The Impact of Milieu Nurse–Client Shift Assignments on Monthly Restraint Rates on an Inpatient Child/Adolescent Psychiatric Unit

Abstract

INTRODUCTION: Restraints in the inpatient child/adolescent psychiatric population pose a threat to client safety and quality of care. Nurses are key in reducing restraints through implementation of evidenced-based interventions to improve quality and safety. AIM: To identify the impact of milieu nurse–client shift assignments on monthly restraint rates when compared with individual nurse–client shift assignments on an inpatient child/adolescent psychiatric unit. METHODS: A quantitative, retrospective, comparative project design was used. The sample included all inpatient child/adolescent clients admitted to the child/adolescent psychiatric unit between the months of January–May 2016 and 2017 who were physically or mechanically restrained. Retrospective chart audits were conducted, and information transcribed onto an adapted chart audit tool by Edwards et al. (2006). Monthly restraint rates were compared using the Mann–Whitney U test. A p value of <.05 was used to determine statistical significance. RESULTS: The Mann–Whitney U test revealed statistical significance between the impact that the individual nurse–client shift assignments ( Mdn = 61.2, n = 6) and the milieu nurse–client shift assignments ( Mdn = 6.8, n = 6) had on monthly restraint rates, U = .000, z = −2.88, p = .004, r = .83. CONCLUSION: Use of milieu nurse–client shift assignments are associated with lower monthly restraint rates when compared to individual nurse–client shift assignments. Milieu nurses provide structure, safety, consistency, and security, leading to early intervention and de-escalation of clients who display aggressive behaviors. Nurse staffing structures also need to be optimized to meet the needs of this population.