Reducing Restraints in Adolescent Psychiatric Inpatient Units Through Trauma-Informed Care

Purpose: This Doctor of Nursing Practice project explores the impact of implementing trauma-informed care (TIC) training and screening interventions within an inpatient adolescent psychiatric unit. The goal is to reduce physical restraint use and improve patient care by fostering a more compassionate and effective treatment approach. Background: Adolescents in psychiatric settings often experience restraints, which can cause trauma and harm therapeutic relationships. Implementing TIC strategies equips staff with de-escalation techniques and structured trauma screenings, creating safer environments and improving patient outcomes. Methodology: The Plan-Do-Study-Act (PDSA) cycle was chosen to guide improvements, aligning with best practices in quality improvement by allowing for continuous assessment and adaptation. 16 out of 28 nurses underwent in-depth TIC training, and the Child and Adolescent Trauma Screening (CATS) tool was implemented. Training transitioned from formal sessions to huddle-based formats to improve participation. Screening tools were relocated to intake charts for easier access. Data analysis involved comparing pre- and post-intervention restraint rates and trauma screening compliance. While participation varied among nursing staff, challenges such as time constraints and initial resistance to change impacted overall engagement. Results: Restraint use decreased by over 50% during the study period, and trauma screening compliance improved significantly. Increased staff engagement and consistent reinforcement of TIC principles contributed to these outcomes. Implications: Expanding data tracking to seclusions would provide a more comprehensive understanding of crisis management. While restraints decreased, time constraints and staff resistance impacted implementation. Making TIC training mandatory, reinforcing leadership, and integrating policies will support long-term improvements in psychiatric care.