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Table 1 Nurses suggestions how violence prevention could be more effective

From: Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study

Category Detailed suggestions Example
In-service training
 To make treatment policies more coherent
 Should be more high-quality, concrete and offer new knowledge
Information: early warning signs, prediction of violence, new drugs and violence-related subcultures
More in-service training for the all staff - especially de-escalation technique training
To be able to practice togetherthe one who does and what, I suppose everyone knows broadly what to do, but what is their location at the situation, it demands some co-practice (ID 6)
Competent interaction
 Staff-to-patient and staff-to-staff, e.g. between a nurse and a physician
 Interaction problems with a physician may endanger patient care: e.g. insufficient medication and lack of information provided to a patient
Courage to ask straight whether a patient has violence-related thoughts
Consequences of violent behavior should be discussed clearly with the patient
The importance of leadership and clear instructions
clarification of nurses’ work in violent events
A consensus among the staff how to deliver treatment
Adequate, stable workforce: when staff knows each other well, interaction is easier
It’s terribly hard for the patients, toowhen there is no such line and they don’t have time to get used to anybodyit increases the risk that something might happen because such a stabile situation is aimed for in which everything is very consistent and everybody knows how to proceed, what they can and cannot do, it is always such a thing that holds the thing together (ID 17)
Presence of nurses
 Patients being themselves, if ward climate tense and frustrated and can lead to violence Familiar nurses provide safety for the patients
Time to be present for the patients and a named nurse with primary responsibility to take charge if there are signs of violent behavior
Only one of the nursing staff speaks to the patient in case of violent event
That the more we can be there, so called present and displayed on the ward, so that way we can make the situations more calm (ID 17)
Security improvement
 Lack of privacy and overcrowded wards
 Unsupervised places, e.g. smoking rooms, balconies
 Dysfunctional computers: if the files are unreachable, critical information may not be reported to next shift
 A patient or a visitor may smuggle drugs or bring weapons into wards
Reduction of beds, increase of single rooms for patients
Avoidance of certain one-to-one situations, e.g. being twosome in kitchen with the patient
Ensuring functioning electronic equipment for efficient reporting
Compliance of security instructions: e.g. locked places should be locked
When in doubt, permission to check patients’ bags even against patients’ will
Drug detection dog on wards if needed
Surveillance cameras and metal detectors on ward exits
Neglecting such direct safety instructions, for example, locked places are left open, e.g. in the kitchen -knife drawers might be left unlocked, I think it is such a security deficit here, as well as dangerous chemicals, such detergents, might be unsupervised that one has a change to drink them for intoxication purposes (ID 3)