| 戎艳鸣,李明芳,李玉华,闵海瑛.精神科护士攻击性行为及降级技术应用的体验及困境的质性研究[J].上海护理,2026,26(8): |
| 精神科护士攻击性行为及降级技术应用的体验及困境的质性研究 |
| A qualitative study on psychiatric nurses'' experience of aggressive behavior and application of de-escalation techniques |
| 投稿时间：2025-11-14 修订日期：2026-08-05 |
| DOI： |
| 中文关键词: 精神科 护士 攻击性行为 降级技术 质性研究 |
| 英文关键词:Psychiatric nursing Nurses Aggressive Behavior De-escalation Techniques Qualitative Research |
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| 中文摘要: |
| 目的 描述和分析精神科病房护士在应对患者攻击行为时应用降级技术的体验和困境，为构建降级技术方案提供依据。 方法 该研究为描述性现象学研究。采用目的抽样法，于2024年1月-4月选取上海市三家区级精神科专科医院的21名护士作为研究对象，进行半结构式访谈，采用Colaizzi 7步分析法对访谈资料进行提取编码、聚类筛选、解释验证。 结果 共提炼出3个主题和11个亚主题，分别为风险识别与安全防护下的自我调节（先兆识别与风险评估、情绪自我调节与避免激惹、安全优先的自我保护意识）、成功应用的降级举措及成效体验（以语言沟通为核心的安抚与协商、非语言行为配合、把握降级实施时机、环境调整与团队协作）、降级技术应用的困境与支持需求（患者病情突发与个体差异导致成效受限、培训理论与情境脱节、人力与组织支持不足、事后复盘与心理支持需求）。 结论 精神科护士在应对患者攻击行为时，需要基于风险识别、自我调节与安全防护，综合运用多种降级技术，但其实施效果受多重困境制约。建议护理管理者完善分层培训与情境模拟，建立可操作的评估与处置流程，优化人力配置与快速支援机制，并完善攻击行为后的心理支持与复盘管理，以提升降级技术实施效果并保障护患安全。 |
| 英文摘要: |
| Objective To describe and analyze the experience and dilemmas of psychiatric nurses participating in managing patients’ aggressive behavior and applying de-escalation techniques, and to provide a basis for developing de-escalation techniques programs. Methods This study was a descriptive phenomenological study. The purposive sampling method was used to conduct semi-structured interviews with 21 psychiatric nurses from three psychiatric hospitals in Shanghai from January to April in 2024. The interview data were extracted，coded，cluster screened，interpreted and verified by the Colaizzi seven-step analysis method. Results A total of 3 themes and 11 sub-themes were extracted: self-regulation underpinned by risk identification and safety protection (including early sign recognition and risk assessment, emotional self-regulation and provocation avoidance, and safety-first self-protection awareness); effectively applied de-escalation measures and their outcome experiences (including verbal communication-centered calming and negotiation, coordination of non-verbal behaviors, grasping the timing of de-escalation implementation, environmental adjustment and team collaboration); and the dilemmas and support needs in applying de-escalation techniques (including limited effectiveness due to sudden onset and individual differences of patient conditions, disconnection between training theory and clinical reality, insufficient human and organizational support, and needs for post-event review and psychological support). Conclusion Psychiatric nurses integrate various de-escalation techniques based on risk identification, self-regulation, and safety protection in response to patient aggression. However, the effectiveness of these techniques is constrained by multiple dilemmas. It is recommended that nursing managers enhance tiered training and situational simulation, establish actionable assessment and management procedures, optimize staffing allocation and rapid support mechanisms, and strengthen psychological support and systematic review following aggressive incidents. These measures will improve the implementation of de-escalation techniques and ensure the safety of both nurses and patients. |
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