Decreasing Patient Agitation Using Individualized Therapeutic Activities

Introduction

The article aims at addressing the issues related to patient agitation by evaluating how effective therapeutic interventions are on patient agitation. Waszynski et al. (2013) argues that patient agitation is of importance to nursing as a profession given its frequent occurrence among hospitalized patients due to their increased sense of loss of control and vulnerability. The most affected group includes psychiatric patients and other patients with cognitive disorders. Traditional interventions are often ineffective when dealing with patient agitation (Waszynski et al., 2013). As such, nurses need to identify an appropriate therapy that is effective and which does not strain the existing resources so as to deal with the clinical problem.

The study evaluated different therapeutic measures employed by various hospitals in addressing patient agitation. According to Waszynski et al. (2013) the most common method is the continuous observation of the at-risk patients through the use of sitters, drawn mainly from the nursing staff. The method is inefficient and lacks support in the literature. The authors also review other therapeutic methods that are employed to manage patient agitation. Some hospitals use Specialized Adult-Focused Environment (SAFE). The SAFE program involves grouping the at-risk patients together for close monitoring as well as offering individualized care (Waszynski et al., 2013). Other hospitals employ the ‘Delirium Room Model’ where a four-bed patient area is created and put under 24-hour nurse monitoring. Waszynski et al. (2013) asserts that both programs include application of pharmacological approaches to reduce patient agitation.

Procedures

Subjects

The subjects of the study comprised of two groups of patients’ identified from an inner-city level-1 trauma and teaching center. The hospital was chosen due to its consistently high number of patients requiring adequate care due to agitation, something that makes the hospital use about forty full-time employees to serve as sitters every year. The first group of participants comprised of 42 patients with the second group constituting 32 patients. The participants constituted of 60 men and 14 women, with the age ranging between 17 and 94 years.

Grouping of Subjects

The patients who were assigned to continuous observation were characterized before the categorization. The patients were categorized based on the causal factor for being put under constant observation. The majority of the patients were grouped as being at-risk due to agitation secondary to psychiatric conditions, as well as substance abuse. The remaining were medical patients with reported suicidal attempts.

Study Activities

During the period of close observation, the researchers put the patients under intensive supervision as well as restraints. The observers also engaged the patient in different activities so as to watch the patient behavior. The patient’s responses to individualized responses were also explored. The observer completed a ‘Personal Approach Form’ together with the patient. The second round of activities involved the observer presenting the patients with items for a preferred activity. The items included CD players, balls, puzzles, flashing lights as well as playing cards which were meant for the patient activity of choice.

Duration of Activities

The first group of subjects which included 40 patients was put on identified therapeutic activities for a period of three months. During that time, the researchers collected data on the patients. The second group of subjects which included 32 patients was put under observation for a period of three months. The researchers also collected data during this time.

Study Measurements

The researchers measured the participant’s agitation levels. The levels of agitation were measured at three stages during the research. The first measurement was done before the initiation of the individualized activities. The second tier was measured during the individualized activities while the third was measured at the end of the activities (Waszynski et al., 2013). The measurement was done using the ‘Agitated Behaviour Scale’ (ABS). The agitation levels were measured based on the fourteen-observable behavior scale. By using the ABS tool, the researchers were able to rate each behavior with scores ranging from one to four (Waszynski et al., 2013).

Comparisons

The study compared the agitation levels among the participants at different intervals. The level of agitation at the beginning of the study was compared with those which occurred during and post the interventional activities. The scores between raters were compared which is one of the advantages of the ABS too as cited by the authors (Waszynski et al., 2013).

Findings

The participants showed a decrease in the level of agitation when subjected to individualized therapeutic activities. The researchers pointed out that the reduction was sustained for a period post the therapeutic activity. Waszynski et al. (2013) indicates that the largest effect of the individualized therapeutic activity was seen in patients who had higher agitation levels at the onset of the study. A small percentage of the participants showed no changes in the agitation levels at all intervals during the research. The qualitative data obtained from the study showed that the individualized therapeutic activities had other positive effects on the participants. The observers indicated that the patients had increased nonverbal cues such as smiling and laughing as well as improved interaction with other patients (Waszynski et al., 2013). The activities acted as a distraction to the patients about their current situation allowing them to talk about their happier days.

The authors acknowledge that the individualized therapeutic activities successfully decreased the levels of agitation among patients. The authors also cite the possibility of other unseen factors contributing to the decline in agitation levels. The results were instrumental in establishing how to increase the effectiveness of sitters for patients who are at risk of agitation.

Conclusions

The research showed that the patient sitters play a pivotal role in ensuring that patient levels of agitation are kept at a bare minimum. However, for the patient observers to be more efficient, they should engage the patients in individualized therapeutic activities. The therapeutic activities are effective not only in reducing the levels of agitation but also in ensuring that patients have a positive image of themselves. Individualized therapeutic activities can reduce the cost and staffing burden placed on the hospitals that use the current agitation management for patients the at-risk patients.

Personal Comments

The main lesson from the study is that the use of individualized therapeutic activities is effective in managing agitation levels among patients. The study also demonstrates that individualized therapeutic activities also have the added benefit of distracting patients and ensuring that they focus on the happy times during their lives (Waszynski et al., 2013). As such individualized therapeutic activities can aid the patient to recover more quickly as opposed to just using dormant observers.

The results of the study results will be applicable in a clinical set up where there are agitated patients. The clinical set-ups would include a geriatric hospital as well as a psychiatric hospital.

Reference

Waszynski, C., Veronneau, P., Therrien, K., Brousseau, M., Massa, A., & Levick, S. (2013). Decreasing patient agitation using individualized therapeutic activities, American Journal of Nursing, 113 (10), 32-39.