Mapping Psychiatric Nursing Skills
Merriam-Webster Dictionary (2012) defines escalation as “An increase in extent, volume, number, amount, intensity, or scope.” (Escalate, para. 1) Escalation is commonly used to describe the behaviors of psychiatric patients as they become increasingly agitated. Delaney and Johnson (2007) describe escalation as “a linear trajectory of behavioral eruption beginning with agitation and proceeding until the patient is out of control” (p. 42). Preventing workplace violence that stems from patient agitation is an important role of psychiatric nurse, as it involves keeping everyone on the unit, including the agitated patient, safe from harm. There are many training programs available to teach psychiatric nurses de-escalation techniques, but it is still unclear as to how to translate those skills into nursing practice. This study was performed to examine how nurses on inpatient psychiatric units use de-escalation strategies, and to obtain staff and patient perceptions regarding the volatile events (Delaney & Johnson, 2006). In order to train nurses on the strategies and skills of de-escalation, how and when these techniques are being used need to be identified in their naturally occurring states. Researchability of Study Problem
The authors of the study state that the purpose of this study is to develop a theory of the de-escalation process by observing how nurses handle sensitive situations with agitated patients, as well as to describe the strategies and interventions nurses used to handle these situations (Delaney & Johnson, 2006). There are very few studies researching the effectiveness of de-escalation training and current interventions used by mental health staff. The authors developed their study based on qualitative methods to describe the context of the volatile situations, and to identify interventions used by nurses to de-escalate the situations. The objective, to describe the de-escalation skills of psychiatric nurses, is consistent with the title of the article (Delaney & Johnson, 2006). Literature Review
The literature review by the authors is logical and relevant. The literature cited supports that violence continues to be a substantial issue for patients and nursing staff, and de-escalation techniques are the preferred strategy of restraint reduction as well as violence prevention (as cited by Delaney and Johnson, 2006, p. 199). However, literature shows that there is little research backing the efficacy of de-escalation techniques in preventing violence or reducing the use of restraints (as cited by Delaney and Johnson, 2006, p.199). Duxbury & Whittington (2005) argue that translating the education of de-escalation methods from classroom to actual practice on the psychiatric unit is also questionable, and has not been sufficiently researched (as cited by Delaney and Johnson, 2006, p. 199). The authors provide a brief and thorough review by integrating the review of literature and discussing articles related to the necessity of further information and increased knowledge regarding de-escalation. Agreement of Purpose, Design, and Methods
The research design used for this qualitative study was grounded theory. The advantages of using grounded theory include its ability to provide a detailed study of a micro issue (de-escalation skills) within a particular setting (psychiatric units). Grounded theory also provides the ability to build a theory while performing the research, as there is no theory when beginning the research, but it is discovered during the research process (Laws & McLeod, 2004). Therefore, grounded theory was a good basis for this study, as one of the aims of the study was to develop a theory of de-escalation. However, the authors make no mention of any weaknesses of the study, which can be found in the interpretation of the interviews. The interviews are guided and interpreted by...