The relational neurobehavioral approach: can a non-aversive program manage adults with brain injury-related aggression without seclusion/restraint?
Raj K Kalapatapu, Gordon M Giles
PMID 27636708WHAT IT FOUND
No seclusion or mechanical restraint was used while staff reported 137 incidents on unit 1 and 358 on unit 2 in a skilled nursing facility using the Relational Neurobehavioral Approach.
Key findings
01No seclusion or mechanical restraint procedures were ever used.
02Staff reported RNA interventions including aggression ignored, closer observation, talking to patient, reassurance, physical distraction, isolation without seclusion, immediate medication by mouth, and holding patient.
03Unit 2 incidents were 61.5% physical aggression and 38.5% verbal aggression, while unit 1 incidents were 35% physical aggression and 65% verbal aggression.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
All incident data came from staff self-report, so what happened may be affected by recall. The patient sample was mainly male, mainly Caucasian, and had a mean age greater than 40, so it may not apply to women, other ethnic groups, or younger adults. The authors stated the design did not allow firm conclusions on efficacy, and a future study directly comparing the RNA with another intervention is needed. Patients were placed on units by interdisciplinary team consensus and clinical assessment, not random assignment, so unit differences may reflect patient mix and environment. Cognitive status was assessed with observational ratings rather than a standardized neurocognitive test battery. Although no seclusion or mechanical restraint was used, holding limbs momentarily and immediate oral medication could be viewed as physical or chemical restraint. The paper does not state the number of patients.
Declared interests
The paper is listed as supported by NIH extramural research. The authors declared no potential conflicts of interest.
The easy way to misread this
Do not conclude that the program was proven to manage aggression. The authors stated the design did not allow firm conclusions on efficacy, and they said a future study directly comparing the RNA with another intervention is needed.