Handling conflict situations in psychosis inpatient care: Nursing staff experiences of the Interactive Approach model.

Abstract

WHAT IS KNOWN ON THE SUBJECT?: In inpatient wards, there is a risk that conflicts occur when nursing staff interact with psychotic patients. The Interactive Approach (IA) model is an action-based model, used in psychiatric settings, to manage conflict situations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The IA model can be used to improve communication between nursing staff and patients in numerous critical situations. Using a structured risk scale to evaluate a conflict can be an effective way to guide action and sort out the different aspects of communication between nursing staff and psychotic patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The clarity of an action-based model will help sort out which interventions are most likely to succeed in each conflict situation. The IA model highlights the importance of understanding and strengthening the patient's perspective, being flexible for each individual patient, and providing the patient with clear information about the situation. ABSTRACT: Introduction The Interactive Approach (IA) model is a structured management tool used to improve communication between caregivers and patients in psychiatric care settings. Aim/Question To examine the nursing staff's experiences of the IA model. How do they use the interventions in conflict situations with psychotic patients? Method A sample of nursing staff (n = 11) was recruited from three psychosis inpatient care units. Semi-structured questions covered staff experiences of working with the problem-solving interventions in the IA model. Transcribed data were analysed by qualitative content analysis. Results Three categories were defined: (1) 'To apply a flexible approach' describes how staff tried to adapt to each patient and situation; (2) 'Try to understand the person's inner world' describes the importance of active listening and exploring the patient's concerns; and (3) 'To communicate clearly' relates to experiences of clear communication and the setting up of boundaries. Discussion The risk scale and training in communication skills helped the interaction between staff and patients in conflict situations. Different interventions were used with a focus on maintaining patient alliance. Implications for Practice The findings highlight the importance of educational efforts and practical training, to prevent violence and the use of coercive measures.