, R.D., Klett, C.J. (1966). NOSIE-30: A treatment-sensitive ward behavior scale. Psychological Reports., 19, 180-182
Cummings, K.S., Grandfield, S.A., Coldwell, C.M. (2010). Caring with comfort rooms. Reducing seclusion and restraint use in psychiatric facilities. Journal of Psychosocial Nursing Mental Health Services, 48(6), 26-30.
This study has shown that providing a diversional activity cart to our BH patients being cared for in an over populated and noisy environment did help decrease the patient’s anxiety level and the amount of sedation medication required. The ED nurses also reported there was a time saving benefit related to less dispensing of medications and less intensive monitoring requirements. The impact to leadership in conducting this study showed the need for them to continue providing the activity cart to maintain both patient and employee satisfaction.
The results showed to be significant. Fifty percent of the patients that participated had a decrease in their anxiety level reported by the nurses’ observation anxiety scale. Eighty percent of the nurses who completed the survey shared that the diversional cart was extremely helpful with the care of the BH patient. The results also showed a decrease in sedation medication required by patients. During the utilization of the diversional cart, only 5 percent of the patients required sedation medications.
RESULTS
CONCLUSIONS
CONTACT INFORMATION
REFERENCESSettingA rural hospital, which is part of a private, not for profit healthcare systemlocated in the Southeastern United States, was the setting for this study.Specifically, the study was conducted in a 23 bed emergency departmentwith a census of 37,000 patients a year. Two percent of the populationseen have a primary behavioral health diagnosis with the average length ofstay of 14 hours.
Participants/SubjectsOnly patients in the ED being cared for with a BH diagnosis and whowere over the age of 18 were included. Patients who had a diagnosis ofbipolar manic and schizophrenia were excluded.
BackgroundThe BH population holding in the ED is a growing national trend.Patients are often agitated and the over simulating environment in the EDoften increases agitation, requiring the need for sedation medication.There was a need to look at other options to provide the patient other thanmedication, restraints, and seclusion.
Items in the diversional cartItems in the diversional cart
0
5
10
15
20
25
No sedation needed Received sedation medication
Prior to Diversional Activity Cart
0
5
10
15
20
25
30
35
No sedation needed Received sedation medication
After Diversional Activity Cart
RN's perception of the Activity Cart
Cart helped the patient Cart did not help/pt remained the same
Likert scale used:N/AMild: Alert, EnergeticModerate: Decreased concentration on 1 event, perspiration, muscle tension, increase HR and resp. rate, irritability,
and pacingSevere: Dry mouth, profuse sweating, rapid shallow pulse & resp., rise in BP, speech impairment, increase muscle
tension, rigid posture, tremors or shivering and H/A, may not follow directions, crying, confused, inability to think abstractly
Panic: Single detail blown out of proportion, fear of loosing control, all the signs of Severe but with an increase in the degree of symptoms
Likert scale used:N/AMild: Alert, EnergeticModerate: Decreased concentration on 1 event, perspiration, muscle tension, increase HR and resp. rate, irritability,
and pacingSevere: Dry mouth, profuse sweating, rapid shallow pulse & resp., rise in BP, speech impairment, increase muscle
tension, rigid posture, tremors or shivering and H/A, may not follow directions, crying, confused, inability to think abstractly
Panic: Single detail blown out of proportion, fear of loosing control, all the signs of Severe but with an increase in the degree of symptoms
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