Patient perspectives on barriers and enablers to the use and effectiveness of de‐escalation techniques for the management of violence and aggression in mental health settings

Abstract

This study investigated patient perspectives on staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. Our framework of barriers and enablers provides indicators of organizational/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques.

Violence and aggression in psychiatric inpatient care in Sweden: a critical incident technique analysis of staff descriptions

“…However, education can provide staff with the knowledge and confidence to manage aggression [47]. With de-escalation, the incident can also be viewed as a shared problem to be solved together with patients, thereby creating trust and safety [34,50]. Training in the management of violence should be supported at an organisational level [49] to foster a culture of change towards a strength-based perspective and a more person-centred process of care [50,51].…”

“…In the same category were CI descriptions of four cases of sexual harassment, and situations where patients took hostages to get medicine or to get their own way in Serious assault (50) Anxious/aggressive/disruptive patient (38) Death threats, including against family (34) Threats with/possession of any object/weapon (32) Sexual harassment (4) Taking hostages 3Threats/violence against co-patients/relatives (21) Violent acts towards others than staff Self-harm/suicide attempt (15) Staff aggression/violence 3Active defence/intervention (70) Ways the staff responded Ways in which staff dealt with aggressive situations and the eventual outcome Alarm/call for help (56) Call for police/fire brigade (31) Passive defence/de-escalation (30) Patient discharged from the ward 1Mechanical restraint 69Ways in which the incident ended Delimiting/supervising (46) Calming down of patient/ebbing of situation (42) Removal from the ward (35) Enforced medication (31) Anaesthetising/rapid tranquillisation of the patient (5)…”

Psychiatric nursing staffs’ attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review

“…Restrictive practices continue to be used frequently to manage aggressive psychiatric patients (Price et al . ), even though it is known that they can have harmful physical and psychological effects on both the patient and the staff (Sailas & Wahlbeck ) and the universal perception has become increasingly unfavourable (Keski‐Valkama et al . ; Shorter ).…”

“…The violent behaviour of psychiatric patients during hospitalization is an ubiquitous challenge for psychiatric nurses (Steinert & Lepping 2009), and coercion is one common method for managing such behaviour (Laiho et al 2014). Restrictive practices continue to be used frequently to manage aggressive psychiatric patients (Price et al 2017), even though it is known that they can have harmful physical and psychological effects on both the patient and the staff (Sailas & Wahlbeck 2005) and the universal perception has become increasingly unfavourable (Keski-Valkama et al 2007;Shorter 2007).…”

Psychiatric nursing managers' attitudes towards containment methods in psychiatric inpatient care

“…Coercion is applied regularly to manage confrontational and disturbed patients in psychiatric care (Price et al, 2017) despite its potentially harmful effects (McLaughlin, Giacco, & Priebe, 2016). Coercive measures can result in adverse treatment outcomes (Gerolamo, 2006), and the reduction of the use of these measures has been an international and national goal for many years (Gooding, McSherry, Roper, & Grey, 2018).…”