Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital[Formula: see text].

INTRODUCTION: The application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care to assure patient safety and expedite release at the earliest opportunity. While current Centers for Medicare & Medicaid Services regulations require trained staff to continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. The experience of an acute psychiatric hospital demonstrates that more frequent registered nurse assessments can decrease duration of mechanical restraint episodes. AIMS: The aim of this three-part quality improvement project was to decrease duration of mechanical restraint episodes by increasing the frequency of registered nurse assessment and surveillance. METHODS: First, the requirement for frequency of face-to-face registered nurse assessment during episodes of mechanical restraint was increased from once every hour to once every 30 minutes. Second, the frequency of assessment was increased on half the hospital's units, from every 30 minutes to continuous registered nurse presence during restraint. Finally, the remaining units adopted 1:1 registered nurses during restraint. Mean hours of restraint per episode were measured and compared before and after each practice change. RESULTS: Mean duration of restraint episodes decreased 23% in the first change cycle, 12% in the second, and 44% in the third. Overall, there was a statistically significant 30% decrease in mean duration of restraint episodes. CONCLUSIONS: Increased frequency of registered nurse assessment and surveillance can significantly decrease duration of mechanical restraint episodes. Nurses are encouraged to adopt mechanical restraint practice standards that provide continuous psychiatric intensive care by a registered nurse.

Self-Management Behaviors in Relation to Psychological Factors and Interdialytic Weight Gain Among Patients Undergoing Hemodialysis in Indonesia.

PURPOSE: The purpose of this study was to understand the influence of demographic and psychological factors on self-management behaviors and interdialytic weight gain (IDWG) as a fluid adherence marker among patients undergoing hemodialysis in Indonesia. DESIGN: A quantitative correlational study. METHOD: A convenience sample of 145 patients undergoing hemodialysis was recruited from the dialysis units in two hospitals in Jakarta from September to December 2015. Questionnaires were used to examine self-management behaviors, depression, anxiety, and stress. Data for IDWG were obtained by subtracting the individual's predialysis weight from his or her postdialysis weight from the previous session. Hierarchical multiple linear regression identified the predictors of IDWG. RESULTS: Self-advocacy was ranked the least performed self-management behavior, while medication adherence was ranked the most likely to be performed. Among the subscales of the Self-Management Behavior Indices, positive correlations were found between the communication dimension with all psychological factors (depression, anxiety, and stress), while self-advocacy had positive correlation with anxiety. Subjects gained a mean of 4.5% of their postdialysis weight, with over 50% exceeding the recommended 4% IDWG. Overall, 53.6% of the IDWG was explained by the weekly duration of hemodialysis, level of depression, communication, partnership in care, and self-advocacy. CONCLUSIONS: Self-management behaviors are potential predictors that can be modified by nephrology nurses in order to enhance clinical outcomes, with the specific outcome being IDWG. Self-management behaviors contribute to the promotion of appropriate IDWG. Depressed patients are less likely to adhere to weight gain restrictions. CLINICAL RELEVANCE: Education combined with training in self-management behaviors-particularly communication, becoming a partner in care, and advocating for care-may improve adherence to IDWG guidelines among Indonesian hemodialysis patients. Interventions targeting depressed patients are needed.

Perception of Spirituality and Spiritual Care among Muslim Nurses in Indonesia.

This cross-sectional study was conducted to examine 256 Muslim nurses' perception of spirituality and spiritual care in Indonesia. The Spirituality and Spiritual Care Rating Scale (SSCRS) was translated and culturally adapted. Moderately high degrees in five domains and total SSCRS were found. Specialty, education level, clinical seniority, having spiritual training, and previous spiritual caring experience could impact on the SSCRS. Most nurses have cared for patients with spiritual needs, but denied having any formal training in providing spiritual care. Providing adequate curriculum and on-job training to equip nurses' knowledge and competence of spiritual care is urgent in Muslim healthcare environment.

The relationships between activity and quality of life for older men and women at different ages in Taiwan.

This study investigated the relationships between types of activity and quality of life (QOL) for older men and women at different ages. Based on cross-sectional data that included 220 community-dwelling elderly persons aged 65 and older in southern Taiwan, the results showed that the participation rates in many activities declined with age for both genders. Social activity and solitary leisure activity were significantly associated with QOL for old-old men, but not for young-old men. Only social activity was significantly associated with QOL for young-old women, but there was no significant association between any activity and QOL for old-old women.