Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

Esario Iv Daguman; Alison Taylor; Matthew Flowers; Richard Lakeman; Marie Hutchinson

doi:10.1111/jocn.17727

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Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

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Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

Esario Iv Daguman, Alison Taylor, Matthew Flowers, Richard Lakeman and Marie Hutchinson

Journal of clinical nursing, Vol.34(11), pp.4698-4709

11/2025

DOI: https://doi.org/10.1111/jocn.17727

PMID: 40084814

Appears in Recent Faculty of Health Publications

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Abstract

mental health services

cluster analysis

de‐escalation

psychiatric nursing

crisis intervention

physical restraints

Aim: An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression. Design: A single-centre retrospective study was undertaken. Method: Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices. Results: Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes. Conclusions: The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly. Relevance to Clinical Practice: Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses. Reporting Method: This study followed the applicable STROBE guidelines. Patient or Public Involvement: Due to the study's retrospective nature, there was no service user or public involvement.

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Title: Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit
Creators: Esario Iv Daguman - Southern Cross University
Alison Taylor - Coffs Harbour Base Hospital (NSW, Coffs Harbour)
Matthew Flowers - Coffs Harbour Base Hospital (NSW, Coffs Harbour)
Richard Lakeman - Southern Cross University
Marie Hutchinson - Southern Cross University
Publication Details: Journal of clinical nursing, Vol.34(11), pp.4698-4709
Publisher: Wiley-Blackwell Publishing Ltd.; HOBOKEN
Grant note: The Translational Research Grant Scheme of the NSW Office for Health and Medical ResearchCouncil of Australian University LibrariansWiley - Southern Cross University agreement via the Council of Australian University Librarians
Acknowledgement is given to Penny Jones and Sarah Fox for the data custodial approvals, the Mid North Coast Local Health District for permitting the use of the data, Paul Glover for his change initiative and the nurses who completed the logs. Open-access publishing was facilitated by Southern Cross University through the Wiley-Southern Cross University agreement with the Council of Australian University Librarians. Open access publishing facilitated by Southern Cross University, as part of the Wiley - Southern Cross University agreement via the Council of Australian University Librarians.
Identifiers: 991013266688802368
Academic Unit: Nursing; Faculty of Health
Language: English
Resource Type: Journal article

Differentiating Therapeutic Responses That Reduce Restrictive Practice Use and Situational Aggression in an Acute Mental Health Unit

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