6/16/2016
Snacks for the Brain
Beth Bivens, BSN, RN
Clinical Nurse Manager
Behavioral Health Services
“A resonance of emerald, a rush of cochineal”
Objectives
• At the conclusion of this
presentation, the learner will be able
to:
– Analyze their own environment
– Recognize the limits of their own
capabilities
– Describe the reptilian brain as it relates
to violence
– Integrate principles of de-escalation
concepts into clinical settings
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6/16/2016
Process Improvement
Background
• 4th St. Jude (BMU) locked medical unit
– Safe place to receive inpatient medical care
• Psychiatric disorders
• Suicidal ideation
• Substance abuse problems
– Unstable patients and potential for violent
outbursts common
– Increase in violent outbursts noted in Spring of
2014
• No assaults per se
• Safety risk for patients and staff
– Clinical Manager and Clinical Nurses wanted to
further enhance culture of safety.
Where We Were
• Triple S – safety, search, smoking
– Staff safety a concern
• Redesign of nurse’s station
– Patient safety
• Geri chairs
• Beds in doorways for improved observation
“2014 worst year ever”
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6/16/2016
Where We Were
• Goal to decrease the violence and
increase supportive environment
• Improve Culture of Safety
• Teaching de-escalation
Significance
• Traditional methods of treating
agitated patients
– Restraints
– Involuntary medications
• New paradigm – 3 step approach
– Patient verbally engaged
– Collaborative relationship established
– Patient verbally de-escalated out of the
agitated state
Significance
• Agitation exists on a continuum
– anxiety to high anxiety to agitation to
aggression
– Behavioral syndrome that may be
connected to different underlying
emotions
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6/16/2016
BSSF Nursing Quality Model
• Plan
– State the problem
– Form a team
– Collect data
• Do
– Describe the
intervention
– Who did what,
where and when
– Include forms,
policies, images,
etc.
• Study
– Collect and analyze
your postintervention data
– Graph it!
– Was the
intervention
successful?
• Act
– Maintain the
improvement
– Fine tune it!
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6/16/2016
Project Name: Snacks for the brain
________________________________
Plan-Do-Study-Act Cycle #__1__
•What did you do
to sustain your
gain or fix your
mistakes?
•What did you do in
this stage? Form
team, data
collection, etc.
Act
Study
•Here you studied
your results –
measurement,
evaluation, etc.
Plan
Do
•What did you do in
this stage?
Nursing Services
Problem Identification
• Staff meeting June 17, 2014
– Previous month’s violence
• Discussion on unit’s rules on snack time
– Strict snack times of 10am, 2pm, 8pm,
10pm
• Observations
– Staff decreased own stress with snacks
– Patient denial of snacks increased
agitation
• Literature review
Plan
• Observed snacking habits of
colleagues
• Snacks as a way of managing stress
• Staff questioning rigidity of snacking
rules
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6/16/2016
Do
• Literature search
– Reveals snacks can reduce agitation
– Snacks considered to be therapeutic and
supportive
• Springtime of violence on unit
– April – 7 episodes
– May – 3 episodes
– June – 3 episodes
Study
• “Choice can be a powerful tool”
–
–
–
–
Collaborative
Empowering
Perception of kindness
Supportive
Act
• Implemented July 15, 2014
• Summertime violence - decreased
– July – 2 episodes
– August – 2 episodes
– September – 3 episodes
• Adopted new relaxed snacking rules
and ‘snacks for the brain’ concept into
CPI classes
• Actions continue…
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6/16/2016
Reptilian Brain
Reptilian Brain
• Part of the
subconscious mind
• Survival
• Fight or flight
• Traits
– Aggression
– Rigidity
– Fear
Recognizing Your Own Limits
•
•
•
•
•
Realize the potential for violence
Stay ahead of their curve
Rational thought is shutting down
“Low and Slow”
No shouting matches
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6/16/2016
Analyze Own Environment
• Examine your own practice
– What are your de-stressors?
– De-escalation 101 – attitude, tone of
voice
– Personal triggers
• Be aware of potential triggers
– NPO
– Received bad news
– Anxious patient
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6/16/2016
Conclusions
• Beer is not a clear liquid and water is
not a snack!
• Sometimes the easiest solution is to
offer the agitated person food &
drink.
• British have been doing this for years
… “a cup of tea and a lie down.”
• Coffee = Trust … NPR
Asking
the
Question
??
Photograph by DeWitt Jones
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6/16/2016
Objectives
• At the conclusion of this
presentation, the learner will be able
to:
– Analyze their own environment
– Recognize the limits of their own
capabilities
– Describe the reptilian brain as it relates
to violence
– Integrate principles of de-escalation
concepts into clinical settings
QUESTIONS?
References
•
•
•
•
•
•
Agitated Patient in the Emergency Department; Foundation for Education
and Research in Neurological Emergencies
http://www.ferne.org/Lectures/agitated_patient_ED_bbunney_saem050
3.htm
Fulde, G., & Preisz, P. (2011). Managing aggressive and violent patients.
Australian Prescriber(34) 115-118. Doi: 10.18773/austprescr.2011.061
Richmond, JS, Berlin, JS, Fishkind, AB, Holloman, GH, Zeller, SL, Wilson
MP, Rifei, MA, and Ng, AT. (2012). Verbal De-escalation of the Agitated
Patient: Consensus statement of the American Association for
Emergency Psychiatry Project BETA De-escalation Workgroup. Western
Journal of Emergency Medicine 13(1). Doi: 10.5811/westjem.2011.9.6864
The Reptilian-Lizard Brain: The emotional alarm center for the brain.
http://www.myshrink.com/counseling-theory.php?t_id=86
Violence and Mental Illness: Innovations in Clinical Neuroscience
http://innovationscns.com/violence-and-mental-illness/
The Sensory Room: An Alternative to Seclusion and Restraint.
http://www.medscape.com/viewarticle/753955
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