Guidelines to support professional nurses in managing aggressive patients within a mental health care unit of Limpopo Province, South Africa

Abstract

The prevalence of workplace violence is a serious challenge for developed and developing nations, particularly in Africa, putting more workers in danger. Due to the nature of the mental illnesses that patients are admitted with, acute psychiatric wards are stressful places to work in. As members of the frontline workforce, nurses have frequent interactions with patients, which increases their chance of experiencing violent occurrences. The purpose of this study was to develop and validate guidelines to support professional nurses in managing aggressive patients within the acute mental health care unit (MHCU) of Limpopo Province, South Africa. A qualitative approach using descriptive, explorative and contextual design was used in this study. Multiphase sampling was used to sample the districts, hospitals, and participants. Districts were purposively sampled. The hospitals were sampled in two stages, namely, sampling of district hospitals and regional hospitals that were purposively selected. The participants were sampled using convenience sampling. The study population was professional nurses with psychiatric nursing science qualifications who were allocated to the acute MHCU. The study was conducted in two phases. Phase one was situational analysis, where multiple theories (The Roy Adaptation Model and Dickoff's six elements of practice) were used to guide the study. Data were analysed thematically using Braun and Clarke’s six steps, and four themes emerged from data generation, namely, management of aggressive patients, care of patients in a seclusion room, challenges faced by professional nurses when managing aggressive patients, and type of support needed by professional nurses when managing aggressive patients. Trustworthiness and ethical principles were adhered to throughout the study. The second phase was developing guidelines to support professional nurses in managing aggressive patients within MHCU and validation. Multiple theories were used to develop the guidelines, namely, Dickoff et al., six elements, SWOT analysis, and BOEM action plan. A team of professionals who are experts in mental health and psychiatric nurses who are the end users validated the guidelines according to Chinn and Kramer’s steps. The study recommends that there should be in-service training and workshops that will enhance knowledge and skills to support professional nurses in managing aggressive patients.