Fear, danger and aggression in a Norwegian locked psychiatric ward: Dialogue and ethics of care as contributions to combating difficult situations

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Abstract

Background:

Fear and aggression are often reported among professionals working in locked psychiatric wards and also among the patients in the same wards. Such situations often lead to coercive intervention. In order to prevent coercion, we need to understand what happens in dangerous situations and how patients and professionals interpret them.

Research questions:

What happens when dangerous situations occur in a ward? How do professionals and patients interpret these situations and what is ethically at stake?

Research design:

Participant observation and interviews.

Participants:

A total of 12 patients and 22 professionals participated.

Ethical considerations:

This study has been accepted by the Regional Committee for Medical and Health Research Ethics in Norway.

Findings:

(a) Both atmosphere and material surroundings were interweaved within dangerous situations, (b) the professionals applied stereotypes when interpreting dangerous situations and (c) the professionals and the patients had different interpretations of what triggered dangerous situations.

Discussion:

The discussion centres on how care ethics and a dialogical practice might contribute towards combating difficult situations and the ways in which change is an ongoing ethical process of becoming.

Conclusion:

The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.

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