Nurses and Consumer Consultants Perspectives on the Implementation of a Novel Violence Risk Assessment and Intervention Framework

Interventions to prevent aggression and reduce use of restrictive practices are essential for recovery-oriented mental health nursing care. This study explored how nurses can best enhance employment of a structured risk assessment instrument paired with an aggression prevention protocol. Fourteen nurses with responsibilities for reducing restrictive practices attended focus groups, and three consumer consultants working with mental health nursing staff participated in one-to-one interviews. The focus groups and interviews were designed to elicit recommendations to assist nurses use of the violence risk assessment instrument and apply the protocol interventions. Thematic analysis was used to analyse the data. Four themes were interpreted from the data. Theme one: The nurses are experiencing incredible difficulty talking about how they can be supported. Theme two: 'calming the farm': The need to self-regulate, with the subthemes: (1) some nurses may need support to 'calm the farm' and (2) if you can't 'calm the farm' another nurse may need to step in. Theme three was the need for robust training and education and the final theme was: The need for 'decompressing' before leaving the shift. Participants suggested while some nurses were very skilled at regulating their emotions while intervening to prevent violence, some had difficulty, or were not aware of their emotional state, and may need support from colleagues when intervening. Suggestions for enhancing the application of aggression prevention interventions include use of mental wellness check-in forms, engaging in clinical supervision and safety huddles at the end of the shift to assist nurses to decompress before leaving.