Decreasing Duration of Mechanical Restraint Episodes by Increasing Registered Nurse Assessment and Surveillance in an Acute Psychiatric Hospital

Background Application of mechanical restraints is a high-risk emergency measure that requires psychiatric intensive care in order to assure patient safety and expedite release at the earliest opportunity. While current regulations require that trained staff continuously observe restrained individuals, assessment by a registered nurse is required only once an hour. This project builds on research that demonstrated a regulatory change requiring more frequent registered nurse assessments led to decreased duration of mechanical restraint episodes in an acute psychiatric hospital. Purpose The purpose of this project was to implement and evaluate a practice change that required increased frequency of registered nurse assessment and surveillance during mechanical restraint episodes. Methods The nursing department standard requirement for frequency of face-to-face registered nurse assessment and surveillance of patients during episodes of mechanical restraint was increased on pilot units from once every thirty minutes to continuous assessment and surveillance throughout the duration of the restraint application. Quantitative data was collected on hours of duration of restraint episodes on four pilot units for three months before and three months after the intervention and mean duration of episodes was compared before and after the practice change. Results Mean duration of episodes on pilot units decreased 44% in the three months post intervention: 15% on adult units and 70% on the adolescent unit. Conclusion and Recommendation Increasing the frequency of registered nurse assessment and surveillance during mechanical restraint has been shown to decrease duration of restraint episodes. Nurses are encouraged to change practice standards for mechanical restraint, which is a high-risk emergency measure, to provide continuous psychiatric intensive care by a registered nurse. Keywords: mechanical restraint, physical restraint, psychiatric patient

Pattern and Variation in Development of Small Urban Watersheds

Increased urbanization has been correlated with hydrologic, chemical, geomorphologic, and biologic changes to receiving streams. Therefore, the status quo in watershed management has been to control the amount of impervious surface area. However, because various measures of development and impervious surface area are correlated, it is hard to discern what aspects of development cause adverse ecological impacts: impervious surface area is correlated with stormwater infrastructure, natural vegetation cover, road density, and so on. In practice, the level of variability in any of these parameters can be high at any intensity of development. We can take advantage of that variability to choose landscape configurations that minimize watershed impacts for any given level of urbanization. To do so, we must understand how watershed land cover parameters co-vary with development intensity (percent impervious surface) and which aspects of configuration most directly impact urban streams. To this end, I examined 14 specific aspects of development configuration and stormwater infrastructure for 235 small watersheds in the Piedmont region of North Carolina. For both landscape metrics and infrastructure features, there was a high degree of variability at almost any level of development intensity. In the case of road density for central ranges of development, there was so much variation that the expected positive correlation of roads with development was no longer significant. Our results set the stage for future exploration of the hydrologic and chemical processes that are altered in urban streams. Relation of development pattern to ecological process in this way will support more nuanced methods for management of watershed development so that hydrologic impacts might be minimized for any given level of development intensity

A Revitalized Role for Library Media Specialists in School Reading Programs

At 8:00 a.m., while children are arriving at school, Mrs.Beasley, the elementary school library media specialist, is busy shelving the books returned yesterday. She has new books to catalog, newspaper and magazines to display and audio visual equipment to distribute to teachers. Before she completes any of this, her first group of children arrives for their regularly scheduled 30 minutes library visit. Mrs. Beasley attempts to help a few children in their selection of appropriate books, but finds that she spends most of her time checking books in and out. To Mrs. Beasley\u27s dismay, there is little time to share her love of books and reading with the children who visit her at the library. As this class leaves, another group of children arrives at the library, and the same scenario continues throughout the day

The New Zealand Experience of a Design-Led Approach to Post-Earthquake Recovery in Christchurch

This paper evaluates the masterplan for Christchurch which was conceived in the wake of the 2011 earthquakes, against projects completed in the intervening 8 years, paying special attention to three key objectives of the blueprint: a low-rise/compact core, a green city, and an accessible city. The paper finds that the design-led, top down, recovery approach forms a minimal framework for recovery, and that successful regeneration following the recovery phase will require significant community engagement and coherent governance

Providing for Capable Readers: Beyond the Basal Manual

This study was an attempt to better understand teacher practices for placement in basal reading series, particularly placement of capable readers. The following questions were addressed: 1. On what do teachers base their placement decisions? 2. What do teachers believe will happen to the skill development of capable students who skip basal reading levels? 3. In actual practice would a teacher allow a capable reader to skip levels in a basal reading series

The Role of Placemaking as a Tool for Resilience: Case Studies from Post-Earthquake Christchurch, New Zealand

In the aftermath of the 2010 and 2011 earthquakes in Christchurch, New Zealand, community-led temporary and adaptive urbanism filled a gap between the emergency response and recovery. In the space between response and recovery, the citizens of Christchurch showed their commitment to rethinking how they wanted to rebuild and then regenerate their city, leading to the embrace of collaborative processes, temporary and adaptive urbanism principles and a range of placemaking responses. In this chapter, the role of placemaking as a tool for post-disaster regeneration and resilience is considered by assessing three case study placemaking projects: the Re:START Mall, the Festival of Transitional Architecture (FESTA) and the placemaking programme at the Commons. Their development along with their success is considered within the context of the recovery of Christchurch and, in particular, how they align to the The Resilient Greater Christchurch Framework as it is set out in the Resilient Greater Christchurch Plan, in order to determine their role in building the resilience of Christchurch

Development of Pedagogical Knowledge Related to Teaching At-Risk Students: How Do Inservice Teachers and Preservice Teachers Compare?

This study examined the development of pedagogical knowledge of preservice and inservice teachers as they implemented newly learned assessment and instructional strategies with at-risk readers in clinical settings. The preservice teachers worked in pairs to tutor children during the regular semester at a university reading clinic; the inservice teachers worked for four days a week for six weeks in a special reading academy. Four stages of development emerged from the examination of the reflective responses of teachers that they wrote after each tutoring sessions with the at-risk readers. The stages identified were: novice, advance beginner, competent, and proficient

Factors associated with intimate partner violence among college students

The purpose of this study is to explore what individual factors are associated with intimate partner violence (IPV) experiences among college students. Intimate partner violence is a huge problem among college students both male and female of all ethnicities, socio-economic classes, sexual orientation, and social class. This study focused on alcohol consumption and attitudes and beliefs of students to see it those two variables played a role in contributing to the rate of IPV occurring among college students

Barry McVinney and David Allen Wehr in a Faculty Duo Recital

This is the program for the faculty duo recital featuring Barry McVinney, playing the flute, alto saxophone, and clarinet, and pianist David Allen Wehr. Guest artist Diane McVinney, playing the flute, assisted the performance. This recital took place on October 22, 1996, in the W. Francis McBeth Recital Hall

Undertaking a structured literature review or structuring a literature review: tales from the field

The diversity of sources of literature within the management disciplines has resulted in a growing need for a systematic methodology to map the territory of its associated theories and models. As such, when scoping out a doctoral or policy based study the Structured Literature Review (SLR) can be considered as a means by which critical literature central to and underpinning the research can be rigorously and systematically mapped out. However, there is little guidance, or evidence, of this being the case when undertaking small scale projects for example undergraduate or masters degree dissertations. This paper reports four case studies using semi-structured interviews of masters degree students following management programmes who undertook a Structured Literature Review based dissertation and the issues and problems they had to encounter during their journey. The findings from the case studies suggest that the approach to SLRs, whilst suited to doctoral level and policy based research is not appropriate when dealing with undergraduate and masters dissertations and projects. The case study findings identified that these students conducting a SLR had to deal with a new set of conceptual, methodological and data collection problems relating to this ‘unorthodox’ approach to conducting a postgraduate research dissertation. The findings show that students had to confront new paradigms of enquiry that are not normally taught or found in ‘traditional’ research texts and research methods courses that are taught on degree programmes. However, the findings do reveal that students gained a greater depth and insight into the subject they were researching through a more rigorous and structured approach. The paper then presents alternative remedies by way of the Rapid Structured Literature Review (RSLR) research strategy which is argued as an appropriate approach in conducting small scale literature based research projects when used with undergraduate and masters degree students rather than the SLR, which is better suited for other types of research such as doctoral and policy based activities