Development of a nursing program to reduce aggressive behavior in psychiatric patients without the use of medication at Sisaket Hospital

Abstract

Currently, mental health problems are showing an increasing trend. Economic changes and lack of social support have led to a growing number of psychiatric patients. Aggressive behavior among psychiatric patients remains a frequently encountered problem in mental health service provision. The development of nursing interventions to reduce aggressive behavior is therefore essential, particularly in hospitals with limited resources for effectively managing this behavior. This research and development project aimed to develop a nursing program to reduce aggressive behavior in psychiatric patients using mixed-method research conducted in four phases. The target group for interviews consisted of 7 nurses. The sample group comprised 34 patient caregivers. The experimental group included 34 psychiatric patients. Research instruments included semi-structured interviews, needs assessment questionnaires, nursing program evaluation forms, the nursing program itself, and aggressive behavior assessment tools. Data were analyzed using frequencies, percentages, means, and standard deviations. A needs assessment was conducted using the PNI index, and hypotheses were tested using Independent t-tests.

The study found that psychiatric patients frequently displayed aggression through both verbal and behavioral expressions. The needs assessment for program development performed using a PNI index of >.02 revealed three main issues: 1) group activity organization (PNI=.38), 2) assessment of emotional and psychological impact (PNI=.36), and 3) assessment of aggressive behavior with physical factors (PNI=.28). The developed nursing program consisted of 5 steps: 1) assessment and planning,        2) activity therapy, 3) mental health promotion and relaxation, 4) appropriate environmental management, and 5) follow-up and evaluation. The developed program demonstrated high levels of appropriateness and feasibility for implementation (Mean=4.35). After implementing the nursing program, psychiatric patients showed only minimal aggressive behavior (Mean=1.15), representing a statistically significant decrease from pre-implementation levels (P<.05). The five-step nursing program that was developed is appropriate, practical, and capable of reducing aggressive behavior. Recommendations include conducting long-term follow-up evaluations lasting 3-6 months, or longer, to measure behavioral stability in patients and assess the sustainability of program outcomes, as well as studying environmental factors and obstacles that may arise during actual implementation.