Dr Owen Price BSc, MSc, RMN
I qualified as a mental health nurse in 2005. My clinical background is in forensic mental health inpatient services and I continue to work clinically on an honorary basis at Greater Manchester West Mental Health NHS Foundation Trust. I have worked at University of Manchester since 2010 as a researcher on numerous projects investigating staff-patient conflict and the use of restrictive practices. I was appointed lecturer at the University in 2015 and completed my PhD in 2016.
Owen’s presentation will discuss preparatory work to develop a de-escalation techniques training package funded by the National Institute of Health Research.
The work includes a quantitative systematic review of training effectiveness, a qualitative systematic review of staff and patient perspectives on de-escalation and two qualitative studies investigating staff and patient perspectives on barriers and enablers to the use and effectiveness of de-escalation techniques in routine practice.
There is currently no model of training that has demonstrated effectiveness in a rigorous experimental evaluation.
The strongest impacts of training from existing evaluations have been on knowledge gained from training, confidence to manage aggression and behaviour change limited to artificial training scenarios.
There is therefore limited evidence of impact on key safety outcomes such as rates of violence, aggression and use of restrictive practices.
Synthesis of findings from our development work indicates firstly that de-escalation techniques are unlikely to be enhanced without addressing the structural disempowerment of patients in these settings through increased accountability for poor practice in relation to restrictive practices and disrespect of patients.
Interventions seeking to enhance de-escalation techniques may additionally need to address: culture and practice in relation to the configuration and application of ward rules; staff emotional regulation strategies; social distance between staff and patients; individualised approaches to de-escalation; and a range of cognitive, affective and organisational factors influencing decision-making in balancing supportive and controlling responses to escalated behaviour.