1. Post an explanation of the results of your literature review and the connection to your practice problem. Then, explain your synthesis of evidence on which to base a practice change, and the need for a practice change initiative. Be specific and provide examples.

Read a selection of your colleagues’ posts. 2.  Reply to this discussion 

To synthesize is to combine independent elements and form a cohesive whole. The literature review should integrate the sources, Identify patterns, and discuss the strengths and weaknesses of sources or the field. Compare and contrast methods, approaches, and findings of authors. Evaluate and interpret what is known in your field and what, if anything, is missing (Walden (n.d.). The literature synthesis is intended to provide a detailed analysis and yield conclusions about the current state of science and the knowledge gaps about the topic of interest (Westlake, 2012).

A literature synthesis may be needed to answer a clinical question for implementation in practice (Westlake, 2012). As a Doctor of Nursing Practice (DNP) provider, it is paramount to understand how to synthesize literature to create evidence-based practices and interventions that aim to promote patient safety and health outcomes. Studies have emphasized the importance of translating evidence into practice, improving safety and quality of patient care. Nurses who are integral point-of-care providers are charged with improving healthcare. Therefore, they should embrace the efforts of generating new evidence and translate it into practice effectively (White et al., 2019).

There is a gap between new developments increasing attention to reducing restraints in hospital settings and a lack of evidence-based practice for using restraints. I conducted a literature review of available data on the beneficial and adverse effects of using restraints in hospital settings. Data search was through a systematic search of the comprehensive index of Nursing and Allied Health Literature (CINAHL) database and a systematic search of PubMed database, Google Scholar, and websites of healthcare organizations by typing keywords from the subject, Boolean operators “AND and “OR” were also used. A literature search was limited to literature published in English publication between 2019 -2023. Ten articles were selected and read for the review. This was achieved by refining the research question to what factors for reducing restraints in the hospital setting.

Practice problem, Evidence, and Practice

Aggressive and violent behaviors resulting from psychiatric and mental illness can be challenging to manage, resulting in patients being restrained physically or chemically. Researchers have demonstrated a research gap in patient safety and patients’ perceptions of staff competence in managing challenging behavior. Many researchers have raised concerns about the utilization of restrictive practices. Such practices continue to be used in healthcare even without therapeutic support. The application of restraints has been found to have adverse psychological effects on patients, and they are not effective in preventing the harmful situations they were indicated for (de Bruijn et al., 2020).

Preventing aggressive situations and reducing restrictive practices are important global healthcare issues, and it is vital to understand what causes challenging behavior (Tolli et al., 2020). A variety of factors have been proposed to reduce the use of restraint in psychiatric inpatient wards, including improving patient–staff relationships/communication, better staff training, use of clear guidelines, open ward procedures, balancing diagnosis composition, and a range of psychological and psychotherapeutic approaches (Lykke et al., 2020).

At my workplace, on average, there are about five restraints a day related to the aggressive behavior of patients' risk of harm to themselves and others. There are more restraints in the forensic units where patients are not well-medicated as they are sent to the hospital through the judicial system. The other unit with increased restraints is the adolescents' continued care unit. This could be attributed to the developmental milestone where teenagers engage in risky behaviors.

Conclusion

Based on my synthesis, there is excellent but conflicting evidence regarding restraints in hospital settings. Currently, there is no indication of practice change; there is a need for further research and investigation for new evidence. Implementing evidence-based practice in the healthcare system to reduce restraints requires organizational collaboration. The stakeholders need to educate staff on interventions and strategies that are aimed at reducing aggressive behaviors among patients, continue supervision of staff, peer support, debriefing, and develop tools that are aimed at reducing restraints.

3. reply to this discussion 

Teenage mental health is a growing public health concern, and despite the availability of intervention strategies to address it, the number of events has increased.  García-Carrión et al. (2019) assert that adolescence and childhood are crucial times to support mental wellness. This is because at these stages, more than half of mental health issues start. According to recent data, the prevalence of mental health issues among adolescents worldwide is on the rise.  As per the World Health Organization's (WHO) 2016 study, approximately 20% of young people suffer from mental health issues. It is well known that a lack of focused and specialized care contributes to the high rate of mental health issues among teenagers. The high rate of mental health issues in teenagers led to a more thorough analysis of the literature to determine the available therapies and their efficacy, with the following PICO question serving as a guide: In adolescents with untreated mental health (P) does the use of combined and targeted interventions (I) compared to single interventions (C) guarantee optimized treatment outcomes (O)?

A study of the literature was done using ten peer-reviewed, evidence-based research articles in order to provide a solution to the practice question mentioned above.  Overall, the assessment process showed that the application of targeted and combination interventions can improve treatment outcomes for teenage mental health issues.  All of the research that was looked at showed that when several therapies are used in tandem, it can help teenagers who are struggling with mental health issues. In this instance, a combination of therapies such as psychopharmacology, support groups, physical exercise, and psychotherapy are used.  In addressing mental health issues among adolescents, for example, a combination of psychotherapy, such as cognitive behavioral therapy (CBT), and pharmacological treatments is associated with better outcomes than using just one intervention approach, according to studies conducted by Walter et al. (2020), Walter et al. (2022), and Kara (2022).

The understanding that mental health issues among teenagers frequently offer complicated and multifaceted obstacles that call for a customized yet all-encompassing approach to address is where the literature review results' connection to the practice problem rests. The review's conclusions have demonstrated that treating mental health issues with a single intervention may not have the expected effects. The core cause of the practice problem is the realization that the methods used to address teenage mental health issues now are inadequate to maximize health outcomes.

The evidence synthesized from the examined research emphasizes the need to address the issue of adolescent mental health through a focused and integrated approach.  Given the ineffectiveness of a single intervention, the research suggests that practices need to change.  For example, Teesson et al.'s recent randomized-controlled cluster study (2020) provided compelling evidence in favor of combination intervention to prevent teenage substance addiction, anxiety, and depression.  Psychopharmacologic and psychotherapy therapies seem to be the best options for the acute treatment of moderate-to-severe depressive disorder in children and adolescents, according to a systematic review and network meta-analysis by Zhou et al. (2020). The body of data clearly points to the need for a paradigm shift in the way that teenage mental health issues are treated, as well as the importance of using integrated, specialized, and targeted interventions to maximize results.

* Create a  2-page tri-fold Pamphlet using any type of publisher software you choose to educate clients on a current patient safety issue.  

For example:

* How aging adults can care for themselves at home

* Medication–polypharmacy and how a patient cannot make a self-medication error,

* Or other appropriate safety issues like Fall prevention etc.

Your pamphlet must include the following items: 

1. At least 5 Tips for preventive care for the patient.

2. Family/Caregiver information that should be shared with family or caregivers.

3. Local Resources in the community that might be available for this type of safety concern.

4. Include at least 3 APA references that are within 5 years old and follow APA format.  

* Here are more specifics about what to include for each of these items:

For the 5 Tips:

Think about preventive care here and what information could be provided to the patient to prevent a safety issue. Perhaps a tip could be to add a shower bar for support. What about rugs or cords that might need to be removed? Think about your safety issue and what could be shared here. 

Family/Caregiver information: What information could the nurse share with the family or caregiver as part of the pamphlet to provide better support for the patient? What does the family or caregiver need to know? 

Local Resources:

**For the local resources, you want to provide resources from your local community. Include the contact information for at least 2 resources, including phone number, full address, and how the resource can benefit your patient. Please avoid online resources as some people may not have access to the Internet. Examples could be a senior center, a public health department, maybe a specific church that is offering a workshop to promote health and wellness, a local community store, etc. Please do not list 911 as a resource. Take some time to research your community and what resources could be available from your community to support your patient. You will need at least 2 local community resources and their contact information. 

1)  Completes reflective journal

a.  150 word minimum reflection. 

b.  Summarizes new information learned by completing this assignment. 

c.  Reflects on how the new knowledge will impact future behavior as a healthcare professional.

d.  Logical reflective flow which follows standard grammatical rules with minimal (1-2) misspellings and APA where applicable.

Detailed criteria are listed in the Grading Rubric