The Effectiveness of Verbal and Non-verbal De-escalation Techniques on Reduction of Aggressive Behaviour and Coercion
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 6
- 试验地点
- 12
- 主要终点
- Number of aggressive incidents before and after the intervention.
研究概览
简要总结
A multicenter, intervention study will be conducted in all psychiatric hospitals in Slovenia.
The purpose of the study is to evaluate the effect of verbal and non-verbal de-escalation techniques on the incidence and severity of aggressive behavior and on the incidence and duration of physical restraints. The proposed hypothesis is that de-escalation training and regular use of de-escalation can reduce aggressive incidents and the use of physical restraints in the acute psychiatric ward.
In Slovenia, inpatient psychiatric treatment is provided by six psychiatric hospitals. There are two acute psychiatric wards in each hospital, one for male and one for female patients. All hospitals will be invited to participate in the study.
The study will be carried out in two phases, a baseline period of five consecutive months and an intervention period of the same five consecutive months in the following year. At the end of the baseline period, hospitals will be randomly assigned to either the experimental or control group.
The intervention will include training on verbal and nonverbal de-escalation techniques for staff teams in experimental wards. The first part of the education is based on theoretical backgrounds: aggressive behavior in a psychiatric patient, risk factors, communication, de-escalation. The second part is a practical workshop. The training will be 16-hour duration in total. A short handbook and a list of verbal and non-verbal approaches will be prepared for all staff members involved in the training.
For the baseline and intervention phase, data on the number and severity of aggressive incidents, the number and duration of physical restraint episodes, and the number of aggressive or restrained patients will be obtained.
详细描述
Aggression is a serious problem in acute psychiatric settings, often followed using physical restraints. Guidelines for the management of aggressive behavior recommend the use of de-escalation techniques as the first choice but evidence of their effectiveness is still limited. Aggression management studies often involve several organizational and structural interventions in the ward environment, staff, and patient management, which can be expensive and time consuming. Two Cochrane reviews (Du M et al. 2017, Spencer S et al. 2018) revealed a lack of relevant studies on the effectiveness of de-escalation techniques in managing aggression. The method of measuring the impact of de-escalation is often assessing the frequency of coercive measures, especially physical restraints. A significant proportion of physical restraints are not a consequence of aggression, so it is important to monitor aggressive incidents and physical restraints according to the reason for the application.
This research will be carried out within the National project of Slovenian Psychiatric Association, aimed to reducing aggressive behavior and the use of coercive measures in acute psychiatric units. Following visits by the CPT's (European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment) to Slovenian psychiatric hospitals with recommendations for greater emphasis on the use of de-escalation before the introduction of coercive measures, a decision was made to prepare de-escalation training for all psychiatric hospitals. During this project, we will conduct the research to evaluate the effectiveness of de-escalation on the incidence and severity of aggressive behavior and on the incidence and duration of physical restraints due to aggression and other reasons.
A multicenter, cluster randomized controlled trial will be performed in all six psychiatric hospitals in Slovenia and will include twelve acute psychiatric wards. The trial will be prepared in accordance with the Consort guidelines.
The aims of the study are:
- To evaluate the effectiveness of verbal and non-verbal de-escalation techniques on the aggression incidence and severity.
- To evaluate the effectiveness of verbal and non-verbal de-escalation techniques on the incidence and duration of physical restraints.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- Single (Outcomes Assessor)
盲法说明
The hospital staff will be unaware of the aim and the design of the study. All psychiatric hospitals will be informed that de-escalation training will be provided within 2 years.
Data from the SOAS-R forms and documentation for the use of physical restraint will be transferred to electronic databases by an independent collaborator who is not familiar with the design of the study. The randomization will be performed after the baseline period, so the baseline data could not be biased.
入排标准
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •acute psychiatric ward - all patients, hospitalized during the study
排除标准
- •acute psychogeriatric ward, acute psychiatric ward for adolescent, acute forensic psychiatric ward
结局指标
主要结局
Number of aggressive incidents before and after the intervention.
时间窗: Data for five months at baseline and for five months during the intervention period.
Aggressive incidents will be measured using the SOAS-R scale. The number of aggressive incidents for the baseline period will be arranged according to which group the individual hospitals will be allocated to after randomization. The number of aggressive incidents will be calculated per 100 treatment days.
Number of physical restraint episodes before and after the intervention.
时间窗: Data for five months at baseline and for five months during the intervention period.
Data on restraint episodes will be obtained from the standardized documentation required by the Mental Health Act. The number of restraint episodes for the baseline period will be arranged according to which group the individual hospitals will be allocated to after randomization. The number of restraint episodes will be calculated per 100 treatment days.
次要结局
- Duration of physical restraints episodes before and after the intervention.(Data for five months at baseline and for five months during the intervention period.)
- Severity of aggressive incidents before and after the intervention.(Data for five months at baseline and for five months during the intervention period.)