Treating Trauma

Sometimes, when caring for the most vulnerable patients, nurses require a helping hand to keep themselves and those for whom they care, safe.

In psychiatric inpatient wards, nurses face the additional challenge of managing confrontations with distressed patients. In some cases, this stress can escalate one step further to become violence, putting the entire unit at risk.

Many health systems such as UF Health have already created resources to equip nurses with the knowledge and skills required to help recognize and de-escalate potentially dangerous situations. But thanks to the efforts of two psychiatric health nurses and a UF College of Nursing faculty member, UF Health care teams may have access to a new strategy that could improve on-unit safety for the better.

Current UF Health psychiatric nurses and Doctor of Nursing Practice students Mariah Rappazzo, RN and Genevieve Banaag, RN, as well as UF College of Nursing associate professor Victoria Menzies, PhD, APRN, FAAN, are currently working to improve de-escalation and de-briefing skills when engaging with the psychiatric patient. As part of the UF Health-UF College of Nursing Demonstration Project initiative, the team connected to create educational training for health care workers to teach staff about a special ‘debriefing model,’ that is ultimately intended to be used system-wide.

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This model, which features revisions to psychiatric codes, introduces reassuring language to patients before an incident occurs in high-stress situations, opportunities for staff to voice concerns and kind gestures such as a fresh change of clothes to make patients feel more at ease, has transformed how nurses and other health care workers communicate with those in their care, as well as each other.

“Staff morale, decreased risk for injury and a feeling of being supported are all important in nursing, and especially so in psychiatric mental healthcare settings,” Baanang said.” That is why it is imperative to address risk in the mental health care setting, as well as reassure members of the mental health care team to understand that they are also being cared for.” Banaag said

The project originally got its start when the UF Health nurse pair decided to improve upon the training provided by their former nurse educator by offering this debriefing model and its resources to all staff throughout UF Health. Above all else, the team hopes their efforts will help protect staff members facing behavioral concerns as they engage with patients.

“We are very passionate about what we do and keeping our nurses and staff safe while caring for patients,” said Rappazzo. “It was our hope these trainings would ensure that everyone walks away with a sense of confidence, and most importantly, feels safe and heard.”

After completing their educational training, the team distributed surveys to staff to determine how these resources impacted staff on each unit. Now putting the final touches on their data analysis, the group plans to present their findings at the Florida Nurse Association conference in Orlando later in July, as well as the Mind Author’s Advanced Nursing Practice Virtual Congress and the World Congress on Nursing Education and Practice in the fall.

“Typical of nursing, there was demonstrated nursing leadership in the desire to assess a revised behavioral code process within an acute psychiatric health setting,” said Menzies. “As a psych nurse myself, how could I not choose to partner with such a goal? The two project leaders are remarkable and it is a gift to work with them.”