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July 2012, Volume 42 Number 7 , p 14 - 17


  • Cynthia Reade BS, RN-BC, NE-BC
  • Rosemary Nourse RN, CCRC


IN MANY psychiatric acute care units, nurses face the challenge of managing patients with diverse diagnoses, including patients at risk for violence. Complicating these issues, the behavior of multiple high-risk patients can escalate at the same time.We performed a retrospective analysis of patient-specific nursing interventions used to de-escalate dangerous behavior in patients with diverse diagnoses with high potential for violence. (For more information, see Understanding our study.) Our goal was to reduce the risk of injury to patients and staff while maintaining a safe and therapeutic environment for all psychiatric acute care inpatients. We conducted this study at St. Luke's University Hospital in Bethlehem, Pa., a 480-bed general hospital, from January to February 2011. This article details our research and our results.General hospitals provide most inpatient psychiatric services in the United States.1,2 Many of these hospitals have a general psychiatric unit rather than specialty units designated for patients with specific disorders. These general units typically encompass a diverse patient population where patients aren't separated according to their clinical status, such as level of functioning, diagnosis, medical issues, severity of symptoms, or potential for violence.Psychiatric units often operate at a net loss, and monetary constraints may influence the patient capacity of a psychiatric unit or the number of psychiatric units available.1 Even general hospitals with multiple psychiatric units may encounter a patient case mix that's not optimal due to bed needs.Nurses must effectively and safely manage escalation while maintaining a therapeutic and safe milieu for all patients.3 These factors are considered necessary for successful interventions:4 * implementation of early and appropriate medication management * intervention by staff educated in the management of aggressive or escalating patient behavior * excellent communication among all involved staff

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