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Citation
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Price O, Baker J, Bee P, Grundy A, Scott A, Butler D, Cree L, Lovell K. J. Adv. Nurs. 2018; 74(3): 614-625. |
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Abstract
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AIM: Investigate patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for aggression in mental health settings.
BACKGROUND: De-escalation techniques are the recommended first-line intervention for the management of aggression in mental health settings internationally, yet use of higher-risk restrictive practices persists. This indicates de-escalation techniques are not used at optimum frequency and/or there are important factors limiting their use and effect.
DESIGN: Descriptive qualitative research using semi-structured interviews and Framework Analysis.
METHODS: Inpatient interviews (N=26) exploring staff, patient and environmental factors influencing the use and effectiveness of staff de-escalation were conducted mid-2014. Three service user researchers led analysis.
RESULTS: Data were synthesized in three deductive themes relating to staff, patient and environmental influences on the use and effectiveness of de-escalation techniques. The dominant view was that restrictive practices, rather than de-escalation techniques, are used in response to escalating patient behavior. Under-use of de-escalation techniques was attributed to: lack of staff reflection on culture and practice and a need to retain control/dominance over patients. Ward rules, patient factors and a lack of staff respect for patients diluted their effectiveness. Participants' identified a systematic process of de-escalation, rule subversion, reduced social distance and staff authenticity as enablers of effective de-escalation.
CONCLUSION: 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/behavior change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Language: en |