Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices

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.

Newly qualified nurses' perceptions of working at mental health facilities: A qualitative study

“…Recovery‐focused care is directed towards patients' needs and strengths and requires nurses to be sensitive to the reasons for and triggers of challenging behaviour (Lim, Wynaden, & Heslop, ). De‐escalation focuses on creating a safe and calm environment, and reflection‐on‐action to achieve learning for future challenges (Berring, Pedersen, & Buus, ).…”

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, ).…”

“…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, ). Empathy and respect should be conveyed (Carlsson, Dahlberg, & Drew, ; Delaney & Johnson, ) and negative emotional responses inhibited (Lowe, ; Virkki, ).…”

“…Attempts should be made to clarify then resolve the problem causing the aggression (Berring, Hummelvoll, et al, 2016;Berring, Pedersen, et al, 2016;Cowin et al, 2003;Duperouzel, 2008;Johnson & Delaney, 2007). Empathy and respect should be conveyed (Carlsson, Dahlberg, & Drew, 2000;Delaney & Johnson, 2006) and negative emotional responses inhibited (Lowe, 1992;Virkki, 2002).…”

Consumer recommendations for enhancing the Safewards model and interventions

“…The ‘talk down’ intervention is a process of de‐escalation, which is implemented when someone may harm themselves or someone else and talking to the person could help calm them down (Berring et al . ). Arguably, this intervention delegitimizes a person's experience and acts to minimize their genuine emotional expression.…”