Managing aggression in a psychiatric hospital using a behaviour plan: a case study

Abstract

This paper focuses on the critical role of nursing in implementing a behaviour plan in a psychiatric hospital. The plan was implemented with a 40-year-old man with a long history of aggression towards others and self. The study used a single-subject research design with baseline and intervention phases (AB Design). Data were collected on (1) frequency of incidents of aggression towards others and self; (2) use of restrictive interventions to manage aggression (i.e. restraints, pro re nata medication, 1:1 special observation); and (3) frequency of staff injury. The data show a decrease in frequency of aggression towards others and self, a concurrent reduction in the use of restrictive interventions to manage aggression, and a decrease in incidents of staff injury. The behaviour plan helped staff maintain a safe and therapeutic milieu. The behaviour plan has given the patient an opportunity to learn positive replacement behaviours and skills, and the opportunity eventually to leave the hospital to live in a less restrictive community home.

Nursing phenomena in inpatient psychiatry

“…• Aggression towards self: 'Behaviours that directly cause, or attempt to cause, physical harm to self including hitting self with open hand or closed fist, banging head against wall or other hard object' (Bisconer et al 2006) • Self-harm behaviours: 'Self-injury, self-mutilation and deliberate self-harm refer to self-destructive behaviours without the intent to die, and are frequently associated with the method of cutting or burning' (Santa Mina et al 2006) Indicative terms (13) Aggression towards self; risk of harm to self; risk to injure themselves; self-injure, self-mutilation and deliberate self-harm; wanting to tear her hair off; carving herself up with a razor blade; re-opened an old self-inflicted laceration; self-harm incident; repeatedly harming themselves; self-injurious behaviours; self-harm; self-harm behaviours;…”

Systematic review of interventions to improve constant observation on adult inpatient psychiatric wards

“…Larger interventions were also reviewed, providing that they included attempts to improve or reduce constant observation. These interventions also attempted to reduce violence and aggression (Bisconer, ; Sullivan et al ., ), reduce all harmful incidents on the ward (Bowers et al ., , , ; James et al ., ) or reduce other forms of restrictive practice (Bowers et al ., , ; James et al ., ; Sullivan et al ., ).…”

“…Studies used many different strategies to develop interventions. Most studies gathered information directly from clinical wards by speaking with staff or patients (Bisconer, ; Bowers et al ., , ; Carr, ; Dennis, ; Sullivan et al ., ; Triplett et al ., ), observing the practice (Bowers et al ., , ) or reviewing ward data (Carr, ; Dennis, ). Other studies also looked at existing research to develop their intervention (Bowers et al ., , , ; Carr, ; Dodds & Bowles ; James et al ., ; Ray, Perkins & Meijer, ; Ray et al ., ).…”

“…Interventions were delivered by training members of staff (Bisconer, ; Bowers et al ., ; Dennis, ; James et al ., ; Kettles & Paterson, ; Reynolds et al ., ), meeting clinical teams (Moran, ) and getting approval by senior clinical staff (Ray, Perkins & Meijer, ; Ray et al ., ). The remaining studies either did not describe how interventions were delivered (Bowers et al ., , ; Carr, ; Sullivan et al ., ; Triplett et al ., ) or described a change that was already taking place at the time of the study (Jenkins, Dye & Foy, ).…”

Being flexible and tuning in: professional caregivers' reflections on management of violent behaviour in nursing homes

“…Previous studies have focused mainly on the management of threats and violent behaviour in psychiatric care (Carlsson et al ., ; Bisconer et al ., ; Daffern et al ., ; McDonnell et al ., ). Studies that focus on the approaches caregivers in nursing homes resort to and how they manage everyday care situations involving threats and violent situations are relatively few.…”