"But I did not touch nobody!"-Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards-A qualitative study.
Jentien M Vermeulen, Paul Doedens, Lindy-Lou N J Boyette and 3 others
PMID 31222795WHAT IT FOUND
Patients and nurses described similar facts after psychiatric ward aggression, but patients saw incidents as less severe and gave personal de-escalation ideas, while nurses focused on medication timing and ward facilities.
Key findings
01Patients and nurses gave similar factual accounts of incidents, but patients generally perceived the aggression as less severe than nurses did.
02Patients gave recommendations for their own care, including humane treatment, personalized calming activities, and involvement in coercive decisions; nurses gave recommendations about medication, timing, and ward facilities.
03Despite severe psychiatric symptoms, patients often remembered the incident in detail, sometimes more than the involved nurse.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Single centre, so ward routines, staffing, and local practices may not match other psychiatric units. Convenience sample with under-reporting of aggressive incidents; nurses probably reported more severe incidents, and 7 eligible patients declined. Most incidents were severe, with 12 of 15 patients secluded, so minor incidents were not represented. Interviews were mostly within 3 days, but 2 interviews were 9 and 13 days after the incident. All patients were admitted during interviews, which may have increased social desirability in their answers. Preparation for a high intensive care unit model may have influenced nurses' recommendations about facilities. Recommendations were not returned to participants for verification, and field notes were not used. Dutch quotes were translated literally, which can make wording awkward and may affect nuance.
Declared interests
The authors declared no conflict of interest.
The easy way to misread this
Do not read these recommendations as proven ways to reduce aggression or coercion. This was a qualitative study of 15 patients and 13 nurses at a single centre, and it did not test whether debriefing, earlier medication, or patient suggestions prevent incidents.