Preventing patient violence in hospitals: Applying critical decision method interviews to understand how skilled staff think and act differently

Abstract

AimsOur aims were to understand how hospital staff who are skilled at managing aggressive patients recognize and respond to patient aggression and to compare the approaches of skilled staff to the experiences of staff who were recently involved in incidents of patient violence. BackgroundViolence from patients toward staff is prevalent and increasing. There is a need for greater understanding of effective approaches to managing patient aggression in a wide variety of hospital settings. MethodsWe conducted grounded theory qualitative research applying Critical Decision Method interviews at two hospitals. Skilled staff and incident-involved staff were asked to describe experiences involving aggressive patients and the data were analyzed qualitatively. ResultsOur interviews (N = 23) identified positive approaches and challenges to managing aggressive patients. Positive approaches included: maintaining empathy for the patient, allowing the patient time and space, exhibiting a calm demeanor, not taking things personally, and implementing strategies to build trust. Challenges included: inadequate psychiatric resources, balancing priorities between patients with urgent physical needs and those exhibiting difficult behaviors, and perceiving pressure to de-escalate situations quickly. Incident-involved staff were more likely to describe the challenges listed above and a limited tolerance for patients whose behavior they perceived as unjustified or detracting from other patients' care. ConclusionThe Critical Decision Method proved valuable for highlighting nuanced understandings of skilled staff that sometimes contrasted with perceptions of incident-involved staff. Our findings support investigation of novel approaches to training such as peer coaching and improving empathy through increased understanding of mental illnesses and addiction.