Background: The increased number of incidents of aggression in the adult acute inpatient psychiatrry unit of a facility in a large metropolitan area higher than the national average for comparable units and averaging about 48 incidents a month with about half resulting to injuries created an urgency to make a change in practice. A national push to use less restictive interventions led to the proposal to the treatment team to explore the use of environmental centered care to reduce in incidents of aggression. Research shows that more than two-thirds of the patients committed as a danger to others are likely to engage in some type of violence 72 hours after admission. The current practice using restrictive interventions, such as restraint/seclusion and or medication had not been effective. Evidence-Based Practice Framework: A model for change to evidence-based practice was used to guide this project. This framework blends steps of evidence-based-practice process and aims at organizational diffusion of change. The framework aims at utilization of research findings in clinical decision making for change in practice. The framework model steps were used to identify the practice that needed change and article search was done. Evidence-based practices available were identified and change was implemented with monitoring process for sustainability of the change process. Methods: The purpose of this scholarly project was to use a non-restrictive intervention called environmental-centered care (ECC) consisting of use of relaxation music, and light and noise reduction to reduce the incidents of aggression during peak incidents time, which is mostly during nursing shift change based on the institutions data. ECC done twice a day over 2 hours and is part of the nursing assignment. Relaxation music is played at the nursing station and echoes on the unit, light is deemed and everyone speaks softly. Reminder signs remind staff and patients an hour before ECC starts. Findings/Results: The results from this project showed that the use of environmental-centered care twice a day reduced the total numbers of incidents of aggression in an in-patient psychiatric unit. The recommendation from this intervention is to prepare the patients each tie prior to initiation of treatment so as to keep the noise level at a minimal while engaging them to be still and relax. Conclusion/Recommendations: The finding that using environmental-centered care which is a non-restrictive intervention reduces the numbers of incidents of aggression is very encouraging. It shows that clinicians can effectively treat aggression without using medications and restraint. Clinicians should consider making environmental changes as part of treatment protocol when treating patients with aggressive and violent behavior.
