Difficulties in providing nursing care to children with neurodevelopmental disorders admitted to child and adolescent psychiatric units for aggressive behavior.
Yuka Kato, Tae Kawahara, Yoshimi Endo and 1 others
PMID 39989006WHAT IT FOUND
Nurses in child psychiatric wards struggle to manage aggression in children with neurodevelopmental disorders due to distrust, inconsistent staff responses, and lack of training.
They rely on trial and error because evidence-based protocols for de-escalation and reflection are missing.
Key findings
01Nurses find it difficult to build therapeutic relationships because children with neurodevelopmental disorders often distrust adults due to past traumatic experiences, and nurses are sometimes perceived as substitute parents.
02Inconsistent responses from different staff members to aggressive behavior confuse children and hinder behavior modification, as children react differently depending on which nurse is present.
03Nurses lack specific training and clear manuals for interventions like 'reflecting on aggressive behavior' and de-escalation, leading to reliance on trial and error and increased emotional burden.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study interviewed only 21 nurses from five hospitals in Japan, which may limit generalizability to other cultural or healthcare contexts. The participants were nurses, not patients or families, so the findings reflect staff perceptions and challenges rather than patient outcomes or experiences. The study describes difficulties but does not test whether specific interventions solve these problems.
Declared interests
The authors declared no conflicts of interest. The study was funded by the Japan Health Research Promotion Bureau.
The easy way to misread this
Do not interpret this as evidence that the described nursing practices are effective. The study reports nurses' difficulties and perceptions of barriers, not outcomes of care. It does not prove that any specific intervention reduces aggression.