The Practices of Expert Psychiatric Nurses: Accompanying the Patient to a Calmer Personal Space

Abstract

The focus of the care of potentially aggressive psychiatric patients has been on the use of seclusion and restraints. Recent concerns, however, about the potential for patient injury have made it imperative that nurses use alternative methods to calm patients who are escalating. Little is known about how expert nurses de-escalate the escalating patient. The purpose of this interpretive phenomenological study was to uncover and describe the knowledge embedded in the stories of psychiatric nurses who are skilled in the practices of de-escalating an escalating patient. Twenty registered nurses were interviewed using an unstructured format. The analysis of the data revealed that these nurses were skilled at noticing the patient, reading the situation and the patient, knowing where the patient was on the continuum, understanding the meaning of the behavior, knowing what the patient needed, connecting with the patient, and matching the intervention with the patient's needs.

How clinicians make (or avoid) moral judgments of patients: implications of the evidence for relationships and research

“…Recent empirical studies have focused on clinicians chosen for expertise in de-escalating aggressive psychiatric patients [109], in role-modeling humanistic bedside behavior [110], and in discussing advance directives [111]. Expertise may be largely tacit [112] and embodied in habits that operate automatically without conscious intention [113].…”

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

“…A recent concept analysis defined de‐escalation as follows: “a range of interwoven staff‐delivered components comprising communication, self‐regulation, assessment, actions and safety maintenance, which aim to extinguish or reduce aggression/agitation irrespective of its cause and improve staff‐patient relationships while eliminating or minimising coercion or restriction” (p16) (Hallett & Dickens, ). Qualitative evidence syntheses on de‐escalation (Bowers, ; Price & Baker, ) indicate the key components involve manipulating environmental conditions to optimize communication and safety (Berring, Hummelvoll, Pederson, & Buus, ; Berring, Pedersen, & Buus, ), removing uninvolved patients/unrequired staff (Johnson & Hauser, ), removing objects with utility as weapons and ensuring clear exit routes (Duperouzel, ). Attempts should be made to clarify then resolve the problem causing the aggression (Berring, Hummelvoll, et al., ; Berring, Pedersen, et al., ; Cowin et al., ; Duperouzel, ; Johnson & Delaney, ).…”

Aggression management in a children's hospital setting

“…Recently, a number of writers have argued that the use of restraints and seclusion to manage verbal and physical threats has a negative impact on patient behaviour by reinforcing victimisation and eroding caregiver trust. Other writers view restraint as a failure of preventative or therapeutic measures Notwithstanding these assertions, much of the literature that addresses the issue of restraint stresses the need for its reduction, due to its high connection with harm and its short-lived effects as an intervention (Johnson and Hauser 2001). Fisher (1994) argues that while seclusion and restraint are used with the aim of preventing injury and limiting agitation, these techniques pose deleterious physical and psychological effects for both patients and staff.…”