De-escalation techniques for managing aggression

Spencer, Sally; Johnson, Paula

doi:10.1002/14651858.cd012034

Cited by 12 publications

(13 citation statements)

References 41 publications

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“…Ineffective communication has been identified by people using services as one of the primary reasons for their aggression (Duxbury & Whittington ). Training in de‐escalation techniques has been identified as one of a number of useful responses (Spencer & Johnson ). This includes verbal and nonverbal techniques to identify and prevent the escalation of aggressive behaviour (Spencer & Johnson ).…”

Section: Discussionmentioning

confidence: 99%

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People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Jury¹,

Lai²,

Tuason³

et al. 2018

Int J Mental Health Nurs

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The Health of the Nation Outcomes Scales (HoNOS) provides an overview of a person's behaviour, impairment, clinical symptoms, and social functioning. This study investigated the profile of people who had been secluded in New Zealand's adult mental health inpatient services using 12 individual HoNOS ratings. Routinely collected clinical data were extracted from the Programme for the Integration of Mental Health Data (PRIMHD). This is the national data set for mental health and addiction services. A logistic regression model was fitted to the data which adjusted for age, sex, ethnicity, bed nights, compulsory treatment, and district health board. After adjustment, three HoNOS items significantly predicted the risk of seclusion: overactive, aggressive, disruptive, or agitated behaviour (adjusted OR = 4.82, 95% CI [3.88, 5.97], P < 0.001); problem drinking or drug-taking (adjusted OR = 1.51, 95% CI [1.25, 1.82], P < 0.001); and problems with hallucinations and delusions (adjusted OR = 1.33, 95% CI [1.09, 1.63], P = 0.006). In addition, two HoNOS items were protective for seclusion: nonaccidental self-injury (adjusted OR = 0.65, 95% CI [0.51, 0.83], P < 0.001) and depressed mood (adjusted OR = 0.58, 95% CI [0.47, 0.72], P < 0.001). Thus, responding effectively to agitation and/or aggression, substance use, and psychosis plays an important role in reducing the use of seclusion. Mental health nurses and other workers can reduce seclusion through early assessment, effective communication, de-escalation techniques, reduction tools, trauma-informed care, and consulting with consumers and whānau.

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Section: Discussionmentioning

confidence: 99%

“…Training in de‐escalation techniques has been identified as one of a number of useful responses (Spencer & Johnson ). This includes verbal and nonverbal techniques to identify and prevent the escalation of aggressive behaviour (Spencer & Johnson ).…”

Section: Discussionmentioning

confidence: 99%

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Jury¹,

Lai²,

Tuason³

et al. 2018

Int J Mental Health Nurs

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“…Support for the use of de-escalation approaches in mental health settings is currently limited (Spencer & Johnson 2016), and even more so with children (Chun et al 2016). There might be benefits for the staff (e.g.…”

Section: De-escalation Approachmentioning

confidence: 99%

Children's moral experiences of crisis management in a child mental health setting

Montreuil

Thibeault

McHarg

et al. 2018

Int J Mental Health Nurs

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The experiences of children related to conflict and crisis management in child mental health settings, especially those aged 12 and below, have been rarely studied. This study examined the moral experiences of children related to conflict and crisis management and the related use of restraint and seclusion in a child mental health setting. A 5-month focused ethnography using a participatory hermeneutic framework was conducted in a day hospital programme for children with severe disruptive disorders within a mental health institute. Children considered restraints and seclusion could help them feel safe in certain instances, for example if another child was being aggressive towards them or in exceptional cases to prevent self-injury. However, their own experiences of being restrained were predominantly negative, especially if not knowing the reason for their use, which they then found unfair. Some of the children emphasized the punitive nature of the use of restraints and seclusion, and most children disagreed with these practices when used as a punishment. Children's perspectives also highlighted the limits of the use of a uniform de-escalation approach by the staff to manage crises. Children considered discussing with the staff and developing a relationship with them as more helpful in case of a crisis then the use of a de-escalation approach or coercive strategies.

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“…De-escalation technique: This technique is a strategy used by the health care providers to calm an angry patient or a way to prevent highly charged or highly aroused person to commit a dangerous act by supporting through talking, listening, and using a supportive way. There are some steps of the verbal de-escalation technique: assess the patient situation immediately and intervene by using a calm voice, use problem-solving technique, be empathetic with patient, calm and reassure the patient that no harm or hurt will come to him/her, and offering help to the patient and do not challenge and use argumentative stances [26].…”

Section: Identify Alternative Policiesmentioning

confidence: 99%

“…The second alternative training program has a high score of implementations compared with other alternatives but has a problem related to cost that may hamper applicability [25]. De-Escalation Technique Manage to reduce of seclusion usage and safe Not appropriate for the budget [26] Status Quo Save effort and time to establish new policy The problem still [10] Open Journal of Nursing…”

Section: Display and Distinguish Among Alternativesmentioning

confidence: 99%

Seclusion Room in Psychiatric Setting (National Center for Mental Health): Policy Analysis

Khalifeh¹,

Khalil²

2018

OJN

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Background: Improving the quality of care in psychiatric settings is the most important goal of policy through the delivery of a comprehensive care, treatment, control, protection, and rehabilitation of patients with mental disorders. The main concern in mental health care is the continuing use of seclusion and the slow pace of change. Purpose: Analyze the seclusion room policy in National Center for Mental Health (NCMH) in Jordan to recognize the issue and present alternative solutions in order to modify and improve the current seclusion room policy. Method: The authors got seclusion room policy from NCMH; the method in this analysis will be used six-step model; and then searched the database for alternatives using EBSCO, PUBMED, MEDLINE, CINAHL, and Ovid. Result: The authors discuss use medications, training program, manipulate environment, de-escalation technique, and status quo alternatives that helps in minimizing use of seclusion, decreasing the incidence of aggressive behaviors occurrences, and decreasing unsafe behaviors against health care providers in the psychiatric settings. Conclusion: Manipulates environment is the best alternative after evaluated alternatives according to criteria.

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De-escalation techniques for managing aggression

Cited by 12 publications

References 41 publications

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

People who experience seclusion in adult mental health inpatient services: An examination of health of the nation outcome scales scores

Children's moral experiences of crisis management in a child mental health setting

Seclusion Room in Psychiatric Setting (National Center for Mental Health): Policy Analysis

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