Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions
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RESEARCH ARTICLE
Open Access
Recognition and management of agitation in acute mental health services: a qualitative evaluation of staff perceptions Joshua Tucker1, Lisa Whitehead2* , Peter Palamara2, Josephine Xenia Rosman2 and Karla Seaman2
Abstract Background: Agitation among patients is a common and distressing behaviour across a variety of health care settings, particularly inpatient mental health. Unless recognised early and effectively managed it can lead to aggression and personal injury. The aim of this paper is to explore the experiences of mental health nurses in recognising and managing agitation in an inpatient mental health setting and the alignment of these experiences with best practice and person-centred care. Methods: This study used a descriptive qualitative methodology. Semi-structured focus group interviews were conducted with 20 nurses working in a mental health unit in 2018. Nursing staff described their experiences of assessing and managing agitation. Descriptive and Thematic Analysis were undertaken of the transcribed focus group dialogue. Results: Nurses combined their clinical knowledge, assessment protocols and training with information from patients to make an individualised assessment of agitation. Nurses also adopted an individualised approach to management by engaging patients in decisions about their care. In keeping with best practice recommendations, de-escalation strategies were the first choice option for management, though nurses also described using both coercive restraint and medication under certain circumstances. From the perspective of patient-centred care, the care provided aligned with elements of person-centred care nursing care. Conclusion: The findings suggest that clinical mental health nurses assess and manage agitation, with certain exceptions, in line with best practice and a person-centred care nursing framework. Keywords: Agitation, Assessment, Management, Mental health, Nurses, person-centred care, Qualitative research
Background Agitation among patients is a frequently cited behavioural problem across a variety of health settings [1]. While it is considered to be distinctly different to aggression [2], without timely assessment and management it can quickly escalate to a loss of personal control, aggression and violence [1] and result in injury to patients and * Correspondence: [email protected] 2 Centre for Nursing, Midwifery and Health Services Research, School of Nursing and Midwifery, Edith Cowan University, Building 21, Level 4, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia Full list of author information is available at the end of the article
staff [3, 4]. Agitation can also lead to increased periods of hospitalisation [5] and episodes of readmission [6] resulting in increased health care costs [5, 7]. There is limited epidemiologic evidence on the prevalence of agitation in mental health settings. Estimates range between a high of 47.5% among newly hospitalised adults with schizophrenia in China [8] to a low of 4.6% among ps
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