Finding the Calm: A Nurse-Led QI Project to Reduce Patient Agitation

By Sylvia Foley, AJN senior editor

Photo by Lanny Nagler, courtesy of Hartford Hospital

Photo by Lanny Nagler, courtesy of Hartford Hospital

For many people, “going to hospital is rather like going to an alien planet,” as the British cartoonist and book illustrator Sir Quentin Blake once observed—it’s a very stressful experience taking place in an unfamiliar environment. For some, the experience of hospitalization can trigger or worsen agitation. In the October CE “Decreasing Patient Agitation Using Individualized Therapeutic Activities,” author Christine Waszynski and colleagues report on a nurse-led quality improvement project that demonstrated promising results. Here’s a short summary.

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.

The authors note that even the act of com­pleting the tool—the Personal Approach Form—was a valuable part of the intervention, because it “helped the observers to engage patients in conversation and aided in patients’ recall of positive experiences.” The Personal Approach Form is available through a link in the article.

To learn more, read the article (it’s free online), and listen to our podcast with two of the authors. And if you’ve cared for agitated patients or served as a sitter, please share your thoughts in the comments.


2017-07-27T14:49:56+00:00 October 4th, 2013|Nursing|1 Comment

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  1. Kenya October 5, 2013 at 5:27 pm

    I can attest that this is an effective strategy. An elderly female with dementia experienced episodic periods of agitation. Her daughter informed us that when the patient was younger she read cook-books and loved to bake. To make a long story short, she now sits with her picture filled cook-book, flips pages, states what the different foods are and talks about what she will make for dinner. Her live in states that this activity keeps her amazingly calm! Thanks for validating

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