Case Study

Does the integration of specially trained health care aides (HCAs) reduce the incidents of escalating behaviours in pediatric off-service mental health?

Background: Contracted security guards are currently utilized for constant observations of patients at risk of escalated behaviour. If the patients escalate, the guards alert the nurses or intervene themselves if physical restraint is required. It is a reactive model. As the guards are contracted, they aren’t part of the team, and aren’t privy to patient information. This causes communication issues and a lack of understanding in how to manage behaviours often resulting in escalation.

Rationale/Importance of this Research: Escalating behaviours can lead to physical/psychological injury to patients and others, and destruction of property. If the integration of HCAs prevents escalations it could prevent suicide attempts/physical harm, assault, extended lengths of stay, vandalism, and costs of repairs.

Research Design: A case research design supports an investigation into the number of escalated behaviours that result in intervention in a pediatric off-service mental health unit over 12 months. This design is positivist in nature by testing the hypothesis that integrating specially trained HCAs will reduce the incidence of escalating behaviours in this population.

Survey Questionnaire: While decreasing escalations is the goal of this research, satisfaction of care by the team is an important secondary goal. Physicians and nurses are increasingly frustrated by guards intervening too late, not interacting with the patients, inappropriately cancelling constant observations ordered by Psychiatry, and resorting to physical intervention instead of prevention. HCAs would be part of the care team, have in depth knowledge of the care plan, consistently have a nurse buddy and regular communication/support, and interact with the patients. Gathering information from nurses and doctors from surveys would be valuable in identifying if changing the model to a more team oriented, preventative, and interactive model is of value for not only decreasing escalations in behaviour but for team morale/satisfaction and general confidence in the patient safety.