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Decreasing Patient Agitation Using Individualized Therapeutic Activities

Waszynski, Christine MS, RN, GNP-C; Veronneau, Patricia MSN, RN; Therrien, Karyn MSN, RN; Brousseau, Melissa BSN; Massa, Angela BSN; Levick, Sarah BSN

AJN, American Journal of Nursing: October 2013 - Volume 113 - Issue 10 - p 32–39
doi: 10.1097/01.NAJ.0000435345.23040.42
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Overview: Hospitalized patients who are suffering from cognitive impairment, delirium, suicidal ideation, traumatic brain injury, or another behavior-altering condition are often placed under continuous observation by designated “sitters.” These patients may become agitated, which can jeopardize their safety even when a sitter is present. This quality improvement project was based on the hypothesis that agitation can be decreased by engaging these patients in individualized therapeutic activities. The authors created a tool that allowed continuous observers to identify a patient's abilities and interests, and then offer such activities to the patient. Data were collected using a scale that measured patient agitation before, during, and after these activities. The authors found that during the activities, 73% of patients had decreased levels of agitation compared with baseline, and 64% remained less agitated for at least one hour afterward.

The intervention appeared effective in reducing levels of agitation in selected patients who were receiving continuous observation on nonpsychiatric units at a large, urban level 1 trauma center. Many patients expressed gratitude for the diversion from their health issues. Further investigation into the effectiveness of this intervention and its impact on the use of medications or restraints is warranted.

A nurse-led quality improvement project resulted in decreased agitation in patients suffering from cognitive impairment, delirium, and other behavior-altering conditions who were receiving continuous observation on a nonpsychiatric unit.

Christine Waszynski is a geriatric NP in the Department of Geriatric Medicine at Hartford Hospital in Hartford, CT. Patricia Veronneau is the nursing coordinator and Angela Massa and Sarah Levick are staff nurses in the Department of Nursing at Hartford Hospital; at the time of this project, Melissa Brousseau was also a staff nurse at Hartford Hospital. Karyn Therrien is a nursing education supervisor in the Practical Nursing Program at Porter and Chester Institute, Rocky Hill, CT; at the time of this project, she was a nurse manager at Hartford Hospital, where she continues to teach per diem in the Parent Education Program. The Catherine and Alexander Wright Fund provided funding for materials used in the project. Contact author: Christine Waszynski, christine.waszynski@hhchealth.org. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

© 2013 Lippincott Williams & Wilkins. All rights reserved.