Updates to American Psychiatric Nurses Association: Seclusion and Restraint Position Statement and Standards of Practice.

Objective: The purpose of this discussion paper is to summarize the 2022 updates to the American Psychiatric Nurses Association's (APNA) Seclusion and Restraint Position Statement and Seclusion and Restraint Standards of Practice.

Method: Both documents were the work of the APNA 2022 Seclusion and Restraint Task Force that consisted of APNA nurses with expertise in the use of Seclusion and Restraint, who practice across a wide range of clinical settings.

Results: The 2022 Updates to the APNA Position Statement and Standards were guided by evidence-based information found in the review of seclusion and restraint literature and clinical expertise from the 2022 Seclusion and Restraint Task Force.

The Impact of Nursing Protocols on Continuous Special Observation.

Background: Continuous Special Observation (CSO) is commonly ordered for patients at risk to injure themselves or others and involves assigning staff to monitor one patient at all times. CSO is intrusive, costly, and often has deleterious effects on patient care. Two nursing protocols were developed as alternative interventions to CSO.

The evolution of practice changes in the use of special observations.

In acute psychiatric settings, it is common practice to increase the intensity of observations of patients who present with self-injurious thoughts, who are at risk of injuring others, or who exhibit behaviors that adversely impact the overall milieu. These intense observations are intrusive and may result in untoward stimulation of the patient. Nurses at an urban academic medical center addressed the problem of intrusive and overstimulating levels of observation by developing two practice changes using intuitive knowledge combined with input from current nursing literature.