@article{ref1,
title="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",
journal="Journal of Advanced Nursing",
year="2018",
author="Price, Owen and Baker, John and Bee, Penny and Grundy, Andrew and Scott, Anne and Butler, Debbie and Cree, Lindsey and Lovell, Karina",
volume="74",
number="3",
pages="614-625",
abstract="AIM: Investigate patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques for aggression in mental health settings. <br><br>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. <br><br>DESIGN: Descriptive qualitative research using semi-structured interviews and Framework Analysis. <br><br>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. <br><br>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. <br><br>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.<br><br>This article is protected by copyright. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0309-2402",
doi="10.1111/jan.13488",
url="http://dx.doi.org/10.1111/jan.13488"
}