Staff's Choice of Formal And Informal Coercive Interventions In Psychiatric Emergencies

Abstract

When facing aggressive, violent, and self-harming patients, staff in psychiatric hospitals have to balance the need for patient and staff safety against the need to provide humane care and efficient treatment. In the present study, simulated case histories were used to examine which types of formal and informal interventions staff at a Norwegian psychiatric hospital prefer when caring for patients that are violent or self-harming. Continuous attention and evaluation of the use of the interventions subjected to formal control procedures (i.e. restraint and seclusion), as well as of a range of other interventions in use, represents an important means for securing improved care for violent and self-harming patients. The interventions available in such emergencies range from talking to patients to giving patients “time out” and using restraint and seclusion. Results demonstrated that staff chose the least restrictive interventions, and that restraint and seclusion were reserved for those situations where patients are actually violent and dangerous. The maximum restrictive interventions represent only a few of the interventions available to staff facing patients that behave dangerously. Increasing focus on other interventions than restraint and seclusion may help staff in choosing less restrictive interventions when this is clinically warranted and safe.