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Testing the acceptability and clinical effectiveness of a nurse-led therapeutic intervention to reduce aggression and restrictive practice in acute mental health facilities

Mid North Coast Local Health District

Grant:
  • Translational Research Grants Scheme
Date Funded:
  • 1 July, 2022
Chief Investigator/s:
  • Allyson Wilson

Project Summary

Testing a nurse-led therapeutic intervention to reduce aggression and restrictive practice in acute mental health facilities.

The main researcher for this project is Ms Allyson Wilson.

What is the issue for NSW?

In acute mental health wards, emotional dysregulation can lead to patient aggression. This can result in nurses employing restrictive measures such as seclusion. While undesirable, these practices are at times necessary to maintain safety. The use of restrictive measures is experienced as traumatising and re-traumatising by patients.  Importantly, embedding Cultural Safety and trauma informed care principles into aggression management practice is also a priority, as Aboriginal and Torres Strait Islander Peoples experience a high burden of poor social and emotional well-being. The elimination of coercive practices in mental health is a national, state and local priority. However, evidence on how to eliminate the use of seclusion and restraint in acute inpatient mental health facilities is limited.  Mental health nurses require a clinical practice method, based on trauma informed care and recovery principles, that provides a repeatable, consistent and collaborative approach to reducing aggression and restrictive practices.

What does the research aim to do and how?

This research will trial a nurse-led collaborative aggression de-escalation model that was developed and tested by clinicians in one inpatient mental health unit. The intervention provides a systematic model for good practice and aims to enhance nurses’ therapeutic capabilities in aggression de-escalation and reduce seclusion and other restrictive practices. Across two LHDs, five acute inpatient mental health units will test the intervention. The project will include intensive skills training and Cultural Safety strategies, aiming to strengthen nurses’ skills in preventing and managing patient aggression in collaborative rather than coercive ways.

The project will assess:

  • Change in nursing practice and patient satisfaction over 12 months.
  • The number of seclusion events and coercive interventions
  • The number of code grey events (i.e. threatening behaviour).