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Journal of the American Psychiatric Nurses Association
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Keeping the Unit Safe: Mapping Psychiatric Nursing Skills

Kathleen R. Delaney

Rush University College of Nursing, Chicago, IL, Kathleen_R_Delaney{at}rush.edu

Mary E. Johnson

Rush University College of Nursing, Chicago, IL

BACKGROUND: The de-escalation skills of inpatient psychiatric nurses are considered key to violence prevention. Yet their efficacy and translation into practice remains in question.

OBJECTIVE: The aim of this study is to describe the de-escalation skills of psychiatric nurses. In the process, the investigators uncover ways nurses interact with patients to create and maintain a safe environment.

STUDY DESIGN: Grounded theory methods are used to collect and analyze data derived from staff interviews and direct observation of milieu interactions.

RESULTS: Staff behaviors are seen to create a safe milieu and promote a positive unit culture. Skills critical to maintaining a safe environment center on nurses’ awareness, attending, caring, and connecting.

CONCLUSIONS: The behaviors identified in this study are at the heart of managing the clinical context of acute psychiatric units. Attention to these behaviors is especially critical in light of the staff expertise needed to keep the unit safe.

Key Words: psychiatric nurses • inpatient treatment • milieu • safety • de-escalation

Journal of the American Psychiatric Nurses Association, Vol. 12, No. 4, 198-207 (2006)
DOI: 10.1177/1078390306294462
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