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Behavior Management on an Acute Brain Injury Unit: Evaluating the Effectiveness of an Interdisciplinary Training Program

Beaulieu, Cynthia PhD, ABPP-Cn; Wertheimer, Jeffrey C. PhD; Pickett, Lee PhD; Spierre, Louise MD; Schnorbus, Tonya MSPT; Healy, Wendy MOT, BSN; Palmer, Candace BSN; Jones, Amy MA

Journal of Head Trauma Rehabilitation:
doi: 10.1097/01.HTR.0000336843.60961.b7
Article
Abstract

Objective: To measure the effect of behavior management training on restraint use and prn medication delivery on an acute inpatient brain injury unit.

Setting/participants: Interdisciplinary staff and hospitalized brain injury patients on a 20-bed unit within a freestanding rehabilitation hospital.

Intervention: Staff participated in the Nonviolent Crisis Intervention® (NCI) program from the Crisis Prevention Institute®.

Main outcome measures: Applied physical restraints and delivered prn medications.

Results: Despite comparable patient levels of agitation severity across the duration of the study, the use of physical restraints initially declined and then increased after training. Data collected on prn medication delivery also indicated a trend for an increase in the delivery of select medication categories across time.

Conclusion: NCI training resulted in a temporary, short-lived reduction in physical restraint use, but had an inverse effect on prn medication delivery for select categories of medication. Medication delivery significantly increased over time and restraint use eventually exceeded baseline level. Ramifications of these results are discussed.

Author Information

From the Brain Injury Program, Brooks Rehabilitation Hospital (Drs Beaulieu, Pickett, and Spierre, and Messrs Jones, Palmer, and Schnorbus), and Brooks Behavioral Medicine (Dr Wertheimer) Jacksonville, Fla; and Brooks Rehabilitation–Fleming Island, Orange Park, Fla (Ms. Healy).

Corresponding author: Cynthia Beaulieu, PhD, ABPP-Cn, Brooks Rehabilitation Hospital, 3599 University Blvd S, Jacksonville, FL 32216 (e-mail: cynthia.beaulieu@brookshealth.org).

The authors thank Jonathan Hawkins and Lyn Montgomery for their invaluable assistance in data collection and database management.

© 2008 Lippincott Williams & Wilkins, Inc.