A realist-informed exploration of factors influencing nurses’ management of mental state deterioration in acute hospital settings

Abstract

Background

Managing patients’ mental state deterioration in acute hospital settings presents significant challenges, often resulting in adverse patient outcomes, traumatic restrictive practices, and negative staff effects. Ensuring timely and appropriate care for patients is critical; however, the efficacy of interventions is contingent upon understanding the underlying causal mechanisms that influence the staff’s capacity to timely manage deterioration.

Aims

To test, validate, and refine theories about factors influencing nurses’ ability to manage mental state deterioration and how these factors impact the functioning of a response model.

Methods

A realist evaluation survey was conducted with nurses in acute hospital settings to refine theories about managing patient mental state deterioration.

Results

A total of 60 nurses (50%) completed the survey. Most (n=48, 80%) had some mental health training, but 56% (n=27) reported less than an hour of training, and 53% (n=29) rated their de-escalation skills as low. About 30% (n=16) had activated response teams, and 16% (n=9) had reported managing mental state deterioration in the previous four weeks. Nurses highlighted the challenges of managing mental state deterioration and emphasised the need for tailored training, daily assessments, improved teamwork, communication, and organisational support for high-risk patients.

Conclusion

The study underscores the importance of addressing staff challenges for the effective functioning of a response model for mental state deterioration in acute hospital settings. Enhancing clinical skills and aligning organisational factors, such as guidelines, escalation workflows, and risk reporting, are essential to improving patient outcomes and staff support.