Qualitative Research Article related to the Topic of Your PICOT

Qualitative Research Article related to the Topic of Your PICOT

PICOT Question

In violent or agitated patients with mental illnesses, is the use of de-escalation strategies more effective compared to the use of physical restrain to manage aggressive behavior and prevent injury and accidents in psychiatric patients during the admission period?

Identifying Information (Journal, Year, Title, Authors)

The article is a section of the journal ‘International Journal of Mental Health Systems’ that was published in August 2020 based on a qualitative study. The article is titled ‘Barriers and facilitators of the effective de-escalation of conflict behaviors in forensic high-secure settings.’ The authors of the journal include Helena Goodman, Helena Goodman, Owen Price, and Elizabeth Barley. Helena Goodmanco-facilitated focus groups, collected information for participant interviews, produced the manuscript draft, interpreted and analyzed data. Papastavrou Brooks participated in the revision of the manuscript and data analysis. Owen Price was the chief investigator in the study and was tasked with the role of designing the study set-up and materials to be used in the qualitative study. Elizabeth Barley contributed to facilitating the focused group, analysis and interpretation of data, and the revision of the manuscript (Goodman et al., 2020).

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The problem addressed in the study

The study was undertaken to identify alternative interventions for aggressive and violent incidents that are usually seen within mental health facilities that are commonly managed using risky physical interventions including seclusion and restraints. The first-line technique used in the management of conflict behaviors and prevention of aggression and violence is de-escalation.

The purpose of the study

The study was undertaken to investigate patients’ and healthcare staff’s perspectives on the facilitators and barriers to the use of de-escalation in the management of conflict behaviors among psychiatric patients (Goodman et al., 2020).

The research question (s) (and/or hypothesis) used in the study

The research hypothesized that behavior change targeting appropriate interventions including those seeking to reduce restrictive practices and violence via the use of de-escalation should be implemented in highly secure mental facilities to reduce harm in aggressive patients. The study sought to answer the question of whether the potential for or occurrence of violence in mental health facilities causes fear among staff and patients. The research question was presumed to be answered through the implementation of factors promoting fear reduction that are highlighted in de-escalation training (Goodman et al., 2020).

Review of current and relevant literature

The relevant literature is based on prior group transcripts and verbatim interviews which are stored securely in various site files in highly secure psychiatric hospitals. The sources discuss the likelihood of indirect patient acknowledgment because of their high-profile nature in several research subgroups, datasets, and transcripts that were generated in the current study which were not publicly available although they were made available when corresponding authors were requested to share information.

Sampling procedures

The study involved focused groups and semi-structured individual interviews that were done with 8 patients, 4carers, and 25 healthcare staff individuals from the highly secure hospital in the United Kingdom. The focused groups and interviews were sampled through theoretical domains framework then transcribed verbatim, digitally recorded, and analyzed by the COM-B behavior change model and framework analysis. The sample was drawn from a high-secure hospital with 284 beds and the capacity to serve inpatient male individuals (Goodman et al., 2020).

Design and methods used in the study

The qualitative study design used were focus groups and semi-structured interviews were done. The theoretical domain framework and behavior change model informed methods used in data collection and analysis.

Ethical issues/IRB (informed consent)

Before the commencement of the study, ethical approval was sought to undertake focus groups and individual interviews with patients and staff. The approval was given following the required procedures as stipulated by the Declaration of Helsinki. All study participants provided written and verbal consent for their anonymized quotes to be published in the journal and publicized in scientific papers (Goodman et al., 2020).

Methods of data collection and analysis

The study participants offered information concerning their gender, age, and ethnicity for patients while clinicians provided information about their experience and role. The data collection process involved asking questions on the patient’s primary diagnosis, the length of current hospital stay and the interventions received. The interviews encompassed structured discussions on participants’ experiences, perspectives, and expectations on the effectiveness and use of de-escalation techniques. The discussions were documentation using the transcribed verbatim and security authorized digital recorder. The data analysis process involved framework analysis by data familiarization, charting, indexing, and interpretation through NVivo 11 software.


The study postulated that successful implementation of de-escalation techniques requires both patients and staff to be able to establish appropriate therapeutic relationships. According to Goodman et al (2020), the understanding and knowledge of the therapeutic relationship between trauma and aggression that is experienced by patients are reduced using the approach. Also, patients and staff should develop and use interpersonal and psychological skills in the management of psychiatric illnesses through incorporating the culture of consistency, fairness, and trust.

Study limitations

The opinions gathered in the study described the perspective of male patients and staff alone in a single UK-based facility thus may not represent fully the entire population or the views of the female population. Another limitation is that the study had some unknown domains which were not omitted in the framework and missed by the adoption of semi-structured approaches during data collection.

Contributions to nursing research and practice

The study findings have significantly contributed to the establishment of theory-informed and evidence-based approaches in de-escalation training practices that are currently implemented in psychiatric wards across the United Kingdom. The feasibility of the training package to improve de-escalation practice is currently being investigated along with the individual, organizational and systemic factors inhibiting or enabling its implementation.


Goodman, H., Papastavrou Brooks, C., Price, O., & Barley, E. A. (2020). Barriers and facilitators to the effective de-escalation of conflict behaviors in forensic high-secure settings: a qualitative study. International journal of mental health systems14(1), 1-16.

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