Dismissing De-Escalation Techniques as an Intervention to Manage Verbal Aggression Within Mental Health Care Settings: Attitudes of Psychiatric Hospital-Based Nigerian Mental Health Nurses

Abstract

The risk of violence within mental health care settings is high. Although literature does indicate certain mental illness symptoms, and or labels, as associated with increased risk for violence there is no definitive causative factor. Interrelated environmental factors directly influence verbal aggression and risk of violence. Specifically, lack of, or inadequate, mental health care legislation and policy, and practitioner attitudes, knowledge and skills are noted as core influential factors. The purpose of this study was to present de-escalation techniques, as an intervention, and describe the response of psychiatric hospital-based Nigerian mental health nurses. A qualitative approach using content analysis of audio recorded pre- and post-intervention focus group discussions was adopted. The intervention – one oral and visual presentation of de-escalation techniques – bisected focus group discussions. The objective for the pre-intervention focus group was to facilitate participants’ descriptions of current experiences and practices towards verbal aggression and violence management in order to inform and contextualise the intervention, specifically the relevant application of information within the intervention. The objective of the post-intervention focus group discussion was to describe participants’ responses to the intervention. Purposive sampling of nurses at unit or ward manager level yielded eight participants who attended both focus groups and the intervention. Results indicate that participants felt betrayed by all role players within the mental health care service system, were disappointed that de-escalation techniques were considered evidence-based practice, and hopeless about their introduction. Participants’ fears for their safety are suggested to have informed a more militant approach to the management of aggression, an approach perceived by participants to strengthen nurses’ control over their own and patients’ physical and emotional welfare. A review of Nigerian mental health legislation to set the context for human rights of both nurses and mental health care patients is recommended. In addition, a need exists for further research utilising a participatory action research approach. Such an approach will allow the participants to reflect, develop self-awareness, understand and respond to a specific context.