Attitude of psychiatric nurses to de-escalation as a strategy for management of psychiatric patient aggression in a Nigerian psychiatric hospital.

Abstract

Aim The aim of this study was to present an intervention and describe the response of psychiatric hospital-based South West Nigerian mental health nurses. Methods A content analysis qualitative approach, using audio recordings of pre- and post- intervention focus group discussions was adopted. The intervention -one oral and visual de-escalation presentation - bisected the focus group discussions. The objective for the pre-intervention focus group: to describe participants’ current experiences and practices towards verbal aggression and violence management in order to inform relevant application of information within the intervention. The objective of the post-intervention focus group discussion: to describe participants’ responses to the intervention. Purposive sampling, comprised of nurses at unit or ward manager level, yielded eight participants. Results Participants felt betrayed by all role players within the mental health care service system, were disappointed that de-escalation was considered the evidence-based practice, and hopeless about its introduction. Participants’ fears for their safety are suggested to have informed a more militant approach to the management of aggression to strengthen nurses’ control over patients’ physical and emotional welfare, as well as their own. Review of Nigerian mental health legislation to set the context for human rights of both nurses and mental health patients is recommended. A need exists for further research utilizing a participatory action research approach that addresses ‘on the spot’ management of verbal aggression and includes trauma counselling and support for nurses.