Anatomy of a transformation: a systematic effort to reduce mechanical restraints at a state psychiatric hospital.

OBJECTIVE: The authors describe efforts to reduce use of mechanical restraints at a state psychiatric hospital. METHODS: Data were collected for individuals admitted to the acute adult unit (AAU) (N=2,910) and the community transition unit (CTU) (N=334) over three years. Two strategies aimed to reduce mechanical restraint use. First, staff were trained in deescalation techniques, and a response team was formed for crisis situations. Second, a policy change required prior approval for use of mechanical restraint. RESULTS: Mechanical restraint was significantly reduced on both units after the first strategy. After the second, additional reduction was noted on AAU (98% total reduction) but not on CTU, where the practice had already been eliminated. No increase in assaults or injuries was noted. CONCLUSIONS: Reduction in mechanical restraint use is possible through deescalation skills training, use of a response team, and policy changes. Strong leadership, staff buy-in, provision of feedback, and quality monitoring were also instrumental.

Validation of the Impact of Health Information Technology (I-HIT) Scale: an international collaborative.

In 2005, the Healthcare Information Management Systems Society (HIMSS) Nursing Informatics Community developed a survey to measure the impact of health information technology (HIT), the I-HIT Scale, on the role of nurses and interdisciplinary communication in hospital settings. In 2007, nursing informatics colleagues from Australia, England, Finland, Ireland, New Zealand, Scotland and the United States formed a research collaborative to validate the I-HIT across countries. All teams have completed construct and face validation in their countries. Five out of six teams have initiated reliability testing by practicing nurses. This paper reports the international collaborative's validation of the I-HIT Scale completed to date.

Changes in society at national and international levels.

Many societal changes will influence the future nature of nursing, nursing informatics and health. Among these are environmental changes, increasing globalization, industrialization of developing countries, and educational developments. The paper considers these issues, and in particular the 'bold transformation' of nurse education that will be necessary if the profession is to be able to deal with the future. The paper concludes with a series of recommended strategic changes.