The Pelican News - June 2017

Page 4 • Pelican News June, July, August 2017
Applying Jean Watson’s Caring Theory to Reduce
Restraint Use in the Acute Psychiatric Area
Glenda Natale MSN, RN, HNB-BC,
Alicia Fitzgerald ASN, RN, Marie Lou Landry BSN,
RN, Keeley Harmon PhD, RN –
Our Lady of the Lake Regional Medical Center
In the acute care setting, the use of physical restraints
has become a common approach in the management
of challenging patient situations. According to Raguan,
Wolfovitz, and Gil (2015), “physical restraints are broadly
defined as any limitation to the freedom of an individual’s
movement and may include bed-rails, belts, “mittens,” wrist
restraints and other devices (p. 633). Further, “it is estimated
that nearly 10,000,000 hospital days in the United States
involve physical restraints” (p. 633). It is cited in the literature
that restraints are often used because of the perception that
restraints may decrease falls and prevent injuries. However,
according to Gilbert and Counsell (1999), facilities that
maintain practices dedicated to avoiding patient restraints
actually report fewer injuries than facilities with a prevalent
use of restraints.
The Nurse Manager of the Acute Psychiatric unit at Our
Lady of the Lake Regional Medical Center (OLOLRMC)
recognized that there was a potential for improvement
relative to the use of restraints on the unit. She wondered if an
increased presence by the nurses on the unit could potentially
reduce the restraints utilized. What does an increased
presence mean? Basically it means that a nurse is stationed in
the hallways at all times rather than intermittently as has been
the case previously. The rationale with the increased presence
of the nurses in the hallway is that the milieu of the unit could
be impacted positively and thus prevent escalating behavioral
issues which may necessitate restraints.
The model incorporated in making the change was Jean
Watson’s Caring Theory. The philosophical foundation for
the science of caring includes the “development of a helpingtrust
relationship, which includes congruence, empathy, and
warmth, and the therapeutic use of self. The strongest tool
a nurse has is his or her mode of communication, which
establishes a rapport with the patient as well as caring by
the nurse. Communication includes verbal and nonverbal
communication as well as listening that connotes empathetic
understanding. Additionally, a second caritas states, “the
cultivation of sensitivity to one’s self and to others,” which
explores the need of nurses to feel an emotion as it presents
itself. The development of a nurse’s own feeling is needed to
interact genuinely, sensitively, and subsequently, authentically
with patients. This is the difference between being with
and doing for the patient. It is between the gap of “being
and doing” that presence reveals itself in a nursing context.
“Being” affords the mature and reflective nurse the gift of
authenticity. Jean Watson describes this as authentic presence,
allowing for the formation of meaningful person-to-person
relationships, “enabling faith, hope and sustaining the deep
belief system and subjective life world of self and one being
cared for” thereby promoting health, well-being and higherlevel
functioning. The results since the incorporation of the
change have been quite staggering. Not only have the number
2017 Brings Big Changes to LSNA
The beginning of 2017 brought big changes to our
organization. Since the beginning of the year LSNA has
continued to evolve and change, and our organization
continues to grow in this new direction. In January of
this year, LSNA moved office locations to join forces
with our governmental affairs advisors, Southern
Strategy Group, and our lobbyist, Randal Johnson
and others with that firm. Many of you recall Randal
served as this year’s Master of Ceremonies at the most
prestigious event, the Louisiana Nurses Foundation
Nightingale awards, as you can see featured in the
photo of Randal Johnson and LSNA Board member
Jackie Hill.
of restraint episodes declined but the minutes in restraints have
also declined. On an acute psychiatric unit that in past years
reported multiple episodes into the teens, can now report three
consecutive months restraint free! Patients are no less ill. The
increased presence of the staff is making a difference.
In summary, increased presence is more than adding
a registered nurse at the end of the hallway. It was evidence
of a specific intervention by which nurses became part of
the healing environment. Through the introduction of an
authentic, caring, and trusting presence in a psychiatric
hallway the potential for violence was reduced—highlighting
the critical need for nurses to remain grounded, self-aware and
cognizant of their strengths and limitations when interacting
with patients.
References
Gilbert, M., and Counsell, C. (1999). Planned change to implement
a restraint reduction program. Journal of Nursing Care
Quality, 13(5), pp. 57-64.
Raguan, B., Wolfovitz, E., and Gil, E. (2015). Use of physical
restraints in a general hospital: A cross-sectional
observational study. Israel Medical Association Journal, 17,
p. 633-638.
Watson Caring Science Institute. Retrieved at https://www.
watsoncaringscience.org/jean-bio/caring-science-theory/10-
caritas-processes/
Much happens regularly in Baton Rouge and in
Washington DC which needs the constant attention
to the details registered nurses have a scope of
interest and responsibility which is varied and broad.
Patent advocacy, patient care, outcome improvement,
education – matters so voluminous that we will leave
some out.
The new LSNA headquarters office and staff are
open, present and working each day. We are in the
shadow of the state Capitol, around the corner from
the Louisiana Department of Health and a few blocks
from the Board of Regents and the state’s Division of
Administration. The legislature may only be in town for
three months or so, but the work of registered nurses
goes on every day and we are privileged to be helping
with that.
Many things are happening and the need for
LSNA to be involved in these matters is crucial. Our
organization is responsible for protecting and ensuring
nurses have a voice in the Capitol. As legislative
matters come up for consideration we may call upon on
membership asking them to contact their legislators on
a particular bill. Nurses represent a crucial role in the
delivery of healthcare to patients and citizens, and it is
our responsibility to make certain that legislators know
this and our services are protected.
LSNA and our partners will continue to advocate
on behalf of its membership and as our organization
continues to evolve and grow and respond to the need
of our members, and we will continue to discuss the
numerous healthcare issues we face as session moves
forward.
RN POSITIONS NOW AVAILABLE
Natchitoches Regional Medical Center,
Located in Natchitoches, LA is seeking highly motivated
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RN Positions Available
If you are interested in working in a growing organization
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