Positive Effects of an Anti-Aggression and De-Escalation Training on Ward Atmosphere and Subjective Safety May Depend on Previous Training Experience

Fröhlich, Daniela; Rabenschlag, Franziska; Schoppmann, Susanne; Borgwardt, Stefan; Lang, Undine E.; Huber, Christian G.

doi:10.3389/fpsyt.2018.00134

Cited by 15 publications

(17 citation statements)

References 14 publications

(23 reference statements)

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“…High fidelity was measured in an Australian study that found seclusion rates to be reduced by 36% after the Safewards implementation in psychiatric inpatient units (33). Further empirical evidence for reducing conflict and containment in psychiatry was found regarding several multi-perspective conflict-reduction interventions focusing on leadership, staff, and patient level (18, 37, 38). Richter and Needham (18), e.g., showed that participating in de-escalation and aggression management staff training can lead to better knowledge and a more precise documentation of conflicts and containment.…”

Section: Introductionmentioning

confidence: 99%

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

et al. 2019

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Introduction Aggression and violence are highly complex problems in acute psychiatry that often lead to the coercive interventions. The Safewards Model is an evidence-informed conflict-reduction strategy to prevent and reduce such incidents. The aim of this study was to evaluate the implementation of this model with regard to coercive interventions in inpatient care. Materials and Methods We evaluated outcomes of the implementation of the Safewards Model in two locked psychiatric wards in Germany. Frequency and duration of coercive interventions applied during a period of 11 weeks before and 11 weeks after the implementation period were assessed through routine data. Fidelity to the Safewards Model was assessed by the Organization Fidelity Checklist. Results Fidelity to the Safewards Model was high in both wards. The overall use of coercive measures differed significantly between wards [case-wise: χ 2 (1, n = 250) = 35.34, p ≤ 0.001; patient-wise: χ 2 (1, n = 103) = 21.45, p ≤ 0.001] and decreased post-implementation. In one ward, the number of patients exposed to coercive interventions in relation to the overall number of Patients decreased significantly [χ 2 (1, 281) = 6.40, p = 0.01]. Furthermore, the mean duration of coercive interventions overall declined significantly [ U (55,21) = −2.142, p = 0.032] with an effect size of Cohen’s d = −0.282 (95% CI: −0.787, 0.222) in that ward. Both aspects declined as well in the other ward, but not significantly. Discussion Results indicate that the implementation of the Safewards interventions according to the model in acute psychiatric care can reduce coercive measures. They also show the role of enabling factors as well as of obstacles for the implementation process.

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Section: Introductionmentioning

confidence: 99%

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

et al. 2019

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“…Open-door policies have been associated with an improved ward atmosphere (7,(35)(36)(37). Patients and HCP in our study reported improved well-being and improved establishment of therapeutic relationships due to decreasing control functions after opening the ward.…”

Section: Category Quotesmentioning

confidence: 57%

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

et al. 2020

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Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.

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“…Another study also found that nurses receiving DE training possessed greater self-perceived confidence than those without, demonstrating that this form of preparation effectively enhanced nurses' performances by strengthening their confidence levels in dealing with WPV [41]. In addition, Fröhlich et al, [42] highlighted DE training's role in helping to cultivate a harmonious atmosphere within psychiatric wards by improving patients' coherence and subjective safety. Most importantly, the application of DE techniques decreases the use of coercive strategies.…”

Section: Introductionmentioning

confidence: 97%

Evaluating the effectiveness of a CRSCE-based de-escalation training program among psychiatric nurses: a study protocol for a cluster randomized controlled trial

Xiao

Wang

et al. 2020

BMC Health Serv Res

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Background: The high incidence of workplace violence (WPV) in clinical mental health settings has caused a series of negative impacts on nurses, which has subsequently increased public concern. De-escalation (DE) is recommended as a training program which aims at providing nurses with skills and strategies to more effectively respond and manage WPV. Very few studies have examined the effectiveness of DE training, with current studies possessing various limitations due to their design and small sample sizes. By using a cluster randomized controlled design, the proposed study aims to evaluate the effectiveness of a CRCSE-based DE training programs among psychiatric nurses. Method: A cluster randomized controlled trial, with a 6-month follow-up period after the end of the intervention, will be conducted among psychiatric hospitals in Guangdong, China. The randomization unit is each involved psychiatric hospital. Participants in the control group will be assigned to routine WPV management training, participants of the intervention group will undergo the same training while additionally receiving DE training. The DE training will include the following five modules: communication, response, solution, care, and environment (CRSCE). Primary outcomes are objective clinical indicators, which will be extracted from the information systems of the enrolled hospitals. These include the incidence of WPV, injuries caused by WPV, and the use of coercion (physical restraint and seclusion) by nurses. Secondary outcomes, aims at evaluating the effects of DE training on nurses, include the capacity of DE, DE confidence, level of job burnout, and professional quality of life. Data will be collected at baseline (T 0), at 3 months (T 1 , intervention completed), and at 6 months after intervention (T 2 , follow-up).

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Positive Effects of an Anti-Aggression and De-Escalation Training on Ward Atmosphere and Subjective Safety May Depend on Previous Training Experience

Cited by 15 publications

References 14 publications

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

Preventing and Reducing Coercive Measures—An Evaluation of the Implementation of the Safewards Model in Two Locked Wards in Germany

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

Evaluating the effectiveness of a CRSCE-based de-escalation training program among psychiatric nurses: a study protocol for a cluster randomized controlled trial

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