In order to establish a safe environment by avoiding violence and coercive measures, a psychiatri... more In order to establish a safe environment by avoiding violence and coercive measures, a psychiatric hospital in Denmark employed de-escalation. However, it was not possible to reduce these critical incidents, therefore this study aimed to explore how and in which way organisational procedures influenced the process. Focused ethnography was used to uncover how staff was enacting de-escalation in three units. Brown and Clarke's methodology for a thematic analysis was followed, and Kurt Lewin's three-step model of change-Unfreeze, Change and Re-freeze-was adopted in the analysis. The analysis revealed three themes: old wine in new bottles; de-escalation favours the aggressive patient; organizational barriers. The results demonstrated how resistance to change was imbedded in the working culture, which could then lead to a state of no change. This insight is not new, but calls for a whole organizational approach that addresses the root causes that lead to violence and the use of coercive measures.
Bladet udkommer kun elektronisk Artikler til bladet Alle artikler skal skrives i word format, skr... more Bladet udkommer kun elektronisk Artikler til bladet Alle artikler skal skrives i word format, skrifttype Times New Roman, størrelse 12. Artiklen må fylde max fire A4 sider. Der skal vedhaeftes billede (som jpg-fil, ikke indsat i word) af forfatteren til artiklen.
International Journal of Environmental Research and Public Health, Jun 9, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Development of a model for shared care between general practice and mental healthcare: a protocol... more Development of a model for shared care between general practice and mental healthcare: a protocol for a co-production study. BMJ Open 2022;12:e061575.
This paper briefly presents a PhD project about de-escalation in clinical psychiatry in Region Ze... more This paper briefly presents a PhD project about de-escalation in clinical psychiatry in Region Zealand, Denmark. 2012-2015. The study investigates whether coercive measures and violence can be reduced in psychiatric wards when staff uses a deescalating approach, as the patient's behaviour is escalating. The study is based on action research principles and the objective is to identify, characterize and test deescalating methods that can "... redirect a patient towards a calmer personal space ..." (National Institute for Clinical Excellence, 2005). Successful de-escalation might prevent violence, and if a patient experiences rapid assistance, the use of coercive measures might be reduced. De-escalation is the collective term for a range of psychosocial interventions to reduce stress and anxiety in escalated and violent situations. De-escalation is a complex, interactive process, which guides the patient toward a calmer personal space (ibid: 24-25), through the use of specific communicative techniques and psychosocial interventions and by a staff focus on having control of the situation and not the patient. De-escalation in a psychiatric context is a relatively new phenomenon in Denmark. Denmark has no official professional guidance on handling violence, as the National Health Service in GB (NICE guideline for the management of disturbed / violent behaviour in psychiatry (ibid)). This NICE guideline recommends de-escalation as a preventive intervention. NICE identifies various theoretical approaches to de-escalation and points out that these are not substantiated scientifically and can be contradictory (ibid: 24-25). According to NICE it is not known whether de-escalation affects the use of coercion. Following, nurses must act on intuition in clinical situations, without evidence of efficacy. NICE recommends further research in order to examine whether de-escalation techniques minimise the use of coercive measures.
In order to establish a safe environment by avoiding violence and coercive measures, a psychiatri... more In order to establish a safe environment by avoiding violence and coercive measures, a psychiatric hospital in Denmark employed de-escalation. However, it was not possible to reduce these critical incidents, therefore this study aimed to explore how and in which way organisational procedures influenced the process. Focused ethnography was used to uncover how staff was enacting de-escalation in three units. Brown and Clarke's methodology for a thematic analysis was followed, and Kurt Lewin's three-step model of change-Unfreeze, Change and Re-freeze-was adopted in the analysis. The analysis revealed three themes: old wine in new bottles; de-escalation favours the aggressive patient; organizational barriers. The results demonstrated how resistance to change was imbedded in the working culture, which could then lead to a state of no change. This insight is not new, but calls for a whole organizational approach that addresses the root causes that lead to violence and the use of coercive measures.
Bladet udkommer kun elektronisk Artikler til bladet Alle artikler skal skrives i word format, skr... more Bladet udkommer kun elektronisk Artikler til bladet Alle artikler skal skrives i word format, skrifttype Times New Roman, størrelse 12. Artiklen må fylde max fire A4 sider. Der skal vedhaeftes billede (som jpg-fil, ikke indsat i word) af forfatteren til artiklen.
International Journal of Environmental Research and Public Health, Jun 9, 2023
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Development of a model for shared care between general practice and mental healthcare: a protocol... more Development of a model for shared care between general practice and mental healthcare: a protocol for a co-production study. BMJ Open 2022;12:e061575.
This paper briefly presents a PhD project about de-escalation in clinical psychiatry in Region Ze... more This paper briefly presents a PhD project about de-escalation in clinical psychiatry in Region Zealand, Denmark. 2012-2015. The study investigates whether coercive measures and violence can be reduced in psychiatric wards when staff uses a deescalating approach, as the patient's behaviour is escalating. The study is based on action research principles and the objective is to identify, characterize and test deescalating methods that can "... redirect a patient towards a calmer personal space ..." (National Institute for Clinical Excellence, 2005). Successful de-escalation might prevent violence, and if a patient experiences rapid assistance, the use of coercive measures might be reduced. De-escalation is the collective term for a range of psychosocial interventions to reduce stress and anxiety in escalated and violent situations. De-escalation is a complex, interactive process, which guides the patient toward a calmer personal space (ibid: 24-25), through the use of specific communicative techniques and psychosocial interventions and by a staff focus on having control of the situation and not the patient. De-escalation in a psychiatric context is a relatively new phenomenon in Denmark. Denmark has no official professional guidance on handling violence, as the National Health Service in GB (NICE guideline for the management of disturbed / violent behaviour in psychiatry (ibid)). This NICE guideline recommends de-escalation as a preventive intervention. NICE identifies various theoretical approaches to de-escalation and points out that these are not substantiated scientifically and can be contradictory (ibid: 24-25). According to NICE it is not known whether de-escalation affects the use of coercion. Following, nurses must act on intuition in clinical situations, without evidence of efficacy. NICE recommends further research in order to examine whether de-escalation techniques minimise the use of coercive measures.
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