Testing Ethical Guidelines for Psychiatric Nurses in Communicating with Clients Presenting Aggressive Behavior: A Pilot Study

Abstract

Introduction Recently, our psychiatric unit has developed ethical practice guidelines for psychiatric nurses when interacting with clients presenting aggressive behaviors. To ensure the effective implementation of these guidelines in our clinical practices, we initiated a pilot test aimed at gathering valuable feedback for future revisions and the successful implementation of the guidelines. 

Objectives To compare the communication scores of psychiatric nurses with clients presenting aggressive behavior before and after application of the ethical practice guideline for psychiatric nurses in communicating with clients with aggressive behavior and to describe the effectiveness of the ethical practice guideline for psychiatric nurses in communicating with clients with aggressive behavior. 

Design The operational research was carried out according to the guidelines established by the National Health and Medical Research Council (NHMRC) of Australia. 

Methodology The study included a sample of 26 professional psychiatric nurses employed at a super tertiary psychiatric hospital in Thailand. The participants were selected through purposive sampling. Data were collected using questionnaires including Personal Information Record Forms, Communication with Aggressive Clients Form, and Clinical Practice Guideline Implementation Evaluation Form. These instruments underwent content validation by experts. The reliability of the communication and evaluation forms were assessed, revealing Cronbach’s alpha coefficients of .94 and .95, respectively. Before implementing the ethical guideline, the sample underwent a pre-test and was subsequently measured over a period of one month. The ethical guideline was introduced and explained to the participants via an online meeting session, after which it was implemented in clinical practice.The communication form was repeatedly used to measure the sample’s performance after one month of implementation. Furthermore, the ethical guideline was evaluated using the Clinical Practice Guideline Implementation Evaluation Form simultaneously. Descriptive statistics and Paired t-tests were employed to analyze the collected data. 

Results The sample consisted entirely of female participants with an average age of 44.7 years (SD = 9.55) and an average work experience of 21.20 years (SD = 12.10). Prior to the implementation of the ethical guideline, the sample revealed a high level of communication scores (M = 85.50, SD = 7.59 ). After the one-month period, the mean communication scores (M = 89.23, SD = 5.44) significantly higher after the utilization of the guideline compared to before its implementation (t = 4.104, p < .001). Approximately 88.0% of the participants rated the effectiveness of the guideline as moderate to high. 

Recommendation Recommendations for enhancing the guideline include simplifying the practice guideline to make it more user-friendly and extending its scope to contain a wider range of clinical outcomes beneficial to both clients and psychiatric healthcare workers. Moreover, it is advised to offer specialized training in communication skills aligned with the ethical guidelines to psychiatric nurses prior to implementing them.