This paper examines therapeutic approaches to mental health care, with a focus on hospitalized patients experiencing cognitive impairment, behavioral disorders, and psychiatric emergencies. It discusses a quality improvement project demonstrating that therapeutic activities reduce patient frustration by 73% during intervention and 64% one hour after. The paper outlines the role of psychiatric nurses in managing complex patient needs, the function of patient sitters, and evidence-based nursing interventions that reduce reliance on physical restraints, which are associated with increased agitation and injury risk. The analysis emphasizes the nursing process as a critical thinking framework for clinical decision-making and patient care.
Hospitalized patients suffering from delirium, cognitive impairment, suicidal ideation, traumatic brain injury, or behavior-altering conditions require constant observation by trained staff. These patients can become frustrated easily, which can compromise their safety even when a sitter is present. Hospitalization is intrinsically demanding: patients are already injured or ill, feel vulnerable in an unfamiliar environment, and experience loss of control. This loss of control often creates anxiety and frustration, which is especially pronounced in patients with cognitive disorders and psychiatric conditions. These patients face heightened risk of self-harm through impulsive behavior and treatment disruption.
Conventional nursing interventions to reduce these risks—such as exit alarms to restrict independent movement and concealing medical equipment—are not feasible for this population. Instead, constant monitoring is required for proper safety. Most hospitals have protocols and guidelines governing continuous observation, typically provided by nursing assistants, nursing students, or trained staff members known as sitters.
This paper is primarily informed by a quality improvement project based on the theory that frustration can be reduced by initiating therapeutic activities with monitored patients. The authors developed a tool to track patients' activities and abilities, offering relevant interventions tailored to each individual. Data were collected using a scale that measured patient frustration before, during, and after the activities.
The results were striking: 73% of patients experienced reduced frustration during therapeutic activities, and 64% remained less frustrated even one hour after the intervention ended. The intervention demonstrated measurable progress in lessening frustration levels in patients under constant surveillance in a non-psychiatric urban Level 1 trauma center. Most patients expressed gratitude for the diversion from their usual health concerns (Waszynski et al., 2013). This finding suggests that evidence-based therapeutic engagement offers a viable alternative to purely custodial monitoring.
A member of the nursing staff—typically a nursing assistant, though nursing students and trained staff members may also serve in this capacity—provides continuous observation. This person, called a sitter, prevents patients from causing harm to themselves or others. The job description may include assistance with mobilization and personal care, and can extend to monitoring for violent tendencies and intervening when necessary (Waszynski et al., 2013). The sitter's presence provides a human connection that can reduce patient anxiety while maintaining safety.
"Expert nursing roles and multidisciplinary mental health care"
Nurses in mental health settings assist with multiple critical areas: encouragement of better physical and mental health and overall wellbeing; addressing reduced work capacity due to emotional, psychiatric, and physiological stress; managing altered thinking patterns, communication, and perception abilities; addressing mental states or behavior patterns that pose threats to safety; managing emotional stress from loss, disability, pain, and illness; symptom management and medication side effects; psychopharmacological involvement and other treatment modalities; addressing physical symptoms resulting from altered mental states; supporting lifestyle and body image changes; and identifying barriers to effective care and recovery, including substance abuse issues.
Psychological symptoms observed alongside altered physiological status are influenced by environmental circumstances, spiritual factors, sociocultural contexts, interpersonal dynamics, and organizational factors that affect the emotional and mental wellbeing of individuals and families. Recovery encompasses maintaining employment, securing housing, and building social support systems that enable people to live functional lives (Psychiatric Mental Health Nursing Scope & Standards, 2006).
Psychiatric mental health registered nursing practice employs the nursing process with individuals experiencing potential or actual mental health problems and psychiatric disorders to promote speedy recovery, assess dysfunction, help patients recover coping abilities, build on strengths, and prevent further disability. Data collection at the point of contact includes observational and investigative activities, overseen by a nurse with deep knowledge of human behavior and psychiatric interviewing techniques (Psychiatric Mental Health Nursing Scope & Standards, 2006).
Nursing science is fundamentally grounded in the critical thinking framework known as the nursing process, which comprises assessment, diagnosis, outcome identification, planning, implementation, and evaluation. These steps form the foundation of clinical decision-making and provide substantiation for practice.
In hospital environments, frustrated patients are frequently subjected to physical restraints, which paradoxically elevate agitation and worsen disruptive behavior. Physical restraint is associated with lower cognitive performance, reduced daily life functionality, diminished mental stability, and increased risk of serious injury (Psychiatric Mental Health Nursing Scope & Standards, 2006). Psychiatric emergencies can occur in all healthcare settings—long-term care facilities, acute care units, hospices, outpatient clinics, and psychiatric facilities. Nurses are tasked with caring for patients from all walks of life who are experiencing a psychiatric crisis or at risk of experiencing one. Nurses must be aware of psychiatric problems, capable of identifying them, and skilled in appropriate intervention techniques (Nadler-Moodie, 2012).
The evidence presented in this paper supports therapeutic approaches and the nursing process as more effective alternatives to restraint-based interventions. By engaging patients in individualized therapeutic activities and applying structured clinical decision-making frameworks, nurses can reduce frustration, maintain safety, and support patient dignity and recovery.
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