Citation

Baba K. J. Jpn. Acad. Psychiatric Mental Health Nurs. 2007; 16(1): 12-22.

Copyright

(Copyright © 2007, Japan Academy of Psychiatric and Mental Health Nursing)

DOI

unavailable

PMID

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Abstract

The purpose of this study was to examine clinical judgment of psychiatric nurses by analyzing the process of how nurses perceived risks of violence from inpatients in psychiatric acute ward. Semi-structured interviews were conducted with nine nurses who had psychiatric acute ward experiences for more than five years, and data was analyzed qualitatively. Participant observation was performed in wards, too. Results were as follows four types of situations in terms of their characteristics: (1) Situation succeeding in preventing violence even though it almost happened, (2) Situation where violence broke out in the presence of nurses, (3) Situation succeeding in putting down violence after it happened, and (4) Situation where violence increased after it happened. When nurses perceived risks of violence, they grasped "patient's situation by observation" and made "comparison between situation by observation and patient's situation so far." They also used clues such as "relationship between the nurse and the patient before the situation," "experiences and ideas of the nurse," "existence of other patients," and "medical care system." As a characteristic of clinical judgment, nurses made a choice using clues they gathered and putting priority on patient's safety, nurse's safety and safety of the other patients. On the other hand, what relationship nurses had with patients before the situation had influence on "judgment" and "evaluation" of their response. It is required for each nurse to have the ability to judge the situation by taking safety of patient and nurse into consideration considering possibilities that nurses themselves or patients get violence to prevent and minimize violence.