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Bennell C, Jenkins B, Blaskovits B, Semple T, Khanizadeh AJ, Brown AS, Jones NJ. Knowledge, Skills, and Abilities for Managing Potentially Volatile Police–Public Interactions: A Narrative Review. Front Psychol 2022; 13:818009. [PMID: 35330722 PMCID: PMC8940200 DOI: 10.3389/fpsyg.2022.818009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
We conducted a narrative review of existing literature to identify the knowledge, skills, and abilities (KSAs) necessary for officers who police in democratic societies to successfully manage potentially volatile police–public interactions. This review revealed 10 such KSAs that are frequently discussed in the literature. These KSAs include: (1) knowledge of policies and laws; (2) an understanding of mental health-related issues; (3) an ability to interact effectively with, and show respect for, individuals from diverse community groups; (4) awareness and management of stress effects; (5) communication skills; (6) decision-making and problem-solving skills; (7) perceptual skills; (8) motor skills related to use-of-force; (9) emotion and behavior regulation; and (10) an ability to treat people in a procedurally just manner. Following our review, we conducted semi-structured interviews (N = 7) with researchers who specialize in police training and adult education, interactions with individuals in crisis, and racialized policing, as well as two police trainers with expertise in de-escalation and use-of-force training. These interviews confirmed the importance of the 10 KSAs and highlighted two additional KSAs that are likely to be critical: understanding the role of policing in a free and democratic society and tactical knowledge and skills. To ensure that police–public interactions are managed effectively, police trainers may want to focus on the development and evaluation of these KSAs—something that is not always done currently.
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Hamm B, Pozuelo L, Brendel R. General Hospital Agitation Management Under the Lens of Leadership Theory and Health Care Team Best Practices Using TeamSTEPPS. J Acad Consult Liaison Psychiatry 2021; 63:213-224. [PMID: 34793998 DOI: 10.1016/j.jaclp.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 10/17/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute agitation management is an emergency clinical intervention, often presenting acute danger to patients and medical staff. Unlike many other emergency clinical interventions, acute agitation management lacks a substantial evidence base regarding leadership and teamwork best practices. The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) framework is a comprehensive strategy for improving health care outcomes in acute clinical situations. OBJECTIVE Practical application of TeamSTEPPS frameworks in team-based acute agitation management in the medical setting. METHODS A literature review was performed from January 1990 to March 2021 for verbal de-escalation in acute agitation management, leadership and teamwork in psychiatry and medicine, and TeamSTEPPS. RESULTS No literature was found that applied TeamSTEPPS for acute agitation management in the general medical unit context although limited application has been trialed in the inpatient psychiatric context. The verbal de-escalation literature describes applicable content including conflict management approaches, communication strategies, security presence management, modeling therapeutic behavior, and debriefing strategies. Several articles were found regarding a rapid response team model for acute agitation management and describing handoff tools in psychiatric care contexts. Translation of the TeamSTEPPS approach provided many additional approaches for operation of a rapid response team in acute agitation management. CONCLUSIONS The leadership and teamwork best practices in TeamSTEPPS provide a clear and actionable framework for team-based acute agitation management as an emergency clinical intervention.
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Affiliation(s)
- Brandon Hamm
- Department of Psychiatry & Behavioral Neuroscience, Northwestern University, Chicago, IL.
| | | | - Rebecca Brendel
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
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Maagerø-Bangstad ER, Sælør KT, Lillevik OG, Ness O. Exploring staff conceptions of prevention and management practices in encounters with staff-directed aggression in supported housing following education and training. Int J Ment Health Syst 2020; 14:60. [PMID: 32782470 PMCID: PMC7414712 DOI: 10.1186/s13033-020-00387-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background Staff-directed aggression is a concern for service providers in mental healthcare, frequently affecting both the quality of services and staff wellbeing. This also applies to supported housing services for people with mental health problems. Staff themselves consider training to be an important route to improve the prevention and management of staff-directed aggression. The aims of this study are to explore how staff in community mental health supported housing services conceptualize practice in prevention and management of aggression and how these conceptions develop following a local education and training endeavor in disempowerment-sensitive, de-escalating and knowledge-based risk assessment and management. Method Phenomenography, a qualitative research approach, was adopted to pursue the study aims. The data consisted of 26 semi-structured interviews with 13 participants from five different municipal housing facilities in Oslo, Norway. Participants were interviewed on two occasions, once prior to participation and once subsequent to the finalization of the education and training sessions. Results The analysis led to the development of six qualitatively different, yet logically interrelated, categories of description regarding practice in encounters with staff-directed aggression: (1) Observation, alertness and awareness, (2) Established understanding and knowledge of service users, (3) Team-based risk management and deliberation, (4) Adaption of own dispositions and behaviors, (5) Reflexivity, sensitivity and care and (6) Involvement and dialogue. These conceptions were found to vary in meaning and focus; they ranged from implementing safeguarding and protective measures, to drawing on what was portrayed in terms of staff’s expert knowledge, to increasingly allowing for, and committing to, tenant perspectives in designing practice. The results indicate a moderate, yet beneficial, effect of the course on conceptual change in the participants. Conclusion This study shows that practice in encounters with staff-directed aggression is conceptualized as complex and multifaceted by staff in mental health supported housing services and that the various conceptions have different implications for the way staff-directed aggression is mitigated individually and collectively. Our findings also suggest that it is beneficial to take conceptual variation regarding practice into consideration when devising education and training aimed at enhancing staff knowledge, skills and practices.
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Affiliation(s)
- Erlend R Maagerø-Bangstad
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Knut Tore Sælør
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway
| | - Ole Greger Lillevik
- Dept. of Health and Care Services, Faculty of Health Sciences, UiT The Arctic University of Norway, P.O. box 385, 8515 Narvik, Norway
| | - Ottar Ness
- Dept. of Health and Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Centre for Mental Health and Substance Abuse, P.O. box 7053, 3007 Drammen, Norway.,Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway
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Goodman H, Papastavrou Brooks C, Price O, Barley EA. Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study. Int J Ment Health Syst 2020; 14:59. [PMID: 32774452 PMCID: PMC7397665 DOI: 10.1186/s13033-020-00392-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.
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Affiliation(s)
- Helena Goodman
- Kate Granger Building, University of Surrey, Guildford, GU2 7YH UK
| | | | - Owen Price
- Jean McFarlane Building, University of Manchester, Manchester, M13 9PY UK
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Patel MX, Sethi FN, Barnes TR, Dix R, Dratcu L, Fox B, Garriga M, Haste JC, Kahl KG, Lingford-Hughes A, McAllister-Williams H, O'Brien A, Parker C, Paterson B, Paton C, Posporelis S, Taylor DM, Vieta E, Völlm B, Wilson-Jones C, Woods L. Joint BAP NAPICU evidence-based consensus guidelines for the clinical management of acute disturbance: De-escalation and rapid tranquillisation. J Psychopharmacol 2018; 32:601-640. [PMID: 29882463 DOI: 10.1177/0269881118776738] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The British Association for Psychopharmacology and the National Association of Psychiatric Intensive Care and Low Secure Units developed this joint evidence-based consensus guideline for the clinical management of acute disturbance. It includes recommendations for clinical practice and an algorithm to guide treatment by healthcare professionals with various options outlined according to their route of administration and category of evidence. Fundamental overarching principles are included and highlight the importance of treating the underlying disorder. There is a focus on three key interventions: de-escalation, pharmacological interventions pre-rapid tranquillisation and rapid tranquillisation (intramuscular and intravenous). Most of the evidence reviewed relates to emergency psychiatric care or acute psychiatric adult inpatient care, although we also sought evidence relevant to other common clinical settings including the general acute hospital and forensic psychiatry. We conclude that the variety of options available for the management of acute disturbance goes beyond the standard choices of lorazepam, haloperidol and promethazine and includes oral-inhaled loxapine, buccal midazolam, as well as a number of oral antipsychotics in addition to parenteral options of intramuscular aripiprazole, intramuscular droperidol and intramuscular olanzapine. Intravenous options, for settings where resuscitation equipment and trained staff are available to manage medical emergencies, are also included.
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Affiliation(s)
- Maxine X Patel
- 1 Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Faisil N Sethi
- 2 Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Thomas Re Barnes
- 3 The Centre for Psychiatry, Imperial College London, London, UK
| | - Roland Dix
- 4 Wotton Lawn Hospital, together NHS Foundation Trust, Gloucester, UK
| | - Luiz Dratcu
- 5 Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Bernard Fox
- 6 National Association of Psychiatric Intensive Care Units, East Kilbride, Glasgow, UK
| | - Marina Garriga
- 7 Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julie C Haste
- 8 Mill View Hospital, Sussex Partnership NHS Foundation Trust, Hove, East Sussex, UK
| | - Kai G Kahl
- 9 Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Anne Lingford-Hughes
- 10 The Centre for Psychiatry, Imperial College London, London, UK and Central North West London NHS Foundation Trust, London, UK
| | - Hamish McAllister-Williams
- 11 Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK.,12 Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Aileen O'Brien
- 13 South West London and St Georges NHS Foundation Trust, London, UK and St George's University of London, London, UK
| | - Caroline Parker
- 14 Central & North West London NHS Foundation Trust, London, UK
| | | | - Carol Paton
- 16 Oxleas NHS Foundation Trust, Dartford, UK
| | - Sotiris Posporelis
- 17 South London and Maudsley NHS Foundation Trust, London, UK and Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David M Taylor
- 18 South London and Maudsley NHS Foundation Trust, London, UK
| | - Eduard Vieta
- 7 Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Birgit Völlm
- 19 Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, UK
| | | | - Laura Woods
- 21 The Hellingly Centre, Forensic Health Care Services, Sussex Partnership NHS Foundation Trust, East Sussex, UK
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Abstract
Patients exhibiting challenging behaviour, which includes any non-verbal, verbal or physical behaviour, is a significant issue in healthcare settings. Preventing such behaviour and the harm it can cause is important for healthcare organisations and individuals, and involves following a public health model comprised of three tiers: primary, secondary and tertiary prevention. Primary prevention aims to reduce the risk of challenging behaviour occurring in the first instance; secondary prevention involves reducing the risk associated with imminent challenging behaviour and its potential escalation; and tertiary prevention focuses on minimising the physical and emotional harm caused by challenging behaviours, during and after an event. De-escalation should be the first-line response to challenging behaviour, and healthcare staff should use a range of techniques - maintaining safety, self-regulation, effective communication, and assessment and actions - to reduce the incidence of challenging behaviour. In some situations, physical interventions may be required to protect the safety of the individual, healthcare staff and other individuals involved, and healthcare staff should be aware of local policies and procedures for this. Following a serious incident, where there was potential or actual harm to patients and healthcare staff, healthcare organisations should use post-incident reviews to learn from the situation, while healthcare staff should be offered the opportunity for debriefing. Positive responses to challenging behaviour at an organisational and individual level can lead to improved work environments for healthcare staff and optimal patient care and outcomes.
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Affiliation(s)
- Nutmeg Hallett
- School of Nursing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, England
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Price O, Baker J, Bee P, Lovell K. The support-control continuum: An investigation of staff perspectives on factors influencing the success or failure of de-escalation techniques for the management of violence and aggression in mental health settings. Int J Nurs Stud 2018; 77:197-206. [DOI: 10.1016/j.ijnurstu.2017.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 10/04/2017] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
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Price O, Baker J, Bee P, Grundy A, Scott A, Butler D, Cree L, Lovell K. 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. J Adv Nurs 2017; 74:614-625. [PMID: 29082552 DOI: 10.1111/jan.13488] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Abstract
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 behaviour. 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/behaviour change targets for interventions seeking to reduce violence and restrictive practices through enhanced de-escalation techniques.
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Affiliation(s)
- Owen Price
- Mental Health Nursing, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - John Baker
- Mental Health Nursing, University of Leeds, Leeds, UK
| | - Penny Bee
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Andrew Grundy
- Mental Health Services Research, University of Nottingham, Nottingham, UK
| | - Anne Scott
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Debbie Butler
- Mental Health Services Research, University of Nottingham, Nottingham, UK
| | - Lindsey Cree
- Mental Health Services Research, University of Manchester, Manchester, UK
| | - Karina Lovell
- Mental Health Nursing, University of Manchester, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Hallett N, Dickens GL. De-escalation of aggressive behaviour in healthcare settings: Concept analysis. Int J Nurs Stud 2017; 75:10-20. [DOI: 10.1016/j.ijnurstu.2017.07.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/05/2017] [Accepted: 07/02/2017] [Indexed: 11/15/2022]
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Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices. Arch Psychiatr Nurs 2016; 30:499-507. [PMID: 27654228 DOI: 10.1016/j.apnu.2016.05.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/14/2016] [Accepted: 05/14/2016] [Indexed: 11/23/2022]
Abstract
This multiple case study explored de-escalation processes in threatening and violent situations based on patients and staff members perspectives. Our post hoc analysis indicated that de-escalation included responsive interactions influenced by the perspectives of both patients and staff members. We assembled their perspectives in a mental model consisting of three interdependent stages: (1) memories and hope, (2) safety and creativity and (3) reflective moments. The data indicated that both patients and staff strived for peaceful solutions and that a dynamic and sociological understanding of de-escalation can foster shared problem solving in violent and threatening situations.
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Mavandadi V, Bieling PJ, Madsen V. Effective ingredients of verbal de-escalation: validating an English modified version of the 'De-Escalating Aggressive Behaviour Scale'. J Psychiatr Ment Health Nurs 2016; 23:357-68. [PMID: 27271938 DOI: 10.1111/jpm.12310] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2016] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Verbal de-escalation is an intervention aimed at calmly managing an agitated client to prevent violence. Effective de-escalation can help reduce the use of seclusion and restraint in psychiatric settings. Despite its importance in practice, there is little agreement on the necessary techniques of de-escalation and most of the research on the topic is based on expert opinion. To our knowledge, only one attempt at quantifying de-escalation skill has been pursued through the German-language De-Escalating Aggressive Behaviour Scale (DABS). While the DABS identified seven qualities necessary for de-escalation, it has not been validated in English and may lack important descriptors. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The present study enhanced the original DABS with best, acceptable and least desirable staff de-escalation practice descriptions for each of the seven items. This enhancement of the DABS lead to the creation of the English modified DABS (EMDABS). The EMDABS was psychometrically validated for use in research and practice: raters could use the EMDABS with a high level of agreement and consistency. Also, the scale appeared to measure a single cohesive construct - de-escalation. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: With further validation, the EMDABS has potential to be the first English quantitative measure of de-escalation. The EMDABS offers seven items, with associated best practice descriptions, that may be used to inform de-escalation practice. The EMDABS can be used to evaluate training and education programmes and inform how these programmes and independent de-escalation practice may be improved. ABSTRACT Introduction Verbal de-escalation is crucial to a non-coercive psychiatric environment. Despite its importance, the literature on de-escalation is sparse and mostly qualitative. To address this, Nau et al. (2009) quantified de-escalation by creating the German-language De-Escalating Aggressive Behaviour Scale (DABS). The DABS provides seven skills necessary for de-escalation, however it has not been validated in English and lacks the necessary anchor descriptions to make it useful. Aim To modify the DABS to include descriptions of best, acceptable and least desirable staff practice and to validate the English modified DABS (EMDABS). Method To develop item descriptions for the EMDABS, 50 conflictual staff-patient interactions were reviewed, summarized and cross-referenced with the literature (n = 19). Three raters then used the EMDABS to evaluate 272 simulations depicting these interactions. Results The EMDABS demonstrated very good inter-rater reliability [ICC (3, 1) = 0.752] and strong internal consistency (α = 0.901). A factor analysis revealed that the seven items were best represented by a single factor. Discussion The EMDABS was validated for future use in research and practice. Additional validation and future research directions are discussed. Implications for practice The EMDABS holds promise as a quantitative measure of de-escalation. Its seven items and best practice guidelines have clinical implications for improving practice and training.
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Affiliation(s)
- V Mavandadi
- Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada
| | - P J Bieling
- St. Joseph's Healthcare, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neuroscience, McMaster University, Hamilton, ON, Canada
| | - V Madsen
- St. Joseph's Healthcare, Hamilton, ON, Canada
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Berring LL, Hummelvoll JK, Pedersen L, Buus N. A Co-operative Inquiry Into Generating, Describing, and Transforming Knowledge About De-escalation Practices in Mental Health Settings. Issues Ment Health Nurs 2016; 37:451-63. [PMID: 27070499 DOI: 10.3109/01612840.2016.1154628] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
De-escalation is concerned with managing violent behaviour without resorting to coercive measures. Co-operative Inquiry provided the conceptual basis for generating knowledge regarding de-escalation practices in acute mental health care settings. The research included service users and staff members as co-researchers and knowledge was generated in dynamic research cycles around an extended epistemology of knowing: experiential, presentational, propositional, and practical. Through this process, co-researchers became de-escalation learners, implementing de-escalation practices while transforming violence management. Neighbouring mental health communities' involvement strengthened the transformation process and assisted in validating the research results.
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Affiliation(s)
- Lene Lauge Berring
- a Psychiatric Research Unit, Region Zealand, Slagelse, Denmark; University of Southern Denmark , Department of Public Health , Odense , Denmark
| | | | - Liselotte Pedersen
- c Psychiatric Research Unit, Region Zealand, Slagelse, Denmark; University of Copenhagen , Department of Psychology , Copenhagen , Denmark
| | - Niels Buus
- d University of Sydney and St. Vincent Private Hospital Sydney, Faculty of Nursing , Sydney , Australia
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13
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Kleinberg I, Scior K. The impact of staff and service user gender on staff responses towards adults with intellectual disabilities who display aggressive behaviour. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2014; 58:110-124. [PMID: 23126336 DOI: 10.1111/j.1365-2788.2012.01640.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/07/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND The impact of staff and service user gender on responses of staff in intellectual disability (ID) services is poorly understood. The present study set out to assess the role of gender in influencing staff emotions, attributions and behavioural intentions in response to aggression displayed by adults with ID. METHOD A new scale measuring staff behavioural intentions was developed. A two × two (staff gender × service user gender) between subjects design was used to compare the responses of day and residential support staff to physical aggression by a hypothetical service user. In response to a vignette depicting a service user with ID assaulting a member of staff, 160 respondents completed measures of affective responses, causal attributions and behavioural intentions while imagining themselves as the target of the service user's assault. RESULTS Female participants reported feeling more fear/anxiety, more depression/anger and less confident/relaxed than male participants. The longer staff had worked with people with ID, the more likely they were to favour safety-focused behaviours. More confident female participants were less likely to favour safety-focused behaviours, but confidence had no effect on male participants' endorsement of these behaviours. Increased confidence in both was associated with lower agreement of safety-focused behaviours in relation to the female vignette, regardless of participant gender. The more control women believed the service user had over their behaviour, the more likely they were to choose safety-focused behaviours. Punitive behaviours were favoured more in response to the male rather than the female service user. Punitive behaviours were also favoured more by more junior staff and by participants who expected feeling more depressed/angry in response to the vignettes. CONCLUSIONS Both staff and service user gender influenced staff responses to aggression, yet the latter played a smaller role than expected. The role of gender in staff-service user interactions should be the focus of further research and should be considered in service delivery.
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Affiliation(s)
- I Kleinberg
- Hammersmith & Fulham Learning Disability Service, Central London Community Healthcare Trust, London, UK
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Hare DJ, Durand M, Hendy S, Wittkowski A. Thinking about challenging behavior: a repertory grid study of inpatient staff beliefs. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 50:468-478. [PMID: 23256689 DOI: 10.1352/1934-9556-50.06.468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Studies examining staff attitudes toward people with intellectual disability have traditionally used pre-determined categories and models or been open to researcher bias. The use of methods derived from personal construct psychology permits an objective investigation of staff views and attitudes without such limitations. Fourteen staff from an inpatient intellectual disability service were interviewed about their perceptions of clients with challenging behavior primarily using the repertory grid technique as developed from personal construct theory. Staff was found to construe their clients and their behaviors in a heterogeneous manner that was not readily reducible to a group average, and they did not make or use attributions about them in a consistent manner. Future research should incorporate work culture and the staff-client relationship. The results have implications for clinical decision making, team working, and clinical supervision.
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Affiliation(s)
- Dougal Julian Hare
- University of Manchester, School of Psychological Sciences, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom.
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Abstract
De-escalation techniques are a highly recommended set of therapeutic interventions that are frequently used to prevent violence and aggression within mental health services. A thematic synthesis literature review identified 11 international papers. Seven themes emerged from the data synthesis. The first three related broadly to staff skills, including: characteristics of effective de-escalators, maintaining personal control, and verbal and non-verbal skills. The last four relate to the process of intervening and include: engaging with the patient, when to intervene, ensuring safe conditions for de-escalation, and strategies for de-escalation (including two sub-themes, autonomy confirming interventions, and limit-setting and authoritative interventions). De-escalation techniques are an example of a complex intervention, which has been overlooked by rigorous research, and it is often assumed that staff are able to perform these techniques in clinical practice.
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Affiliation(s)
- Owen Price
- School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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