The issue of patient safety continues to inform the psychiatric care of inpatients suffering from mental illness through the institutionalization onto the modern practices of psychiatric nursing. In most cases, confinement will arise from safety out of both the fear or public safety and societal stigma. Others will include benevolently aims in protecting these individuals from any kind of body harm. The main challenge for many hospitals however has been detection and confiscation of such items. The following project argues that within the environment of a psychiatric unit, safety should be maintained as one of the predominant value and management of risk in psychiatric nursing and care.

The aim of this project is to develop a standardized list of items deemed to be unsafe from entering a locked-down inpatient psychiatric hospital and to educate staff, patients, and visitors about the listing. With the guidance of the Director of Nursing, an inter-professional team used evidence-based practice to identify items considered to be unsafe. The project also identified how unsafe items were entering the unit, and determined strategies that could be used to prevent these items from entering a psychiatric hospital. This project was done through a standardized search process as part of the best practice to avoid items from reaching the psychiatric unit.

The capstone project was done for a period of five weeks. Where the researcher conducted a literature review of credible sources, and best practices were obtained to come up with a contraband management protocol. To complete the project, the student came up with a team of professionals who supported the implementation process, conducted meetings, made presentations, created posters, and came up with a checklist to educate staff, patients, and visitors about banned objects from entering the units. The team was also trained with a nurse educator and developed competency sessions for the staff. The implementation resulted in a standardized contraband management process that was designed based on evidence-based practice. The student collaborated with various stakeholders and, through the application of this project, was able to affect change within the organizational practice.

CHAPTER ONE

INTRODUCTION

Then chapter provides an introduction to the development of search protocol as a way of improving the management of contraband in psychiatric institutions. The section will come up with the background to the problem, objectives of the project statement and rationale.

1.1 Background to the Problem

The entry of contraband items in a mental hospital is unavoidable. However, it is important that the staff of the hospital does everything in their power to stop the spread, unless they risk having all the contraband items enter the facility. Tracking process for contraband is consistent from unit to unit in the hospital. One staff may give a patient an item that another team member deem contraband. Therefore, it requires every staff effort and cooperation to keep these items out of the facilities. There are various reasons nurses and paraprofessional personnel are not consistent with the current contraband process involving patients and visitors at the psychiatric facility. Some of the causes identified were variation in items staff considered to be contraband, inconsistency of admission process, the high turnover rate for direct care staff and frequent movement of personnel to work in an unfamiliar population of patients with different rules and cultural norms.

According to Chizh (2015), when a team member is familiar with the environment it is very critical to maintaining safety (p.63). In this capstone, there was a review of all contraband reporting was read. One of the major factors discovered in the process was staff interpretation of what was considered contraband and the rules surrounding contraband confiscation and accommodation. Woodthrope, Bakhsh, and Paton (2013) states, “The lack of a commonly shared definition of quality or patient safety are consistent with the lack of prominence of these concepts in training" (p.388). Vincent advised, “until you have the concepts, the practice will elude you" (as cited in Woodthropet et al., 2013 p.388).

1.2 Statement of the Problem

Detecting prohibited items within a psychiatric facility is essential in maintaining the safety of patients, staff, and visitors. However, detecting such banned items is always a problem, despite the fact that such unsafe items can contribute to dangerous behavior towards the patient, the physician and people around them. It thus calls for a laid out procedure clear and concise process to defined the gap as the current contraband process jeopardizes the safety of patients, staff, and visitors.

1.3 Project Aims

This project aims to improve safety and management of contraband on the inpatient psychiatric unit.

1.4 Objectives

Identify contraband items that are likely to be found with patients or caregivers within a psychiatric facility.
Find out current barriers and processes for confiscating and preventing contraband items from entering a psychiatric facility.
Come up with workable methods to identify and manage contraband within a psychiatric facility.

1.5 Rationale

For the hospital to achieve the contraband management process, the hospital must prevent the entry of items that are potentially hazardous to patients, staff, and visitors to the floors by implementing a standardized search process. There are several proposed solutions to prevent potentially hazardous items from entering the units. This change forms the primary focus of this project and entails developing a standardized process for a contraband search that can be applied to every patient by every staff working at the front line at the psychiatric facility. Winokur, Loucks, and Raup (2018) state that the use of a standardized procedure or protocol is an effective way to have consistency in practice from unit to unit. The collaboration of a competent nurse and other behavioral health leaders will be used to approve the proposed change and offer insight on how to engage key stakeholders. It will be critical to identify the key stakeholders and comprehend how they will affect the process of change throughout the organization
Contraband is defined by Webster dictionary "as smuggled goods." In most Psychiatric hospitals, contraband is an item that is potentially hazardous to patients, staff, and visitors. According to Abela-Dimech, Johnson and Strudwick (2017), the safety of staff, patient and visitors on psychiatric inpatient units is compromised by unsafe items entering the unit, (p.104). The procedures for searching patients and their belongings vary among staff and units. Policies can also be involved in guiding the entire process. There was an instance where on one unit a patient was given items confiscated by another staff and put away. However, on the next shift, another staff gave the patient access to the confiscated item without any reservation for safety. This patient gained access to a cigarette, a lighter, and proceeded to the bathroom to smoke. Another staff from a different unit gave a patient a bag from the restricted area without checking the content of the bag. This action allowed the patient to have access to a razor blade, scissors, and a lighter. These items are in the current policies and procedures for a contraband check as items not allowed without supervision. There seems to be a breakdown in the compliance and consistency of the contraband check process. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be "clear and consistent communication of the rule" (p. 104). There is an increase in contraband found in patients' possession in the hospital. This trend compromises safety for the patients, staff, and visitors. Evidence-based practices and best practices will be required to effectively reduce unsafe items (contraband) from entering the inpatient psychiatric unit. This plan of action consists of identifying the problem, the cause(s) of the problem, and developing a clinical nurse search approach process for stakeholders to increase buy-in and motivation.

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

This section consisted of a literature review which was conducted from 30 reliable sources regarding contraband management on inpatient psychiatric unit. It looked at the various practices, rules, banned items and environmental safety improvement process through various databases. Some of them included WGU library, Google scholar, free full PDF, and PubMed. All articles were published in the last five years and reviewed based on inclusion, evidence grade and applicability to the project. The database sources were peer-reviewed, and a general appraisal of findings and significance for the project. These sources are in Appendix A, Credible Sources.

2.1 Best Practices

Based upon the literature review, best practice identification for contraband search and creating and maintaining a safe environment for staff and patient is creating interventions involving standardized communication. The proposed change which forms the primary focus of this project entails developing a standardized process for a contraband search that can be applied to every patient by every staff. The literature review also supports a standardized procedure or protocol as an effective way to have consistency in practice.
2.2 Evidence Summary

2.2.1 Standardized practice

Abela-Dimech et al. (2017) support incorporating a safe search protocol showing that standardized method fosters consistency in care, staff, and patient safety, recognizes leadership, reduces the risk of unsafe items entering the unit and reduces the confrontation from patient and visitors on an inpatient psychiatric unit. Chizh (2015) argues that staff who are familiar with the standardized process of their work area will know how to respond to patient's needs accordingly and prevent conflict to the team. The model allows learning about group behaviors in its unique setting through observation as a unit rather than a separate entity (Batra, Duff, Smith, 2014, p.2). Plsek and Greenhalgh advised because complex adaptive systems require that, for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment as (cited by Wojciechowski et al., 2016, p.1).

Abela-Dimech et al. (2017) argue that having a standardized search protocol to improve patient’s safety is a critical element that distinguishes organization where patient and staff maintain a safe unit. When the hospital is able to come up with high performing culture of effective communication among staff, patients, and visitors would reduce the risk of contraband entering the psychiatric facility. Woodthrope et al. (2013) also came up with the idea that the lack of commonly shared definitions of quality or patient safety is consistent with the lack of prominence in these concepts. Therefore, education and training are vital to maintaining contraband safety on the inpatient psychiatric unit. Winokur et al. (2018) concluded that the use of a standardized procedure or protocol is an effective way to have consistency in practice from unit to unit. Standardized proceedings instituted by nursing staff reduced the use of restraints by more than 50%, allowing staff nurses to participate in knowledge-based decision making through clinical opportunities for collaborative work within the organization.

Establishing a high performing culture of effective communication among staff, patients and visitors would reduce the risk of contraband entering the floors. Woodthrope et al. (2013) reveal that the lack of commonly shared definitions of ‘quality' or ‘patient safety' is consistent with the lack of prominence in these concepts. Therefore, education and training are vital to maintaining contraband safety on the inpatient psychiatric unit. Hoke (2015) suggests that people with mental illness most likely misunderstand because of the lack of awareness of mental illness. Marcus, Herman, Frankel, and Cullen (2017) indicated that 94.9% of the altercation in a mental health hospital resulted in “little or no harm and could have been prevented” (para.2). Laidlaw et al. (2017) suggested strategies which included the use of mental detecting technologies to facilities search for unsafe items entering the units. D’Lima et al. (2016) explained that the “social stigma surrounding mental illness issues “affect safety on the unit. To keep the environment safe, one must improve communication and understanding among staff and patients (para 2).

Also Read: CAPSTONE PROJECT WRITING SERVICE

Evans, Wojda, Jones, Otey, and Stawicki (2015) recommended that early detection of unsafe objects is one of the best practice strategies to avoid an incident with dangerous items in the inpatient setting. For organization to prevent contraband or hazardous items from entering inpatient psychiatric unit, the organization must ensure that their communication is defined and consistent. According to Abela-Dimech and Johnson (2017), sharing of discussion about a process by leaders is an effective way to implement change. A study by Metse et al. (2014) revealed that there must be a joint effort from the inpatient and outpatient community mental health centers to communicate the health benefits to these patients. This study implies that the staff and community should offer more focused intervention on the communication of the addictive behaviors and its impact on the patients' reactions and safety.

The Mental health staff is at high risks of being assaulted by patients than any other inpatient setting especially the Novice mental health staff. Some studies have examined systematic approaches to improve safety on the inpatient psychiatric unit. Chizh (2015) suggested that knowing the surrounding is “critically important" to maintaining security in the inpatient setting (p. 63). Abela-Dimech et al. (2017) suggested that the education of the staff patient and family is the key to keeping unsafe items of the units. The risk reduction is higher for banned objects when all are aware. Moreno-Poyato et al. (2016) agreed that therapeutic connection from patient to staff or vice versa is the bedrock for maintaining safety in psychiatric hospitals. Wykes et al. (2018) suggested that educating the staff further improves the perception of the environment, hence benefiting both staff and patient to maintain security. A study conducted by Olsson, Audulv, Strand, and Kristiansen (2015) revealed that most of the patients on the inpatient psychiatric setting want to have a safe, trusting relationship with staff. Slemon, Jenkins, and Bungay (2017) identified strategies for risk reduction associated with the care provided to patients in a psychiatric hospital. Applying these strategies to staff and patient can maintain a safer environment. According to Marcus et al. (2017), safety on the psychiatric unit outside the VA hospital has been overlooked for research. Ridenour et al. (2015) argued that psychiatric employees are at higher risks of violence than other healthcare staff. Stevenson et al. (2015) Concluded that most psychiatric employees are complacent with the intensity of violence they encounter on their jobs.
2.3 Recommended Practice Change, Quality Improvement, or Innovation

As defined by the Webster Dictionary, Contraband is all about "smuggled goods." That find their way in psychiatric hospitals; they can be items that are potentially hazardous to patients, staff, and visitors. According to Abela-Dimech et al. (2017), "The safety of staff, patient, and visitors on psychiatric inpatient units is compromised by unsafe items entering the unit" (p.104). The procedures for searching patients and their belongings vary among staff and units. Policies are also involved in guiding the entire process. There was an instance where on one unit a patient was given items confiscated by another staff and put away. However, on the next shift, another staff gave the patient access to the confiscated item without any reservation for safety. This patient gained access to a cigarette, a lighter, and proceeded to the bathroom to smoke. Another staff from a different unit gave a patient a bag from the restricted area without checking the content of the bag. This action allowed the patient to have access to a razor blade, scissors, and a lighter. Some of these items are listed in the current policies and procedures for a contraband check, as items not allowed without supervision.

There seems to be a breakdown in the compliance and consistency of the contraband check process. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be "clear and consistent communication of the rule" (p. 104). There is an upward trend in contraband found in patients' possession after the admission process. This trend compromises patient, staff, and visitors’ safety. Evidence-based practices and best practices would be required to effectively reduce unsafe items (contraband) from entering the inpatient psychiatric unit. This plan of action would consist of identifying the problem, the cause of the problem and developing a clinical nurse search approach process for the stakeholders to increase buy-in and motivations. The team addressed the problem with contraband entering the hospital because of the risk it poses to the safety of patients, staff and visitors’ safety. West (2014) argued that it is the facility responsibility to keep documentation of all patient's safety screening.

2.3 Conclusion

In conclusion, understanding the process of patient searches, as well as the responsibilities of those involved in completing the contraband band search required all team members to have the same understanding of what is contraband, and the impact it has on patients, visitors, and staff’s safety. From the literature reviews, there is evidence for the proposed solution to support fixing the problem through standardization of protocol, improving communication, and relationship between patient and staff. Stocking, Clancy, Bowman, Terry, and Wye (2014) revealed in their study that employee's perception and attitude toward patient could have an impact on their cooperation with the treatment plan.

CHAPTER THREE: IMPLEMENTATION

3.1 Capstone Project step

During the first week, the advanced practice nurse approved the proposed change. The advanced practice nurse articulated the stakeholder's effectiveness in implementing the change throughout the hospital. During the second week, a literary review of thirty- plus sources was conducted to determine the best evidence-based practice articles on contraband search protocol, and security on a psychiatric inpatient unit. The Director of Nursing met with her management team about the topic of safety and contraband entering the hospital. A standard search process and a list of contraband items were identified based on a literature review. The third week was used to determine the best evidence-based practice for the contraband search process to improve patient safety on the unit which would align with the organization's goals. The contraband search process was assessed on the fourth and fifth weeks, and competency was written and reviewed with the Nurse Educator. The stakeholders conducted a meeting with the student. There was a presentation given by the student on identifying safety concerns of contraband items on the unit. The student and unit managers created a poster and other visual aid to educate staff, patients, and visitors about the process.

3.1 Changes made to the original implementation plan for contraband Management

Most of the original implementation plan stayed on course. The contraband management protocols steps were all completed as stated by the student.

3.1.1 Redefining Contraband Items

As it generally is, contraband looks at items prohibited in the psychiatric hospital. In this project, there were particular items that were clearly considered to be contraband in the psychiatric environment. They included unauthorized drugs, inflammable items, unauthorized drugs an items that have a sharp edge. Other items were also included in the list like electrical cords, torn sheet, wire and silver ware (Abela-Dimech et al. 2017). These items were redefined as they were considered to be used by the patient in harming oneself or someone else, also the items would pose a risk and interfere with the rights of other people (Chizh, 2015). In addition, the team also put it across that patients and caregivers must not have excessive amounts of unauthorized items, and personal items that may not be determined but are considered contraband like cigarettes, laxatives, mirror, hair comb, inflammables like perfumes.

There was also a classification of monitored items which look at a specific contraband item which is mostly used in the daily activities that can be allowed under control in reference to the safety of the item and the individual using it. It was suggested that the items must not be allowed in the psychiatric facility without authorization of Psychiatric Safety Department (Abela-Dimech et al. 2017). . This means that all items should be monitored by the psychiatric staff and put in a safe place on the unit when the patient or the staff are not using it. Such items include hair drier, small make up compact, nail clippers, razors, scissors, safety pens, activity related items and personal hygiene items. Also all equipment used during the rehabilitation process like knitting needs, garden tools will only be used with patients during a group or individual activity. After that they should be kept from their reach (Chizh, 2015). There will be a Closed Circuit Television (CCTV) to monitor all patients and staff leading the activities. Lastly food items that are brought in by visitors or patients will only be allowed if; they have been inspected by the security and the staff in the psychiatric unit before they are given to a patient. Also the staff inspecting the food would be allowed to stop it coming to the psychiatric unit or given to the patient if they feel it has been compromised or the seal is broken. Also any type of food that will be ordered and delivered through the local vendor can only be allowed after it has been approved by the unity after security inspection. All unsealed food items from visitors and local vendors will no longer be allowed.

3.2 The Barrier associated with the implementation of the plan.
The barriers to the contraband management process were identifying and gathering all the necessary information to assess the hospital accommodation. The obstacle to the proposed change was due to a stall in communication with stakeholders (Chizh, 2015). The Nursing Director had several meetings with senior leaders during the implementation phase of the student capstone.

3.3 Overcoming barrier

The student overcame most of the barriers of this project by exercising patience, resourcefulness, and good communication. Staff resistant to change was another barrier to the implementation. The team expressed their concerns about learning a new process. The student overcame this barrier by focusing on the safety for staff, patients, and visitors based on the evidence-based practices from the literature review (Abela-Dimech et al. 2017). .

Also to overcome barrier, it was suggested that each employee in the Psychiatric unit is given a role to perform in ensuring contraband management in the inpatient psychiatric unit.

The Risk Manager at the psychiatric facility need to constantly review the new changes and come up with a hospital-wide policy united and departmental procedural changes that will include everything that has been considered as contraband above.

Also as part of overcoming barriers, the director of the psychiatric nursing department need to immediately implement new procedures for searching contraband and screening patients when they are admitted, and when there is any suspicion that contraband may have been sneaked in to the patient ( Chizh, 2015). This however should not include cavity searches. It is also important that the director implements all procedures above for the prevention of contraband from the entering the inpatient psychiatric unit. Also implementation of procedures for preventing contraband to come in to the units were established which included nursing following particular protocols before admitting an inpatient to the psychiatric unit (Chizh, 2015). This also includes details of things that can be allowed to the various areas of the units in respect to an assessment by the treatment team.

The physician was also given the power to restrict what is allowed in the psychiatric unit. In addition, standards for conducting searches for contraband items were also established, including full documentation as this will help overcome barriers. Also patients and their relatives or friends were required to allow staff to check or screen envelops for any case of contraband. The staff were also allowed to read the patient’s incoming mail for any form of danger or contraband.

Physicians who meet any type of barrier are also required to write orders for to overcome such restrictions in respect to rights of the patients (Abela-Dimech et al. 2017). . They will be required to provide an authorization to conduct searches if the patient or the patient’s relative is suspected to carry contraband.

When it comes to the safety officer, they will always check people visiting patients in the main facility entrance as part of the hospital policy, they can also allow staff to screen items brought to facility. The same action will be taken by discipline chiefs and heads of departments where they will provide updates on operations meant to manage and confiscate contraband (Abela-Dimech et al. 2017). . Also all contractors and staff should be informed that all facilities in the psychiatric unit including lockers are under the hospital’s control, custody and supervision, so that they understand it as part of the hospital policy to keep on checking it time after time.

3.4 Trans professional Relationships

By conducting the capstone project, the student was able to develop professional relationships with various leaders at the hospital. The student collaborated with the Director of Nursing, all four-unit managers, and the front-line staff in facilitating the implementation of the proposed change in contraband management. The Director granted the permission and provided access to resources and equipment to heighten the student's knowledge of working with the hospital system. The unit managers worked with the student by giving various details and information about patient populations at the hospital. This kind of collaboration allowed the student to have an insight into the strategic plan of the hospital to provide the best care for the patient and maintain its financial stability.

3.5 How relationships facilitated implementation plan

The Director of Nursing is a vital member of the implementation process of the contraband management project for the psychiatric hospital. She introduced the student to key stakeholders that would have a direct impact in the organizational change. The Director of Nursing created the culture of buy-in from the key stakeholders in the organization by showing support and interest. The Director of Nursing guided the student by developing a culture of standardization that could have a positive impact on the safe outcome of the patient while aligning with the mission and values of the organization. The risk manager and the unit managers helped identify possible risks associated with the implementation. Their experiences and knowledge gave the student the confidence that was needed to lead the front-line staff. The mentoring of all the nursing leaders involved with the implementation gave the student the support that was required to develop the contraband search management program that was attainable for the future participants and hospitals.

CHAPTER 4 POST CAPSTONE PROJECT CONSIDERATIONS

4.1 Capstone Successes

Successful aspects of the capstone was triumphant in identifying common contraband situations related to inpatient psychiatric unit, approaches to managing contraband from reaching the patient and ways to over barriers to monitoring and confiscating contraband. The capstone was also able to ensure that each key play like the nurses, physicians, security presonell were given their roles in managing contraband. It gave the student and the leadership team at the hospital the opportunity to improve patient safety on a psychiatric inpatient unit through professional leadership with the organization and the patient population. The Capstone was an opportunity to reduce items that were deemed unsafe from reaching the patient or the staff by implementing a standardized search process. The number of incidents of contraband item reaching the pilot units decreased significantly after the implementation of the new method.

4.2 Impact on future projects

The capstone has created awareness of safety and the need for change at the hospital. Acknowledging the need for change is the first excellent steps in fostering change.

The Director of Nursing and the unit managers were impressed with the capstone project that they would like to create a safety coach committee to continue the safety alertness and awareness using current evidence-based practice. All stakeholders recognized the Director of Nursing for creating a conducive environment for the staff to promote safe patient outcomes. The Director of Nursing can create positive change with future project by creating a positive impact.

4.3 Capstone Challenges

Aspects of the capstone that did not go well. The most challenging part of the capstone project was the period when communication was delayed from the student to all stakeholders due to scheduling conflicts. The meetings scheduling process with stakeholders were complicated.

4.4 Impact on future projects

The Director of Nursing and all the stakeholders recognized and agreed that patient, staff and visitor's safety was necessary to create an environment that is providing a positive patient outcome, and financial sustainability. As a result, from the piloted units, senior stakeholders requested implementation of the contraband management process across all the units.

4.5 Evidence and Current Practice

The capstone project was able to bridge the gap between evidence and current practice by first identifying the need to maintain and ensure milieu safety on an inpatient psychiatric unit. The literary research conducted during the capstone project supports standardized procedure and protocol as effective ways to have consistency in practice. Winokur, Loucks, and Raup (2018) encouraged the use of a standardized process, or protocol as an effective way to have consistency in practice from unit to unit. Chizh (2015) argued that staff who are familiar with the standardized process of their work area would know how to respond to patient’s needs and accordingly prevent conflict with them. Abela-mech et al. (2017) revealed incorporating a safe search protocol showing that standardized practice reduces the risk of unsafe items entering the unit. Woodthrope et al. (2013) explained that the lack of commonly shared definitions of ‘quality' or ‘patient safety' is consistent with the lack of prominence in these concepts. According to Abela-Dimech et al. (2017), when implementing a process to improve safety on a psychiatric inpatient unit, there must be “clear and consistent communication of the rule" (p. 104). Slemon, Jenkins, and Bungay (2017) identified strategies for risk reduction with care provided to patients in psychiatric hospitals. Applying these strategies to staff and patients, they can maintain a safer environment. The evidence suggested that the need to create and maintain a safe milieu on an inpatient psychiatric unit was a needed practical change for the hospital to preserve patients’ safety and remain financially stable. A good contraband management process based on improved patient outcome, evidence-based practice, and the organization’s mission and values can improve and increase the organization’s reputation within its surrounding communities.

4.6 Post Implementation plan

Implementation of the capstone project on contraband management process was a success. The short-term goal for the hospital and the organization is to continue using this process on the current units for three months while collecting data. The goal is to get approval for this capstone project to be a mandatory part of all new employee orientation. The long-term goal of the capstone is to become part of the hospital expected standard for patient care.

To maintain the credibility of the process, the leadership team decided to develop a safety committee team that will monitor and retain the contraband management process as part of the long-term goal. The safety committee will be responsible for reviewing and updating the process as needed in reference to evidence-based practice.

4.7 Resources Required for Post-Implementation Support

To implement the project, the leaders of the units would need to identify front-line staff to be part of the safety committee to monitor and uphold the practice of safety in the hospital. Staffing of the units would need to be on an ongoing revision process to allow time off for the selected staff members would attend meetings about safety coaches’ best practices. Since there are nine units within the hospital with a different population of patients at various stages of mental illness, it would require planning for staff meetings to update each other, which is part of keeping standardization and consistency in the process and training of staff. The project would create some additional work for individuals who are chosen to be on the committee. The leaders would ask for more funding for individuals who are working on safety and contraband management project as a change agent.

CHAPTER 5: REFLECTION

Integrate clinical reasoning with organizational, patient-centered, culturally appropriate strategies to plan, deliver, and evaluate-evidence-based practice.

The capstone enabled the student to research best evidence-based practice to develop a safe search contraband management while using a standardized protocol to deliver patient-centered care that is measurable. The contraband management process included areas that focus on patient-centered-care employing the evidence-based practice. The performance improvement area involves the participation of participants in at least one performance improvement project (PI) that is clearly defined to a clinical practice area and focuses on one of the national patient safety goals established by the joint commission. The Joint Commission standards are the highest standards of an objective evaluation process to help health care organizations assess, measure, and improve performance centered on their patients. The student applied the PDSA cycle to evaluate the whole project; this is an organized plan that allows the project leader to study and act on a change within a clinical environment. According to the Improvement of Health Institute, the PDSA cycle model can be instrumental in developing, testing, and implementing change. (“Plan-Do-Study”, 2018).

Construct inter professional teams to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of excellence.

The capstone allowed for the design of an organization and leadership team that promotes high-quality care through constructing inter-professional team to communicate, coordinate, collaborate, and consult with other health professionals to advance a culture of excellence. Abela-Dimech et al. (2017) suggested that the education of the staff, patient, and family is the key to keeping unsafe items from entering the units. Plsek and Greenhalgh advised because complex adaptive systems require that, for organizations to maintain equilibrium and survive, the organizations must respond to an ever-changing environment as (cited by Wojciechowski et al., 2016, p.1). Moreno-Poyato et al. (2016) agreed that the therapeutic connection from patient to staff or staff to patient is the bedrock for maintaining safety in psychiatric hospitals. Wykes et al. (2018), suggested that educating the staff about safety improves the perception of the environment, hence benefitting both staff and patient to maintain safety. A study conducted by Olsson, Audulv, Strand, and Kristiansen (2015) revealed that most of the patients on the inpatient psychiatric setting want to have a safe, trusting relationship with staff. The support of the senior leaders was necessary to ensure that the capstone project was implemented and carried out. The collaboration, coordination, and communication of the various stakeholders were vital to the success of the project. The implementation of the contraband management search process allowed the leaders to provide safe, high-quality practice for best patient care and outcome.

Reference

Abela-Dimech, F., & Johnson, K. (2017). Safe searches: The scale and spread of a quality improvement project. Journal for Nursing in Professional Development, 33(5), 247-254.

Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28891880

Abela-Dimech, F., Johnson, K., & Strudwick, G. (2017). Development and pilot implementation of a search protocol to improve patient safety in a psychiatric inpatient unit. Clinical Nurse Specialist, 31(2), 104-114. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28169898

Batras, C., Duff, C. & Smith, B. J. (2016). Organizational change theory: Implications for health promotion practice. Health Promotion International, 31(1), 231-241. https://doi.org/10.1093/heapro/dau098

Chizh, C. (2015). Ensuring milieu safety in a forensic psychiatric unit. Nursing, 45(9), 63-65.

https://doi.org/10.1097/01.nurse.0000470425.40180.e9

D’Lima, D., Archer, S., Thibaut, B I., Ramtale, S. C., Dewa, L. H. & Darzi, A. (2016). A systematic review of patient safety in mental health: Protocol based on the inpatient setting. Systematic Reviews, 5(203).

https://doi.org/10.1186/s13643-016-0365-7

Evans, D. C., Wojda, T R., Jones, C. D., Otey, A J. & Stawicki, S. P. (2015). Intentional ingestions of foreign objects among prisoners: A review. World Journal of Gastrointestinal Endoscopy, 7(3), 162-168. https://doi.org/10.4253/wjge.v7.i3.162
Hoke, S. (2015). Mental illness and prisoners: Concerns for communities and healthcare providers. The online journal of issues in nursing, 20(1), doi: 10.3912/OJIN vol20No01Man03

Laidlaw, J. Dix, R., Slack, P. Foy, C. Hayward, A., Metherall, A … Rose, A. (2017). Searching for prohibited items in mental-health hospitals: A randomized controlled trial of two metal-detecting technologies. Medicine, Science, and the Law, 57(4), 167-174. doi: 10.1177/0025802417725642

Marcus, S., Herman, R., Frankel, M., & Cullen, S. (2017). Safety of psychiatric inpatients at the veteran’s health administration. Psychiatric Services 69(2) 204-210. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29032707

Merriam-Webster. (n.d.). Contraband [Online dictionary entry]. Retrieved from https://www.merriam-webster.com/dictionary/contraband

Metse, A., Bowmen, A., Wye, P., Stocking, E., Adams, M., Clancy, R… Prochaska, J (2014). Evaluating the efficacy of an integrated smoking cessation intervention for mental health patients: study protocol for a randomized controlled trial. Biomed Central, 15, (266). https://doi.org/10.1186/1745-6215-15-266

Moreno-Poyato, A. R, Monteso-Curto, P., Delgado-Hito, P., Suarez-Perez, R., Acena-Dominguez, R., Carreras-Salvador, R.… Roldan-Merino, J.F., (2016). The therapeutic relationship in inpatient psychiatric care: A narrative review of the perspective of nurses and patients. Archives of Psychiatric Nursing 30 (6), 782-787. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27888975

Olsson, H., Audulv, A., Strand, S., & Kristiansen, L. (2015). Reducing or increasing violence in forensic care: A qualitative study of inpatient experiences. Archives of Psychiatric Nursing 29(6), 393-400. Retrieved from http://www.psychiatricnursing.org/article/S0883-9417(15)00131-4/abstract

Institute for Healthcare Improvement. (2018). Plan -do-study-act. Retrieved from http://www.ihi.org/resources/Pages/Tools/Plan Do Study Act Worksheet.aspx

Ridenour, M., Lanza, M., Hendrick, S., Hartley, D., Rierdan, J., Zeiss, R., & Amandus, H. (2015). Incidence and risk factors of workplace violence on psychiatric staff. Work 51(1) 19-28. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/24894691

Slemon, A., Jenkin, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The impact of risk management culture on mental health nursing practice. Wiley Nursing Inquiry, 24 (4). Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/28421661

Stevenson, K., Jack, S., O’Mara, L., & LeGris, J. (2015) Registered nurses’ experience of patient violence on acute care psychiatric inpatient unit: an interpretive descriptive study. BMC Nursing, 14(35). Retrieved from https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-015-0079-5

Stocking, E., Clancy, R., Bowman, J., Terry, M., & Wye, P. (2014) Evaluating the efficacy of an integrated smoking cessation intervention for mental health patient: Study protocol randomized controlled trial. Retrieved from http://journals.sfu.ca/hneh/index.php/hneh/article/viewFile/87/78

Woodthrope, N., Bakhsh, E., &, Paton, C., (2013). Quality and patient safety in mental health. British Journal of Health Management, 19 (8), https://doi.org/10.12968/bjhc.2013.19.8.383

West, J. (2014). EMATLA obligations for psychiatric patients. Journal of Healthcare Risk Management 34, (2), 5-12. doi: 10.1002/jhrm.21153.

Winokur, E., Loucks, J. & Raup, G. (2018). Use of a standardized procedure to improve behavioral health patients’ care: A quality improvement initiative. Journal of Emergency Nursing 44(1) 26-32, https://doi.org/10.1016/j.jen.2017.07.008

Wojciechowski, E., Murphy, P., Pearsall, T., French, E. (2016). A case review: Integrating Lewin’s theory with Lean’s system approach for change: The Online Journal of Issues in Nursing 21 (2),4. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/27854425

Wykes, T., Csipke, E., Williams, P., Koeser, L., Rose, D., Craig, T., & McCrone, P. (2018). Improving patient experiences of mental health inpatient care: a randomized controlled trial. Psychological Medicine 3(48), 488-497, https://doi.org/10.1017/S003329171700188X

Appendix A: Credible Sources

Author(s) (Formatted as an in-text citation)	Database (CINAHL, EBSCO, Cochrane, Pro-Quest)	Peer-Reviewed (Yes/No)	Applicability (Yes/No)	Evidence Grade (Strength/ Hierarchy)	Appraisal (Summary of findings; how findings inform your project?)	Inclusion (Yes/No)
Abela-Dimech, & Johnson (2017)	WGU library	yes	yes	6/Single qualitative studies	Explores Failure mode and effects analysis framework to develop a standardized search protocol. Shows analysis benefits and opportunities for improvement in safety.	Yes
Abela-Dimech, Johnson. & Strudwick (2017)	WGU library	yes	yes	7/expert opinion	The article describes a standardized approach for safe searches implementation. Reveals that managers' and staff nurses' knowledge of the model must align for safety on the unit.	Yes
Batras, Duff, & Smith. (2016).	Google Scholar	yes	yes	1/systematic review	This study reveals the understanding of organizational changes strategies for trans formational leadership theory.	yes
Chizh, (2015)	PubMed	yes	yes	7/expert opinion	Describes a standardized approach for ensuring the milieu is safety for patients and staff by providing a step by step approach.	yes
D’Lima, et al. (2016)	PubMed	yes	yes	1/systematic review	A systematic review of patient safety in a mental health setting. Exploring the existing research based on patient safety in an inpatient setting.	yes
Winokur, Louck& Raup (2018)	WGU Library	yes	yes	6/single qualitative studies	Meeting the complex needs of the BH patients in an ED environment presents a continuing challenge. Developing a coordinated approach that involves all stakeholders using an STP to focus interventions and responses provides optimal chances for success in achieving progress toward key performance outcomes	yes
Laidlaw et al. (2017)	Sage pub med	yes	yes	2/ Randomized trial	Randomized trial of different security devices to detect contraband items in mental health hospitals.	yes
Ellis, Rufino, Allen, Fowler& Jobes (2015)	WGU	yes	yes	3/quasi experiment	Utilized the CAMS assessment to keep patient safety and to reduce suicidality	no
Moreno-Poyato et al., (2016)	Google Scholar	yes	yes	1/ systematic review	Describes how therapeutic relationship inpatient psychiatric care is essential to keeping the unit safe. The relationship is built on trust and respect allowing the caregiver to care for the patient and allowing the patient to receive the care.	yes
Kelly, Fenwick, Brekke & Novaco (2016)	WGU	yes	yes	6/Descriptive study	A study conducted to measure if staff well-being (depression, anger and physical health effect the safety of the unit. The study concluded that the creation of a therapeutic environment should be an essential goal for a psychiatric to reduce violence.	no
Marcus, Hermann, Frankel, & Cullen (2017)	Google scholar	no	yes	2/ Randomized sample	Results indicate that the patient’s safety events in the psychiatric unit were relatively common, but most of the incidents resulted in little or no harm to the patient	yes
Stevenson, Jack, O’Mara& LeGris (2015)	WGU	no	yes	4/Non -experimental design descriptive study.	Describes how the experiences of nurses on inpatient psychiatry hospitals can influence understanding of patient violence and influence interventions to prevent the violence	yes
Metse et al. (2014)	PubMed	yes	yes	2/Randomized study	This protocol describes a randomized controlled trial that aims to assess the efficacy of linking mental health inpatients to community-based smoking cessation supports upon discharge as a means of reducing smoking prevalence.	yes
Margaret (2015)	WGU	Yes	Yes	1/ Systematic review	The study concluded that nurses are the target of both verbal and physical violence by patients. The nurses need and support from their organization to do their jobs	No
Smith, Lynch, Stephens &Kistner (2014)	WGU	Yes	Yes	4/descriptive review	Describes how the best facet to predicating aggression and violence on an inpatient psychiatric unit is the patient's self-perception reporting.	No
Hoke (2015)	WGU	No	Yes	7/ expert opinion	Addresses the concerns of educating the public about mental illness and the population that is affected.	yes
Jeffrey (2014)	WGU	Yes	No	7/ expert opinion	Evaluates the effectiveness of solitary confinement to the federal prison system and how it increases the risk of violence.	No
Ridenour et al. (2015)	WGU	Yes	No	4/non-experiment	Study result showed that to prevent violence in the workplace is being aware of the risk and knowing which risk factors are significant.	yes
West (2014)	WGU	yes	yes	7/ expert opinion	Describes the steps in making the environment safe for patients and staff by removing contrabands once the patient was noted to be a danger to self and others.	yes
Stockings, Clancy, Bowman, Terry & Wye (2014)	PubMed	no	no	1/randomized controlled trial	Describes community centers involvement with mental health patients to help reduce violence and contraband on inpatient psychiatric hospital	yes
Evans, Wojda, Jones, Otey,& Stawicki (2015)	WGU	No	Yes	7/expert opinion review	Explores the practice of intensive monitoring and prevention plan to reduce the risk of intentional patient ingestion of contraband objects	Yes
Oster, Gerace, Thomson&Mur-Cochrane (2016)	Free full PDF	yes	Yes	7/Expert opinion	Compare the hours of restraint and seclusion internationally and the behaviors that lead to these interventions.	NO
Woodthorpe, Bakhsh &Paton (2013)	WGU	Yes	Yes	4/nonexperimental	Develop recommendations for improving patient safety within mental healthcare	Yes
Sebergsen, Norberg &Talseth (2016)	WGU	yes	Yes	6/ Descriptive study	Nurses’ openness and sensitivity to the changing care needs of persons who suffer from psychotic illness create moments of confirmation within caring acts that concretely help the persons to feel better, and that may enhance their health. The results show the importance of taking the experiential knowledge of persons who have experienced psychotic illness seriously to develop and increase the quality of mental health care in acute psychiatric wards.	NO
Pileno, Morello & Losa-Iglesias (2016)	WGU	Yes	Yes	6/Qualitative study	Explored the nurse's concepts of working as a team to keep patients safe in an inpatient psychiatric hospital	NO
Martin (2015)	Google Scholar	yes	No		Explored the value of having a physical exam for mental health nursing.	No
Giarelli et al. (2017)	Google Scholar	yes	yes	5/meta-synthesis	Findings from this study can be used to improve high-quality care for hospitalized patients with acute mental health problems. Findings confirmed that nursing staff must be continually vigilant primarily for self-protection as they were the principal target of violence and aggressive acts.	NO
Wykes et al. (2018)	Free full PDF	yes	yes	1/Randomized controlled trial	A discussion of improving staff perception of mental illness can improve patient compliance with rules and regulation of the unit.	yes
Fellinger, Waldhor, Bluml, Williamsb& Vyssoki (2018)	Free full PDF	yes	No	4/ case-control studies	The study concluded that women spent more time being hospitalized than men.	No
Olsson, Adudulv, Strand&Kristiansen (2015)	Free Full PDF	Yes	yes	6/Qualitative study	Description of how patients use different strategies to reduce violence on the unit, therefore, increasing self-esteem and accepting the current situation allowing the staff and patient to co-exist in creating a safer environment.	Yes
Slemon, Jenkins & Bungay (2017)	Free full PDF	yes	yes	7/Expert opinion	Explores the use of effective risk assessment of the client and how it impacts the invention utilization to create and maintain a safer environment for both staff and patients	Yes

Our Nursing Papers Samples/Examples

Contraband management on inpatient psychiatric unit

Abstract

INTRODUCTION