DEPOSITION:
My case against HOSTING SERVER BARBER SURGEON and NOSY NEIGHBORS AND THE GANG is clearly illustrated in the posts I share today.
This article in BALTIMORE SUN is a continuous stream of media making clear the economy in Baltimore is systemically criminal and corrupt with the CRONYISM out of this world. When a governance is allowed to be SO ENTRENCHED it becomes
DYSTOPIC AND OPERATES WITH IMPUNITY. THIS IS WHAT ALLOWS A STRUCTURE LIKE HOSTING SERVER NOSY NEIGHBORS AND GANG TO OPERATE OUTSIDE OF RULE OF LAW----WITH IMPUNITY.
My lawsuit details a BRAIN/BODY IMPLANTING which began with a false employment at JOHNS HOPKINS using a new employee physical exam to IMPLANT with COCHLEAR DEVICE. This was the start of an EXPERIMENTAL RESEARCH using AUDITORY DEVICES AND IMPLANTS.
'Dr. Meghan Wyskiel received her Bachelor’s in Communication Disorders in 2013 and her Doctorate of Audiology in 2017'
My lawsuit also entails WILMER EYE, NOSE, THROAT clinics which were involved in the BRAIN/BODY IMPLANTS done without knowledge during a BROKEN LEG BONE SURGERY. This is when a RETINAL IMPLANT and what feel likely is a SINUS IMPLANT occurred. Below we see how these global hedge fund BARBER SURGEONS patent and create INNOVATIVE STARTUPS from the 'EVIDENCE-BASED DATA' collected in these CRIMINAL IMPLANTATIONS.
'GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration'.
It is highly likely I as a VICTIM of illegal implantation research studies---will develop MACULAR DEGENERATION----when I would not have if not forced into implantation. GRAYBUG LLC will make money from these UNDER-THE-RADAR EXPERIMENTAL STUDIES.
DANIELS of BLOOMBERG SCHOOL OF PUBLIC HEALTH is of course the TOP GUN in all that is criminal and illegal about this research. The ethos of -----GIVING ACCESS TO HEALTH CARE in exchange for forced research assignments----HIT THAT MAN HIT THAT WOMAN ----LET'S EVEN HIT THEIR CATS AND DOGS with IMPLANTING.
Yes, even the cats and dogs have been implanted in these few decades of DOING ANYTHING FOR A PATENTED PRODUCT.
'Christy Wyskiel
Senior Adviser to the President
Johns Hopkins University
Christy Wyskiel
Christy Wyskiel
The vibrancy of Baltimore is palpable to Christy Wyskiel, and from her desk at Johns Hopkins University it’s easy to see why.
Wyskiel is the senior adviser in matters of innovation, commercialization and entrepreneurship. She heads up Johns Hopkins Technology Ventures, which includes technology transfer, the FastForward innovation hubs and commercial partnerships.
In the last fiscal year, Johns Hopkins had $700 million in venture funding coming into its companies, up considerably from about $50 million five years ago'.
Here is another example-------I am being HIT-----illegally surveilled 24/7 with video and audio inside my living space and in public spaces because of THIS========the WIFI----RFID MICROCHIPS====the GIGABIT ETHERNET===are all what allows HOSTING SERVER NOSY NEIGHBORS AND GANG to follow me wherever I go and WYSKIEL TECH, gets millions and soon billions of dollars in that experimental research which ME AS THE TARGET.
'About Us - Wyskiel Tech
wyskieltechnologies.com
Wyskiel Technologies, Inc. has been serving the Silicon Valley and San Francisco Bay Area since 2006. Our designs have included PCIe, Gigabit Ethernet, Bluetooth, WiFi, GPS, RFID, Wireless Communications, LED Lighting and Telecommunications'.
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'Meghan Wyskiel, Au.D.
Dr. Meghan Wyskiel received her Bachelor’s in Communication Disorders in 2013 and her Doctorate of Audiology in 2017 from Central Michigan University. Dr. Wyskiel completed her residency under the supervision of the Advanced Audiology Institute audiologists. After graduating from CMU, she started as a full time audiologist at Advanced Audiology Institute. Dr. Wyskiel’s aim is to deliver the best possible care and service to all patients and to make every visit a positive one. Dr. Wyskiel moved to Las Vegas in 2016 after 24 years as a resident of Northern Michigan. She enjoys traveling to new places, baking, and reading'.
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'In 2009, Wyskiel founded CWW Research with a mission to help evaluate and facilitate startup activity around Baltimore. She narrowed in on Johns Hopkins researchers after realizing the wealth of innovative happenings taking place there.
"I could add value by helping faculty members write business plans, connect with investors, do some business plan modeling, some market analysis, and I got really excited about that," Wyskiel says.
The partnerships she formed led her to be co-founder, along with Johns Hopkins faculty members, of two companies. Funded through a GlaxoSmithKline research agreement, Cureveda LLC, which develops drugs to counteract autoimmune and inflammatory diseases, was formed in 2010 from intellectual property created in Shyam Biswal's lab in the Bloomberg School of Public Health. GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration'.
When we shout against BALTIMORE DEVELOPMENT CORPORATION as criminal and corrupt-------this is it. The entire economy in Baltimore is so captured that only a few institutions and leaders control ALL -----in a DARK AGES pay-to-play.
BDC president: Dixon’s claim on $30M loan fund ‘un-factual’
By: Adam Bednar Daily Record Business Writer February 20, 2020
Former Baltimore Mayor Sheila Dixon. (File Photo)
The head of Baltimore’s economic development entity said claims by a former mayor that the quasi-public organization is sitting on $30 million in funds it should be lending are untrue.
During the Baltimore Development Corp.’s board meeting Thursday, Christy Wyskiel, a board member from Johns Hopkins University, asked about claims made by former Mayor Sheila Dixon during a candidates’ forum sponsored by Open Society Institute-Baltimore on Feb. 5 that the organization is hoarding funds in its micro-lending fund.
“I don’t know where that comes from. It’s completely un-factual,” said Colin Tarbert, president and CEO of the BDC.
A recently completed audit of the organization, which was released after the board meeting, shows BDC currently has total assets of more than $26.9 million and roughly $2.98 million in loan funds.
There’s currently about $380,000, Tarbert said, in the agency’s micro-lending pool. BDC uses those funds to provide loans generally ranging from $5,000 to $30,000, he said. Businesses primarily use the credit to purchase new equipment.
“A few big loans and we won’t have any more loan funds,” Tarbert told board members.
Dixon made her claims in response to a question asked by the forum’s moderator about what she would do as mayor to expand investment into downtrodden neighborhoods. The former mayor started by saying she would use incentives to encourage small developers to make investments in communities suffering disinvestment before pivoting to BDC.
“Right now BDC, the Baltimore Development Corporation, has $30 million in micro-lending money that has not been given out into one small company. I would take that $30 million out of Baltimore Development Corporation and work with small businesses to enhance them to grow or start their business,” Dixon said.
Dixon’s campaign did not immediately respond to a request for comment on this story. In two other candidates forums available for review online the former mayor did not repeat the claim.
The first African-American woman elected city council president and the first woman elected mayor of Baltimore, Dixon resigned in early 2010 as part of a plea deal after she admitted guilt to a perjury charge and was previously convicted of a misdemeanor embezzlement charge.
After leaving office Dixon worked as marketing director for the Maryland Minority Contractors Association, which advocates for those types of companies to receive more opportunities and access to public contracts.
Dixon in 2016 ran to regain her old job. She lost the Democratic mayoral primary to former Mayor Catherine Pugh by about 2,400 votes. Pugh resigned from office last year during a federal investigation of her self-dealing “Healthy Holly” scandal and subsequently pleaded guilty to four federal charges.
Dixon is once again running for mayor in a crowded Democratic primary field that includes current Mayor Bernard C. “Jack” Young, City Council President Brandon Scott, state Sen. Mary Washington, attorney Thiru Vignarajah, and Mary Miller, who served in former President Barack Obama’s administration.
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Here we see that same thing------this is PAY-TO-PLAY gets you a business startup allowing people to do anything to make money----USE who-ever or what-ever to bring money.
CYBER-WARRIOR is exactly what NOSY NEIGHBORS AND THE GANG are. These are the players paid to HIT----HIT HIM HIT HER-----we need 25 people for a STUDY------find those people and HIT THEM.
DIVERSITY in who has the power to HIT and literally KILL people who don't fall in line or who are 'THEM' and not 'US'----makes this guy feel EMPOWERED.
LANCE LUCAS is one of a city full of players saying WHY TAKE ME DOWN----WHAT I DO IS PADDY-CAKE compared to what is being done in this city.
LANCE LUCAS IS CORRECT-------SO WHY ARE THESE FEW PEOPLE BEING TAKEN DOWN FOR DOING WHAT GLOBAL HEDGE JOHNS HOPKINS DOES FOR BILLIONS OF DOLLARS?
'paid bribes to Glenn between May 2018 and July 30 so she would introduce a provision that allowed certain businesses to receive contracts as part of the Cyber Warrior Diversity Program'
Notice, LANCE LUCAS is featured on TED---X ----global banking 1% FAKE NEWS MEDIA pretending this guy is a winner.
technical.ly
Lance Lucas pleads guilty to bribery of former lawmaker Cheryl Glenn - Technical.ly Baltimore
Lucas, who founded Digit All Systems to offer IT certifications as a way to fight poverty in Baltimore, paid bribes to Glenn for actions on a cyber training program bill and medical marijuana licenses, according to federal authorities.
As REAL LEFT SOCIAL PROGRESSIVE LIBERAL CAPITALISTS from 300 years of FOUNDING FATHER economics FIGHTS against MOVING FORWARD DARK AGES ROBBER BARON LAISSEZ FAIRE------we have been shouting the US UNIVERSITIES once strong academics---have been made PATENT PRODUCT MILLS ----where fewer and fewer of a crony system of people capture all of what was our SOVEREIGN US TREASURY and FEDERAL/STATE funding.
COMMERCIALIZATION OF DISCOVERIES/INVENTIONS.
We speak often about the FAKE DATA bringing BAD PRODUCT to market----the class action lawsuits by people DAMAGED and KILLED by this FAST-TRACKING spoken of in this article.
We not only protest these PATENT PRODUCT MILL corruption of our US universities---but, there it is ---TEACH FOR AMERICA-----killing our strong---independent PUBLIC K-12 and teachers able to provide REAL INFORMATION and educated CITIZENS to HOLD POWER ACCOUNTABLE.
'Wyskiel is no stranger to being at the helm of things. Out of the office, she is vice chairman of Teach for America in Baltimore'.
BALTIMORE has no public schools in part because of TEACH FOR AMERICA------installing RACE TO THE TOP COMMONER CORE.
Christy Wyskiel to oversee JHU's commercialization of discoveries, inventions
By Samantha Iacia
/ Published Nov 2013When Christy Wyskiel moved to Baltimore 14 years ago, she was on the cusp of setting off a domino effect that would lead to her present-day role as an innovator and advocate for the city's startup scene.
Image caption: Christy Wyskiel
In January, Wyskiel, the newly appointed senior adviser for enterprise development to Johns Hopkins President Ronald J. Daniels, takes on the task of overseeing the commercialization of discoveries and inventions by Johns Hopkins faculty, staff, and student researchers.
With almost 20 years of medical investing and stock analysis behind her, Wyskiel says she is ready for the job.
An alumna of Williams College and New York University, Wyskiel worked for J.P. Morgan and the Cowen Group, where she focused on health care investment banking.
In New York, the Texas-bred Wyskiel met her now-husband, Matt, a fellow Williams College graduate and Baltimore native. They relocated to Baltimore in 1999, and Wyskiel was hired as a medical and life sciences analyst in the equities division of T. Rowe Price. She played a similar role when she was recruited in 2002 by Maverick Capital, working as a managing director for the New York firm out of Baltimore and traveling often to medical conferences and companies whose stock she followed.
But the private investing that Wyskiel did while working for Maverick, she says, is what kick-started her entrepreneurial interests.
"My team at Maverick made a couple of investments in medical technology companies that did very well," she says. "And it was about that point in time when I realized that my true passion lay in helping entrepreneurs and being part of the startup ecosystem rather than just being a financial analyst."
In 2009, Wyskiel founded CWW Research with a mission to help evaluate and facilitate startup activity around Baltimore. She narrowed in on Johns Hopkins researchers after realizing the wealth of innovative happenings taking place there.
"I could add value by helping faculty members write business plans, connect with investors, do some business plan modeling, some market analysis, and I got really excited about that," Wyskiel says.
The partnerships she formed led her to be co-founder, along with Johns Hopkins faculty members, of two companies.
Funded through a GlaxoSmithKline research agreement, Cureveda LLC, which develops drugs to counteract autoimmune and inflammatory diseases, was formed in 2010 from intellectual property created in Shyam Biswal's lab in the Bloomberg School of Public Health. GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration.
Along the way, Wyskiel made mental notes on how Johns Hopkins could improve its relationship with faculty researchers. She discussed her thoughts with President Daniels, which led to her becoming an adviser until she officially assumes her position as senior adviser starting Jan. 1.
Wyskiel is no stranger to being at the helm of things. Out of the office, she is vice chairman of Teach for America in Baltimore. The mother of two also heads an annual fundraiser in partnership with her husband called Next Generation Investing Event, which brings investors together to raise money for three nonprofits.
"My free time I really spend trying to focus on Baltimore, and how to improve the educational opportunities for children in the city," Wyskiel says.
Connecting the dots like this is something Wyskiel plans to incorporate into her new role at Johns Hopkins. She says she will serve as "connective tissue" on the innovation front—taking ideas from the lab and optimizing them for the commercial market.
So far, Wyskiel has spent her time assessing what the JHU entrepreneurial community has, what it wants, and what it needs. She says there are three elements missing in JHU's entrepreneurial platform: space, services, and funding.
"Those are the three pillars in my mind of a successful ecosystem if you look at other universities around the country, or even around the world, that have done this well," Wyskiel says.
To address the issue of space, Wyskiel plans to work with a committee chaired by Drew Pardoll of the Sidney Kimmel Comprehensive Cancer Center and Jennifer Elisseeff of the Wilmer Eye Institute and the Department of Biomedical Engineering to create an innovation hub in East Baltimore that will expand on work done by FastForward, JHU's technology accelerator already in place.
As for services, Wyskiel wants to provide educational resources for writing business plans and learning how to connect with investors, along with marketing, legal, and accounting information.
She's also working on Dream
It Health Baltimore, an accelerator project co-sponsored by Johns Hopkins that will act as a health-related entrepreneurial boot camp from January to May 2014. Ten startup finalists will be recruited from around the world. The hope is that some will choose to remain in Baltimore after completing the accelerator program.
Wyskiel says that in the near future, she would like to see both Johns Hopkins and Baltimore become hotspots for entrepreneurial activity.
"I think that what we're doing is good for student learning and could potentially supply funds to support an academic mission," she says.
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One of the goals of HOSTING SERVER BARBER SURGEONS in what is fast becoming treatments for 'mental health' whether depression through addictions------is this idea of STANFORD TOTAL PRISON MODEL where the VICTIM is totally isolated from the greater community with what is called SECLUSION AND RESTRAINT.
THE BRAIN/BODY IMPLANTS used against me opened the door to anyone being able to access my BRAIN FUNCTION around MEMORY----GLANDULAR FUNCTION-----SUBLIMINAL MESSAGING THROUGH COCHLEAR IMPLANTS ----all while using RETINAL IMPLANTS to create the illusion of READING PEOPLE'S MINDS because they can interpret everything you think through those implants.
Without coincidence my HOSTING SERVER BARBER SURGEON is NADLER among others.
'Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009;'
YOU HAVE NO CONTROL ONCE THESE IMPLANTS ARE INSTALLED----YOU CANNOT TAKE THEM OUT---YOU CANNOT TURN THEM OFF.
This structure is being called SHE HAS A MACHINE IN HER HEAD---------creating artificial seclusion. HITTING has NOSY NEIGHBORS following any person telling people how to interact.
THIS IS SECLUSION AND RESTRAINT BUT WAS ALL DONE THROUGH UNCONSENTED, UNWILLING, WITHOUT KNOWLEDGE ----EXPERIMENTAL RESEARCH.
'We articulate the following fundamental principles to guide action on the issue of seclusion and restraint:
Individuals have the right to be treated with respect and dignity and in a safe, humane, culturally sensitive and developmentally appropriate manner that respects individual choice and maximizes self-determination'.
OH, REALLY??? PEOPLE HAVING FUNDAMENTAL RIGHTS TO DIGNITY AND FEELING SAFE?
'Oversight of seclusion and restraint must be an integral part of an organization’s performance improvement effort and these data must be open for inspection by internal and external regulatory agencies'.
We are warning our US 99% of WE THE PEOPLE what we call ONE WORLD ONE TELEMEDICINE FOR ALL is exactly this. Global banking 1% have managed to MAINSTREAM these medical policies into our US university and mental health agencies.
Without coincidence my HOSTING SERVER BARBER SURGEON is NADLER among others.
'Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009;'
WHAT ARE BEING CALLED ----ONE OR TWO HOUR PROCEDURES ARE PERMANENT----REGARDLESS OF A DIAGNOSIS.
This is what we call CORPORATE SOCIAL WORKER/POLICING SECURITY systems fast becoming the only HEALTH CARE to be found.
That's funny says HOSTING SERVER BARBER SURGEON ---she was completely fine until this past year of PSYCHO-SEXUAL TORTURE----it seems to have made her MAD----
APNA Position on the Use of Seclusion and Restraint
The newly updated Position Statement on the Use of Seclusion and Restraint was approved by the Board of Directors on March 13, 2018.
Accompanying this position paper are the Seclusion and Restraint Standards of Practice.
A continuing education session, Seclusion and Restraint: Keys to Assessing and Mitigating Risks and 2018
Competency Based Training for Conducting the One Hour Face-to-Face Assessment for Patients in Restraints or Seclusion are also available to supplement these two resources.
APNA Position Statement on the Use of Seclusion and Restraint
(Original, 2000; Revised, 2007; Revised, 2014; Revised, 2018)
Introduction
Psychiatric-mental health nursing has a 100 year history of caring for persons in psychiatric facilities.
Currently, nurses serve as direct care providers as well as unit-based and executive level administrators in virtually every organization providing inpatient psychiatric treatment. Therefore, as the professional organization for psychiatric-mental health nurses, the American Psychiatric Nurses Association (APNA) recognizes that the ultimate responsibility for maintaining the safety of both individuals and staff in the treatment environment and for maintaining standards of care in the day-to-day treatment of individuals rests with nursing and the organizational leadership that supports care settings.
Thus, APNA supports a sustained commitment to the reduction and ultimate elimination of seclusion and restraint and advocates for continued research to support evidence-based practice for the prevention and management of behavioral emergencies.
Furthermore, we recognize the need for and are committed to working together with physicians, clients and families, advocacy groups, other health providers, and our nursing colleagues in order to achieve the reality of eliminating the use of seclusion and restraint.
In the mid-1800s, proponents of “moral treatment” of psychiatric patients advocated for the elimination of the practice of restraining patients. Despite the relative success of this movement in England and Europe, psychiatrists in the United States concluded that restraints could never be eliminated in the United States (Fisher, 1994). Belief in the necessity for continuing the practice of secluding and restraining patients as a way to prevent injury and reduce agitation persisted until the beginning of the 21st century. Nurses then concluded that this practice was not grounded in research that supported its therapeutic efficacy, but upon the observation that these measures interrupted and controlled the patient’s behavior (Sailas & Fenton 2000; Paterson & Duxbury, 2007; Steinert et al. 2010; Scanlan 2010). Regulatory changes and increased study led to recognition that seclusion and restraint are not grounded in research and are not therapeutic (World Health Organization, 2017).
Reports of patient injuries and deaths (Berzlanovich, Schöpfer & Keil, 2012; Cecchi et al. 2012; Rakhmatullina, Taub and Jacob, 2013; Duxbury, 2015) and studies of patients’ experiences in restraint and seclusion (Kontio, 2011; Steinert et al. 2013; Soininen et al., 2013; Ling, 2015; Okanli, 2016) have prompted psychiatric-mental health nurses to give serious consideration to the ethical conflict inherent in the use of seclusion and restraint: between the nurse’s responsibility to prevent harm and the patient’s right to autonomy (Cleary, Hunt and Walter 2010; Mohr, 2010; APNA Janssen Scholars, 2012; Ezeobele, 2013). However, violence cannot always be predicted, and since the nursing staff are held responsible for maintaining the safety of all patients, they sometimes see seclusion and restraint as the only way to maintain that safety (Duxbury, 2015). Therefore, studies of the impact of assault on those who care for patients must be taken into consideration when developing standards for practice and when addressing organizational strategies to assure equal commitment to workers, as well as patient safety (Flannery et al., 2011; Happell & Koehn, 2011). Research has highlighted the influence of unit philosophy and culture, treatment philosophy, staff attitudes, staff availability, staff training, ratios of patients to staff and location in the United States on either the disparity in the incidence of seclusion and restraint or the perpetuation of the practice of secluding and restraining psychiatric patients ( Happell & Koehn, 2011; Azeem et al., 2011; Chandler, 2012; Ashcraft, Bloss & Anthony, 2012; Chang et al., 2013). In 2012, NASMHPD’s Six Core Strategies to Reduce Seclusion and Restraint Use program (2008) was recognized by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices, based on the results of a five-year, eight-state research project. This multi-modal approach has been implemented widely by organizations striving to decrease seclusion and restraint use (Delacy et al., 2003; Masters, 2017).
“Skilled assessments of individuals who are restrained or secluded will not only ensure the safety of individuals in these vulnerable conditions, but also will ensure that the measures are discontinued as soon as the individual is able to be safely released.”
From the research, it appears that the key to seclusion and restraint reduction is prevention of aggression by (a) maintaining a presence on the unit and noticing early changes in the patient and the milieu (Johnson & Delaney, 2007; Ward et al., 2011; Taylor et al., 2012), (b) assessing the patient and intervening early with less restrictive measures, such as verbal and non-verbal communication, reduced stimulation, active listening, diversionary techniques, limit setting and medication (Bak et al., 2012; Sivak, 2012; Bostwick & Hallman, 2012; Chalmers et al., 2012; Bowers et al., 2012) and (c) changing aspects of the unit to promote a culture of structure, calmness, negotiation and collaboration, rather than control (Kontio et al., 2012; Bowen, Privitera, and Bowie, 2011; Jones, 2012). The Safewards Program (Bowers, 2014; Hamilton, 2016) has helped caregivers in the United Kingdom to reduce the use of containment procedures by avoiding flashpoints that precede aggression. The Scottish Patient Safety Programme (2016) achieved reduction in the rate of restraint by promoting the idea that when people are and feel safe, staff are and feel safe. Recent evidence has shown that use of a standardized tool to improve time to first medication has been a factor in a successful restraint reduction effort in an emergency department (Winokur, Loucks and Rapp, 2018). Another important factor seems to be adequate staffing skill mix (Staggs, Olds, Kramer & Shorr, 2017).
There is evidence that changes in a unit’s treatment philosophy can lead to changes in patient behavior that will ultimately impact the incidence of the use of seclusion and/or restraints (Delaney and Johnson, 2012; Goetz and Taylor-Trujillo, 2012). There is also growing awareness that inpatient treatment must be shaped by the principles of trauma-informed care and the recovery movement and that these philosophies will create a collaborative spirit that is essential to restraint reduction and elimination efforts (Hammer et al., 2011; Hardy & Patel, 2011; Subica, Claypoole & Wylie, 2012; Bowen, Privitera & Bowie, 2011; Azeem et al., 2011; SAMHSA, 2018).
Despite the best efforts at preventing the use of seclusion and restraint, there may be times that these measures are used. Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009; Huf & Adams, 2012; Hollins & Stubbs, 2011; Mohr & Nunno, 2011; Georgieva et. al, 2012). Moreover, the dangers inherent in the use of seclusion and restraint include the possibility that the person’s behavior is a manifestation of an organic or physiological problem that requires medical intervention and may, therefore, predispose the person to increased physiological risk during the time the individual is secluded or restrained. Therefore, skilled assessments of individuals who are restrained or secluded will not only ensure the safety of individuals in these vulnerable conditions, but also will ensure that the measures are discontinued as soon as the individual is able to be safely released.
APNA believes that psychiatric-mental health nurses play a critical role in the provision of care to persons in psychiatric settings. This role requires that nurses provide effective treatment and milieu leadership to maximize the individual’s ability to effectively manage potentially dangerous behaviors. To that end, we strive to assist the individual in minimizing the circumstances that give rise to seclusion and restraint use.
Therefore:
We advocate for policies at the federal, state, and other organizational levels that will protect individuals from needless trauma associated with seclusion and restraint use, while supporting both individual and staff safety.
We take responsibility for providing ongoing opportunities for professional growth and learning for the psychiatric-mental health nurse whose treatment approach promotes individual safety, as well as autonomy and a sense of personal control.
We promulgate professional standards that apply to all populations and in all settings where behavioral emergencies occur and that provide the framework for quality care for all individuals whose behaviors constitute a risk for safety to themselves or others.
We advocate and support evidence-based practice through research directed toward examining the variables associated with the prevention of and safe management of behavioral emergencies.
We recognize that organizational characteristics have substantial influence on individual safety and call for shared ownership among leaders to create a work culture that supports minimal seclusion and restraint use and that will enable the vision of elimination to be realized.
We articulate the following fundamental principles to guide action on the issue of seclusion and restraint:
Individuals have the right to be treated with respect and dignity and in a safe, humane, culturally sensitive and developmentally appropriate manner that respects individual choice and maximizes self-determination.
Seclusion or restraint must never be used for staff convenience or to punish or coerce individuals.
Seclusion or restraint must be used for the minimal amount of time necessary and only to ensure the physical safety of the individual, other patients or staff members and when less restrictive measures have proven ineffective.
Individuals who are restrained mechanically must be afforded maximum freedom of movement while assuring the physical safety of the individual and others. The least number of restraint points must be utilized and the individual must be continuously observed.
“We promulgate professional standards that apply to all populations and in all settings where behavioral emergencies occur and that provide the framework for quality care for all individuals whose behaviors constitute a risk for safety to themselves or others.”
Seclusion and restraint reduction and elimination requires preventative interventions at both the individual and milieu management levels using evidence based practice.
Seclusion and restraint use is influenced by the organizational culture that develops norms for how persons are treated. Seclusion and restraint reduction and elimination efforts must include a focus on necessary culture change.
Effective administrative and clinical structures and processes must be in place to prevent behavioral emergencies and to support the implementation of alternatives.
Hospital and behavioral healthcare organizations and their nursing leadership groups must make commitments of adequate professional staffing levels, staff time and resources to assure that staff are adequately trained and currently competent to perform treatment processes, milieu management, de-escalation techniques and seclusion or restraint.
Oversight of seclusion and restraint must be an integral part of an organization’s performance improvement effort and these data must be open for inspection by internal and external regulatory agencies. Reporting requirements must be based on a common definition of seclusion and restraint. Specific data requirements must be consistent across regulatory agencies.
Movement toward future elimination of seclusion and restraint requires instituting and supporting less intrusive, preventative, and evidence-based interventions in behavioral emergencies that aid in minimizing aggression while promoting safety.
Approved by the APNA Board of Directors March 13, 2018.
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The US was taken to colonial status during OBAMA ERA when US TREASURY was allowed to literally commit TREASONOUS acts by SUBPRIMING our US treasury bond market----leading to $20 trillion in national debt.
This is ONE person----you know---those HILLARY NASTY LADIES------who pushed this. Now she wants to be MAYOR OF BALTIMORE.
Does it matter if the current JACK YOUNG or this MARY MILLER win the coming election?
NO, THEY ARE THE SAME PEOPLE----THEY BOTH WORK FOR GLOBAL BANKING .00014% OF PEOPLE----BOTH WILL MOVE FORWARD THE SAME PUBLIC POLICIES.
Run for Mayor of BaltimoreBy
Josh Kurtz
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January 6, 2020
Mary J. Miller, a former Treasury Department official, is about to become a candidate for mayor of Baltimore. Treasury Department photo
A former top official at the U.S. Treasury Department during the Obama administration is poised to make a late entry into the Baltimore mayoral election, Maryland Matters has learned.
Mary J. Miller, who had a long career in finance at T. Rowe Price in Baltimore, is sending out invitations for a “Celebration of Baltimore” Tuesday evening at the Museum of Industry.
But according to four sources, Miller is announcing her plans to join the already crowded Democratic primary for mayor. She has already begun assembling a campaign team, which will be led by Ann Beegle, a one-time top aide to former Baltimore County executive Jim Smith (D) who is also the former executive director of the Maryland Democratic Party.
Beegle, who led Baltimore’s celebration of the War of 1812 bicentennial celebration, told friends of her new job in a mass email obtained by Maryland Matters.
Miller, who lives in the Guilford neighborhood, was the Treasury Department’s undersecretary for Domestic Finance. In that role, she was responsible for developing and coordinating Treasury’s policies and guidance in the areas of financial institutions, federal debt financing, financial regulation, and capital markets.
Before that, Miller served as assistant secretary of the Treasury for Financial Markets, where she advised the secretary on matters of domestic finance, financial markets, federal, state and local finance, and federal government lending policies. In this role, she was also responsible for Treasury’s management of the public debt.
Prior to joining the Obama administration, Miller spent 26 years working for T. Rowe Price Group, Inc., where she was the director of the Fixed Income Division and a member of the firm’s Management Committee.
Miller, who is in her ’60s, is currently a senior fellow at The Johns Hopkins University 21st Century Cities Initiative and a trustee of the Urban Institute in Washington, D.C. She and her husband James Dabney Miller, an attorney and faculty member at the Johns Hopkins Bloomberg School of Public Health, have two grown sons.
In her email, Beegle cited a New Republic article from 2011 that referred to Miller as one of the most powerful but least famous people in Washington, D.C.
“This seems to sum up how I have found her to be — deeply connected to others who are passionate about getting things done, and humble in her approach,” Beegle wrote.
It isn’t quite clear how viable a candidate a political novice like Miller would be in a crowded Democratic field that includes Mayor Bernard C. “Jack” Young, City Council President Brandon M. Scott, former mayor Sheila Dixon, state Sen. Mary L. Washington, former assistant attorney general Thiru Vignarajah, and former Baltimore Police Department spokesman T.J. Smith. She would be the first white candidate of any stature in the race, which is not insignificant in a race with so many prominent candidates of color.
But ever since former mayor Martin J. O’Malley (D) won reelection in 2003, white candidates have fared poorly in citywide elections. Whether Miller has political chops, a fundraising apparatus or personal funds to spare is completely unknown.
My case against HOSTING SERVER BARBER SURGEON and NOSY NEIGHBORS AND THE GANG is clearly illustrated in the posts I share today.
This article in BALTIMORE SUN is a continuous stream of media making clear the economy in Baltimore is systemically criminal and corrupt with the CRONYISM out of this world. When a governance is allowed to be SO ENTRENCHED it becomes
DYSTOPIC AND OPERATES WITH IMPUNITY. THIS IS WHAT ALLOWS A STRUCTURE LIKE HOSTING SERVER NOSY NEIGHBORS AND GANG TO OPERATE OUTSIDE OF RULE OF LAW----WITH IMPUNITY.
My lawsuit details a BRAIN/BODY IMPLANTING which began with a false employment at JOHNS HOPKINS using a new employee physical exam to IMPLANT with COCHLEAR DEVICE. This was the start of an EXPERIMENTAL RESEARCH using AUDITORY DEVICES AND IMPLANTS.
'Dr. Meghan Wyskiel received her Bachelor’s in Communication Disorders in 2013 and her Doctorate of Audiology in 2017'
My lawsuit also entails WILMER EYE, NOSE, THROAT clinics which were involved in the BRAIN/BODY IMPLANTS done without knowledge during a BROKEN LEG BONE SURGERY. This is when a RETINAL IMPLANT and what feel likely is a SINUS IMPLANT occurred. Below we see how these global hedge fund BARBER SURGEONS patent and create INNOVATIVE STARTUPS from the 'EVIDENCE-BASED DATA' collected in these CRIMINAL IMPLANTATIONS.
'GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration'.
It is highly likely I as a VICTIM of illegal implantation research studies---will develop MACULAR DEGENERATION----when I would not have if not forced into implantation. GRAYBUG LLC will make money from these UNDER-THE-RADAR EXPERIMENTAL STUDIES.
DANIELS of BLOOMBERG SCHOOL OF PUBLIC HEALTH is of course the TOP GUN in all that is criminal and illegal about this research. The ethos of -----GIVING ACCESS TO HEALTH CARE in exchange for forced research assignments----HIT THAT MAN HIT THAT WOMAN ----LET'S EVEN HIT THEIR CATS AND DOGS with IMPLANTING.
Yes, even the cats and dogs have been implanted in these few decades of DOING ANYTHING FOR A PATENTED PRODUCT.
'Christy Wyskiel
Senior Adviser to the President
Johns Hopkins University
Christy Wyskiel
Christy Wyskiel
The vibrancy of Baltimore is palpable to Christy Wyskiel, and from her desk at Johns Hopkins University it’s easy to see why.
Wyskiel is the senior adviser in matters of innovation, commercialization and entrepreneurship. She heads up Johns Hopkins Technology Ventures, which includes technology transfer, the FastForward innovation hubs and commercial partnerships.
In the last fiscal year, Johns Hopkins had $700 million in venture funding coming into its companies, up considerably from about $50 million five years ago'.
Here is another example-------I am being HIT-----illegally surveilled 24/7 with video and audio inside my living space and in public spaces because of THIS========the WIFI----RFID MICROCHIPS====the GIGABIT ETHERNET===are all what allows HOSTING SERVER NOSY NEIGHBORS AND GANG to follow me wherever I go and WYSKIEL TECH, gets millions and soon billions of dollars in that experimental research which ME AS THE TARGET.
'About Us - Wyskiel Tech
wyskieltechnologies.com
Wyskiel Technologies, Inc. has been serving the Silicon Valley and San Francisco Bay Area since 2006. Our designs have included PCIe, Gigabit Ethernet, Bluetooth, WiFi, GPS, RFID, Wireless Communications, LED Lighting and Telecommunications'.
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'Meghan Wyskiel, Au.D.
Dr. Meghan Wyskiel received her Bachelor’s in Communication Disorders in 2013 and her Doctorate of Audiology in 2017 from Central Michigan University. Dr. Wyskiel completed her residency under the supervision of the Advanced Audiology Institute audiologists. After graduating from CMU, she started as a full time audiologist at Advanced Audiology Institute. Dr. Wyskiel’s aim is to deliver the best possible care and service to all patients and to make every visit a positive one. Dr. Wyskiel moved to Las Vegas in 2016 after 24 years as a resident of Northern Michigan. She enjoys traveling to new places, baking, and reading'.
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'In 2009, Wyskiel founded CWW Research with a mission to help evaluate and facilitate startup activity around Baltimore. She narrowed in on Johns Hopkins researchers after realizing the wealth of innovative happenings taking place there.
"I could add value by helping faculty members write business plans, connect with investors, do some business plan modeling, some market analysis, and I got really excited about that," Wyskiel says.
The partnerships she formed led her to be co-founder, along with Johns Hopkins faculty members, of two companies. Funded through a GlaxoSmithKline research agreement, Cureveda LLC, which develops drugs to counteract autoimmune and inflammatory diseases, was formed in 2010 from intellectual property created in Shyam Biswal's lab in the Bloomberg School of Public Health. GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration'.
When we shout against BALTIMORE DEVELOPMENT CORPORATION as criminal and corrupt-------this is it. The entire economy in Baltimore is so captured that only a few institutions and leaders control ALL -----in a DARK AGES pay-to-play.
BDC president: Dixon’s claim on $30M loan fund ‘un-factual’
By: Adam Bednar Daily Record Business Writer February 20, 2020
Former Baltimore Mayor Sheila Dixon. (File Photo)
The head of Baltimore’s economic development entity said claims by a former mayor that the quasi-public organization is sitting on $30 million in funds it should be lending are untrue.
During the Baltimore Development Corp.’s board meeting Thursday, Christy Wyskiel, a board member from Johns Hopkins University, asked about claims made by former Mayor Sheila Dixon during a candidates’ forum sponsored by Open Society Institute-Baltimore on Feb. 5 that the organization is hoarding funds in its micro-lending fund.
“I don’t know where that comes from. It’s completely un-factual,” said Colin Tarbert, president and CEO of the BDC.
A recently completed audit of the organization, which was released after the board meeting, shows BDC currently has total assets of more than $26.9 million and roughly $2.98 million in loan funds.
There’s currently about $380,000, Tarbert said, in the agency’s micro-lending pool. BDC uses those funds to provide loans generally ranging from $5,000 to $30,000, he said. Businesses primarily use the credit to purchase new equipment.
“A few big loans and we won’t have any more loan funds,” Tarbert told board members.
Dixon made her claims in response to a question asked by the forum’s moderator about what she would do as mayor to expand investment into downtrodden neighborhoods. The former mayor started by saying she would use incentives to encourage small developers to make investments in communities suffering disinvestment before pivoting to BDC.
“Right now BDC, the Baltimore Development Corporation, has $30 million in micro-lending money that has not been given out into one small company. I would take that $30 million out of Baltimore Development Corporation and work with small businesses to enhance them to grow or start their business,” Dixon said.
Dixon’s campaign did not immediately respond to a request for comment on this story. In two other candidates forums available for review online the former mayor did not repeat the claim.
The first African-American woman elected city council president and the first woman elected mayor of Baltimore, Dixon resigned in early 2010 as part of a plea deal after she admitted guilt to a perjury charge and was previously convicted of a misdemeanor embezzlement charge.
After leaving office Dixon worked as marketing director for the Maryland Minority Contractors Association, which advocates for those types of companies to receive more opportunities and access to public contracts.
Dixon in 2016 ran to regain her old job. She lost the Democratic mayoral primary to former Mayor Catherine Pugh by about 2,400 votes. Pugh resigned from office last year during a federal investigation of her self-dealing “Healthy Holly” scandal and subsequently pleaded guilty to four federal charges.
Dixon is once again running for mayor in a crowded Democratic primary field that includes current Mayor Bernard C. “Jack” Young, City Council President Brandon Scott, state Sen. Mary Washington, attorney Thiru Vignarajah, and Mary Miller, who served in former President Barack Obama’s administration.
______________________________________________
Here we see that same thing------this is PAY-TO-PLAY gets you a business startup allowing people to do anything to make money----USE who-ever or what-ever to bring money.
CYBER-WARRIOR is exactly what NOSY NEIGHBORS AND THE GANG are. These are the players paid to HIT----HIT HIM HIT HER-----we need 25 people for a STUDY------find those people and HIT THEM.
DIVERSITY in who has the power to HIT and literally KILL people who don't fall in line or who are 'THEM' and not 'US'----makes this guy feel EMPOWERED.
LANCE LUCAS is one of a city full of players saying WHY TAKE ME DOWN----WHAT I DO IS PADDY-CAKE compared to what is being done in this city.
LANCE LUCAS IS CORRECT-------SO WHY ARE THESE FEW PEOPLE BEING TAKEN DOWN FOR DOING WHAT GLOBAL HEDGE JOHNS HOPKINS DOES FOR BILLIONS OF DOLLARS?
'paid bribes to Glenn between May 2018 and July 30 so she would introduce a provision that allowed certain businesses to receive contracts as part of the Cyber Warrior Diversity Program'
Notice, LANCE LUCAS is featured on TED---X ----global banking 1% FAKE NEWS MEDIA pretending this guy is a winner.
technical.ly
Lance Lucas pleads guilty to bribery of former lawmaker Cheryl Glenn - Technical.ly Baltimore
Lucas, who founded Digit All Systems to offer IT certifications as a way to fight poverty in Baltimore, paid bribes to Glenn for actions on a cyber training program bill and medical marijuana licenses, according to federal authorities.
As REAL LEFT SOCIAL PROGRESSIVE LIBERAL CAPITALISTS from 300 years of FOUNDING FATHER economics FIGHTS against MOVING FORWARD DARK AGES ROBBER BARON LAISSEZ FAIRE------we have been shouting the US UNIVERSITIES once strong academics---have been made PATENT PRODUCT MILLS ----where fewer and fewer of a crony system of people capture all of what was our SOVEREIGN US TREASURY and FEDERAL/STATE funding.
COMMERCIALIZATION OF DISCOVERIES/INVENTIONS.
We speak often about the FAKE DATA bringing BAD PRODUCT to market----the class action lawsuits by people DAMAGED and KILLED by this FAST-TRACKING spoken of in this article.
We not only protest these PATENT PRODUCT MILL corruption of our US universities---but, there it is ---TEACH FOR AMERICA-----killing our strong---independent PUBLIC K-12 and teachers able to provide REAL INFORMATION and educated CITIZENS to HOLD POWER ACCOUNTABLE.
'Wyskiel is no stranger to being at the helm of things. Out of the office, she is vice chairman of Teach for America in Baltimore'.
BALTIMORE has no public schools in part because of TEACH FOR AMERICA------installing RACE TO THE TOP COMMONER CORE.
Christy Wyskiel to oversee JHU's commercialization of discoveries, inventions
By Samantha Iacia
/ Published Nov 2013When Christy Wyskiel moved to Baltimore 14 years ago, she was on the cusp of setting off a domino effect that would lead to her present-day role as an innovator and advocate for the city's startup scene.
Image caption: Christy Wyskiel
In January, Wyskiel, the newly appointed senior adviser for enterprise development to Johns Hopkins President Ronald J. Daniels, takes on the task of overseeing the commercialization of discoveries and inventions by Johns Hopkins faculty, staff, and student researchers.
With almost 20 years of medical investing and stock analysis behind her, Wyskiel says she is ready for the job.
An alumna of Williams College and New York University, Wyskiel worked for J.P. Morgan and the Cowen Group, where she focused on health care investment banking.
In New York, the Texas-bred Wyskiel met her now-husband, Matt, a fellow Williams College graduate and Baltimore native. They relocated to Baltimore in 1999, and Wyskiel was hired as a medical and life sciences analyst in the equities division of T. Rowe Price. She played a similar role when she was recruited in 2002 by Maverick Capital, working as a managing director for the New York firm out of Baltimore and traveling often to medical conferences and companies whose stock she followed.
But the private investing that Wyskiel did while working for Maverick, she says, is what kick-started her entrepreneurial interests.
"My team at Maverick made a couple of investments in medical technology companies that did very well," she says. "And it was about that point in time when I realized that my true passion lay in helping entrepreneurs and being part of the startup ecosystem rather than just being a financial analyst."
In 2009, Wyskiel founded CWW Research with a mission to help evaluate and facilitate startup activity around Baltimore. She narrowed in on Johns Hopkins researchers after realizing the wealth of innovative happenings taking place there.
"I could add value by helping faculty members write business plans, connect with investors, do some business plan modeling, some market analysis, and I got really excited about that," Wyskiel says.
The partnerships she formed led her to be co-founder, along with Johns Hopkins faculty members, of two companies.
Funded through a GlaxoSmithKline research agreement, Cureveda LLC, which develops drugs to counteract autoimmune and inflammatory diseases, was formed in 2010 from intellectual property created in Shyam Biswal's lab in the Bloomberg School of Public Health. GrayBug LLC, founded in 2011 with three faculty members from the Wilmer Eye Institute, focuses on time-release drug-delivery systems for eye diseases such as age-related macular degeneration.
Along the way, Wyskiel made mental notes on how Johns Hopkins could improve its relationship with faculty researchers. She discussed her thoughts with President Daniels, which led to her becoming an adviser until she officially assumes her position as senior adviser starting Jan. 1.
Wyskiel is no stranger to being at the helm of things. Out of the office, she is vice chairman of Teach for America in Baltimore. The mother of two also heads an annual fundraiser in partnership with her husband called Next Generation Investing Event, which brings investors together to raise money for three nonprofits.
"My free time I really spend trying to focus on Baltimore, and how to improve the educational opportunities for children in the city," Wyskiel says.
Connecting the dots like this is something Wyskiel plans to incorporate into her new role at Johns Hopkins. She says she will serve as "connective tissue" on the innovation front—taking ideas from the lab and optimizing them for the commercial market.
So far, Wyskiel has spent her time assessing what the JHU entrepreneurial community has, what it wants, and what it needs. She says there are three elements missing in JHU's entrepreneurial platform: space, services, and funding.
"Those are the three pillars in my mind of a successful ecosystem if you look at other universities around the country, or even around the world, that have done this well," Wyskiel says.
To address the issue of space, Wyskiel plans to work with a committee chaired by Drew Pardoll of the Sidney Kimmel Comprehensive Cancer Center and Jennifer Elisseeff of the Wilmer Eye Institute and the Department of Biomedical Engineering to create an innovation hub in East Baltimore that will expand on work done by FastForward, JHU's technology accelerator already in place.
As for services, Wyskiel wants to provide educational resources for writing business plans and learning how to connect with investors, along with marketing, legal, and accounting information.
She's also working on Dream
It Health Baltimore, an accelerator project co-sponsored by Johns Hopkins that will act as a health-related entrepreneurial boot camp from January to May 2014. Ten startup finalists will be recruited from around the world. The hope is that some will choose to remain in Baltimore after completing the accelerator program.
Wyskiel says that in the near future, she would like to see both Johns Hopkins and Baltimore become hotspots for entrepreneurial activity.
"I think that what we're doing is good for student learning and could potentially supply funds to support an academic mission," she says.
_______________________________________
One of the goals of HOSTING SERVER BARBER SURGEONS in what is fast becoming treatments for 'mental health' whether depression through addictions------is this idea of STANFORD TOTAL PRISON MODEL where the VICTIM is totally isolated from the greater community with what is called SECLUSION AND RESTRAINT.
THE BRAIN/BODY IMPLANTS used against me opened the door to anyone being able to access my BRAIN FUNCTION around MEMORY----GLANDULAR FUNCTION-----SUBLIMINAL MESSAGING THROUGH COCHLEAR IMPLANTS ----all while using RETINAL IMPLANTS to create the illusion of READING PEOPLE'S MINDS because they can interpret everything you think through those implants.
Without coincidence my HOSTING SERVER BARBER SURGEON is NADLER among others.
'Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009;'
YOU HAVE NO CONTROL ONCE THESE IMPLANTS ARE INSTALLED----YOU CANNOT TAKE THEM OUT---YOU CANNOT TURN THEM OFF.
This structure is being called SHE HAS A MACHINE IN HER HEAD---------creating artificial seclusion. HITTING has NOSY NEIGHBORS following any person telling people how to interact.
THIS IS SECLUSION AND RESTRAINT BUT WAS ALL DONE THROUGH UNCONSENTED, UNWILLING, WITHOUT KNOWLEDGE ----EXPERIMENTAL RESEARCH.
'We articulate the following fundamental principles to guide action on the issue of seclusion and restraint:
Individuals have the right to be treated with respect and dignity and in a safe, humane, culturally sensitive and developmentally appropriate manner that respects individual choice and maximizes self-determination'.
OH, REALLY??? PEOPLE HAVING FUNDAMENTAL RIGHTS TO DIGNITY AND FEELING SAFE?
'Oversight of seclusion and restraint must be an integral part of an organization’s performance improvement effort and these data must be open for inspection by internal and external regulatory agencies'.
We are warning our US 99% of WE THE PEOPLE what we call ONE WORLD ONE TELEMEDICINE FOR ALL is exactly this. Global banking 1% have managed to MAINSTREAM these medical policies into our US university and mental health agencies.
Without coincidence my HOSTING SERVER BARBER SURGEON is NADLER among others.
'Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009;'
WHAT ARE BEING CALLED ----ONE OR TWO HOUR PROCEDURES ARE PERMANENT----REGARDLESS OF A DIAGNOSIS.
This is what we call CORPORATE SOCIAL WORKER/POLICING SECURITY systems fast becoming the only HEALTH CARE to be found.
That's funny says HOSTING SERVER BARBER SURGEON ---she was completely fine until this past year of PSYCHO-SEXUAL TORTURE----it seems to have made her MAD----
APNA Position on the Use of Seclusion and Restraint
The newly updated Position Statement on the Use of Seclusion and Restraint was approved by the Board of Directors on March 13, 2018.
Accompanying this position paper are the Seclusion and Restraint Standards of Practice.
A continuing education session, Seclusion and Restraint: Keys to Assessing and Mitigating Risks and 2018
Competency Based Training for Conducting the One Hour Face-to-Face Assessment for Patients in Restraints or Seclusion are also available to supplement these two resources.
APNA Position Statement on the Use of Seclusion and Restraint
(Original, 2000; Revised, 2007; Revised, 2014; Revised, 2018)
Introduction
Psychiatric-mental health nursing has a 100 year history of caring for persons in psychiatric facilities.
Currently, nurses serve as direct care providers as well as unit-based and executive level administrators in virtually every organization providing inpatient psychiatric treatment. Therefore, as the professional organization for psychiatric-mental health nurses, the American Psychiatric Nurses Association (APNA) recognizes that the ultimate responsibility for maintaining the safety of both individuals and staff in the treatment environment and for maintaining standards of care in the day-to-day treatment of individuals rests with nursing and the organizational leadership that supports care settings.
Thus, APNA supports a sustained commitment to the reduction and ultimate elimination of seclusion and restraint and advocates for continued research to support evidence-based practice for the prevention and management of behavioral emergencies.
Furthermore, we recognize the need for and are committed to working together with physicians, clients and families, advocacy groups, other health providers, and our nursing colleagues in order to achieve the reality of eliminating the use of seclusion and restraint.
In the mid-1800s, proponents of “moral treatment” of psychiatric patients advocated for the elimination of the practice of restraining patients. Despite the relative success of this movement in England and Europe, psychiatrists in the United States concluded that restraints could never be eliminated in the United States (Fisher, 1994). Belief in the necessity for continuing the practice of secluding and restraining patients as a way to prevent injury and reduce agitation persisted until the beginning of the 21st century. Nurses then concluded that this practice was not grounded in research that supported its therapeutic efficacy, but upon the observation that these measures interrupted and controlled the patient’s behavior (Sailas & Fenton 2000; Paterson & Duxbury, 2007; Steinert et al. 2010; Scanlan 2010). Regulatory changes and increased study led to recognition that seclusion and restraint are not grounded in research and are not therapeutic (World Health Organization, 2017).
Reports of patient injuries and deaths (Berzlanovich, Schöpfer & Keil, 2012; Cecchi et al. 2012; Rakhmatullina, Taub and Jacob, 2013; Duxbury, 2015) and studies of patients’ experiences in restraint and seclusion (Kontio, 2011; Steinert et al. 2013; Soininen et al., 2013; Ling, 2015; Okanli, 2016) have prompted psychiatric-mental health nurses to give serious consideration to the ethical conflict inherent in the use of seclusion and restraint: between the nurse’s responsibility to prevent harm and the patient’s right to autonomy (Cleary, Hunt and Walter 2010; Mohr, 2010; APNA Janssen Scholars, 2012; Ezeobele, 2013). However, violence cannot always be predicted, and since the nursing staff are held responsible for maintaining the safety of all patients, they sometimes see seclusion and restraint as the only way to maintain that safety (Duxbury, 2015). Therefore, studies of the impact of assault on those who care for patients must be taken into consideration when developing standards for practice and when addressing organizational strategies to assure equal commitment to workers, as well as patient safety (Flannery et al., 2011; Happell & Koehn, 2011). Research has highlighted the influence of unit philosophy and culture, treatment philosophy, staff attitudes, staff availability, staff training, ratios of patients to staff and location in the United States on either the disparity in the incidence of seclusion and restraint or the perpetuation of the practice of secluding and restraining psychiatric patients ( Happell & Koehn, 2011; Azeem et al., 2011; Chandler, 2012; Ashcraft, Bloss & Anthony, 2012; Chang et al., 2013). In 2012, NASMHPD’s Six Core Strategies to Reduce Seclusion and Restraint Use program (2008) was recognized by the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Registry of Evidence-based Programs and Practices, based on the results of a five-year, eight-state research project. This multi-modal approach has been implemented widely by organizations striving to decrease seclusion and restraint use (Delacy et al., 2003; Masters, 2017).
“Skilled assessments of individuals who are restrained or secluded will not only ensure the safety of individuals in these vulnerable conditions, but also will ensure that the measures are discontinued as soon as the individual is able to be safely released.”
From the research, it appears that the key to seclusion and restraint reduction is prevention of aggression by (a) maintaining a presence on the unit and noticing early changes in the patient and the milieu (Johnson & Delaney, 2007; Ward et al., 2011; Taylor et al., 2012), (b) assessing the patient and intervening early with less restrictive measures, such as verbal and non-verbal communication, reduced stimulation, active listening, diversionary techniques, limit setting and medication (Bak et al., 2012; Sivak, 2012; Bostwick & Hallman, 2012; Chalmers et al., 2012; Bowers et al., 2012) and (c) changing aspects of the unit to promote a culture of structure, calmness, negotiation and collaboration, rather than control (Kontio et al., 2012; Bowen, Privitera, and Bowie, 2011; Jones, 2012). The Safewards Program (Bowers, 2014; Hamilton, 2016) has helped caregivers in the United Kingdom to reduce the use of containment procedures by avoiding flashpoints that precede aggression. The Scottish Patient Safety Programme (2016) achieved reduction in the rate of restraint by promoting the idea that when people are and feel safe, staff are and feel safe. Recent evidence has shown that use of a standardized tool to improve time to first medication has been a factor in a successful restraint reduction effort in an emergency department (Winokur, Loucks and Rapp, 2018). Another important factor seems to be adequate staffing skill mix (Staggs, Olds, Kramer & Shorr, 2017).
There is evidence that changes in a unit’s treatment philosophy can lead to changes in patient behavior that will ultimately impact the incidence of the use of seclusion and/or restraints (Delaney and Johnson, 2012; Goetz and Taylor-Trujillo, 2012). There is also growing awareness that inpatient treatment must be shaped by the principles of trauma-informed care and the recovery movement and that these philosophies will create a collaborative spirit that is essential to restraint reduction and elimination efforts (Hammer et al., 2011; Hardy & Patel, 2011; Subica, Claypoole & Wylie, 2012; Bowen, Privitera & Bowie, 2011; Azeem et al., 2011; SAMHSA, 2018).
Despite the best efforts at preventing the use of seclusion and restraint, there may be times that these measures are used. Thus, it is important to be cognizant of the vulnerability of individuals who are secluded or restrained and the risks involved in using these measures (Nadler-Moodie, 2009; Huf & Adams, 2012; Hollins & Stubbs, 2011; Mohr & Nunno, 2011; Georgieva et. al, 2012). Moreover, the dangers inherent in the use of seclusion and restraint include the possibility that the person’s behavior is a manifestation of an organic or physiological problem that requires medical intervention and may, therefore, predispose the person to increased physiological risk during the time the individual is secluded or restrained. Therefore, skilled assessments of individuals who are restrained or secluded will not only ensure the safety of individuals in these vulnerable conditions, but also will ensure that the measures are discontinued as soon as the individual is able to be safely released.
APNA believes that psychiatric-mental health nurses play a critical role in the provision of care to persons in psychiatric settings. This role requires that nurses provide effective treatment and milieu leadership to maximize the individual’s ability to effectively manage potentially dangerous behaviors. To that end, we strive to assist the individual in minimizing the circumstances that give rise to seclusion and restraint use.
Therefore:
We advocate for policies at the federal, state, and other organizational levels that will protect individuals from needless trauma associated with seclusion and restraint use, while supporting both individual and staff safety.
We take responsibility for providing ongoing opportunities for professional growth and learning for the psychiatric-mental health nurse whose treatment approach promotes individual safety, as well as autonomy and a sense of personal control.
We promulgate professional standards that apply to all populations and in all settings where behavioral emergencies occur and that provide the framework for quality care for all individuals whose behaviors constitute a risk for safety to themselves or others.
We advocate and support evidence-based practice through research directed toward examining the variables associated with the prevention of and safe management of behavioral emergencies.
We recognize that organizational characteristics have substantial influence on individual safety and call for shared ownership among leaders to create a work culture that supports minimal seclusion and restraint use and that will enable the vision of elimination to be realized.
We articulate the following fundamental principles to guide action on the issue of seclusion and restraint:
Individuals have the right to be treated with respect and dignity and in a safe, humane, culturally sensitive and developmentally appropriate manner that respects individual choice and maximizes self-determination.
Seclusion or restraint must never be used for staff convenience or to punish or coerce individuals.
Seclusion or restraint must be used for the minimal amount of time necessary and only to ensure the physical safety of the individual, other patients or staff members and when less restrictive measures have proven ineffective.
Individuals who are restrained mechanically must be afforded maximum freedom of movement while assuring the physical safety of the individual and others. The least number of restraint points must be utilized and the individual must be continuously observed.
“We promulgate professional standards that apply to all populations and in all settings where behavioral emergencies occur and that provide the framework for quality care for all individuals whose behaviors constitute a risk for safety to themselves or others.”
Seclusion and restraint reduction and elimination requires preventative interventions at both the individual and milieu management levels using evidence based practice.
Seclusion and restraint use is influenced by the organizational culture that develops norms for how persons are treated. Seclusion and restraint reduction and elimination efforts must include a focus on necessary culture change.
Effective administrative and clinical structures and processes must be in place to prevent behavioral emergencies and to support the implementation of alternatives.
Hospital and behavioral healthcare organizations and their nursing leadership groups must make commitments of adequate professional staffing levels, staff time and resources to assure that staff are adequately trained and currently competent to perform treatment processes, milieu management, de-escalation techniques and seclusion or restraint.
Oversight of seclusion and restraint must be an integral part of an organization’s performance improvement effort and these data must be open for inspection by internal and external regulatory agencies. Reporting requirements must be based on a common definition of seclusion and restraint. Specific data requirements must be consistent across regulatory agencies.
Movement toward future elimination of seclusion and restraint requires instituting and supporting less intrusive, preventative, and evidence-based interventions in behavioral emergencies that aid in minimizing aggression while promoting safety.
Approved by the APNA Board of Directors March 13, 2018.
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The US was taken to colonial status during OBAMA ERA when US TREASURY was allowed to literally commit TREASONOUS acts by SUBPRIMING our US treasury bond market----leading to $20 trillion in national debt.
This is ONE person----you know---those HILLARY NASTY LADIES------who pushed this. Now she wants to be MAYOR OF BALTIMORE.
Does it matter if the current JACK YOUNG or this MARY MILLER win the coming election?
NO, THEY ARE THE SAME PEOPLE----THEY BOTH WORK FOR GLOBAL BANKING .00014% OF PEOPLE----BOTH WILL MOVE FORWARD THE SAME PUBLIC POLICIES.
Run for Mayor of BaltimoreBy
Josh Kurtz
-
January 6, 2020
Mary J. Miller, a former Treasury Department official, is about to become a candidate for mayor of Baltimore. Treasury Department photo
A former top official at the U.S. Treasury Department during the Obama administration is poised to make a late entry into the Baltimore mayoral election, Maryland Matters has learned.
Mary J. Miller, who had a long career in finance at T. Rowe Price in Baltimore, is sending out invitations for a “Celebration of Baltimore” Tuesday evening at the Museum of Industry.
But according to four sources, Miller is announcing her plans to join the already crowded Democratic primary for mayor. She has already begun assembling a campaign team, which will be led by Ann Beegle, a one-time top aide to former Baltimore County executive Jim Smith (D) who is also the former executive director of the Maryland Democratic Party.
Beegle, who led Baltimore’s celebration of the War of 1812 bicentennial celebration, told friends of her new job in a mass email obtained by Maryland Matters.
Miller, who lives in the Guilford neighborhood, was the Treasury Department’s undersecretary for Domestic Finance. In that role, she was responsible for developing and coordinating Treasury’s policies and guidance in the areas of financial institutions, federal debt financing, financial regulation, and capital markets.
Before that, Miller served as assistant secretary of the Treasury for Financial Markets, where she advised the secretary on matters of domestic finance, financial markets, federal, state and local finance, and federal government lending policies. In this role, she was also responsible for Treasury’s management of the public debt.
Prior to joining the Obama administration, Miller spent 26 years working for T. Rowe Price Group, Inc., where she was the director of the Fixed Income Division and a member of the firm’s Management Committee.
Miller, who is in her ’60s, is currently a senior fellow at The Johns Hopkins University 21st Century Cities Initiative and a trustee of the Urban Institute in Washington, D.C. She and her husband James Dabney Miller, an attorney and faculty member at the Johns Hopkins Bloomberg School of Public Health, have two grown sons.
In her email, Beegle cited a New Republic article from 2011 that referred to Miller as one of the most powerful but least famous people in Washington, D.C.
“This seems to sum up how I have found her to be — deeply connected to others who are passionate about getting things done, and humble in her approach,” Beegle wrote.
It isn’t quite clear how viable a candidate a political novice like Miller would be in a crowded Democratic field that includes Mayor Bernard C. “Jack” Young, City Council President Brandon M. Scott, former mayor Sheila Dixon, state Sen. Mary L. Washington, former assistant attorney general Thiru Vignarajah, and former Baltimore Police Department spokesman T.J. Smith. She would be the first white candidate of any stature in the race, which is not insignificant in a race with so many prominent candidates of color.
But ever since former mayor Martin J. O’Malley (D) won reelection in 2003, white candidates have fared poorly in citywide elections. Whether Miller has political chops, a fundraising apparatus or personal funds to spare is completely unknown.
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