Aggressive behaviour and seclusion on closed psychiatric wards
AIM: To improve knowledge on the influence of nursing staff and other risk factors concerning the use of seclusion and incidence of aggressive behaviour on closed psychiatric wards.
METHOD: We used several research methods: 1) a systematic review; 2) a two-year observational study on a closed psychiatric ward; 3) a grounded theory study with patients and nurses; and 4) a statistical simulation study.
FINDINGS: Patients and nurses share mutual understanding about the facts of the patient’s aggression, but not on the perceived severity. Nurses view seclusion as a necessary intervention to deal with dangerous situations. Teams with a majority of female nurses were associated with more seclusion and aggressive behaviour. High team scores on personality traits specifically openness, extraversion and neuroticism were associated with, respectively, less seclusion, more verbal aggression and more physical aggression.
DISCUSSION: Due to data collection on a single ward, generalisability of study findings might be limited. We measured the influence of nurses on shift team level and ignored the influence of individual nurses.
CONCLUSION: Personal contact between patients and nurses is important to prevent aggression and seclusion. Although no golden solution, increased attention to development of nursing skills seems an essential next step for clinical practice.
Keywords Aggression, seclusion, psychiatry, nursing, personality