Managing distressed and disturbed patients: the thoughts and feelings experienced by Italian nurses

ACCESSIBLE SUMMARY: •ÔÇé The aim of the research was to examine the thoughts and feelings experienced by Italian nurses when caring for distressed and aggressive patients in acute psychiatric settings. •ÔÇé Fear was the prevalent feeling experienced by nurses: fear of being harmed by the patient and fear of harming the patient and fear of damaging the therapeutic relationship. •ÔÇé When managing distressed and aggressive patients, the nursing team have to share similar feelings and be emotionally in tune with each other. •ÔÇé The paper offers clear explanations of nurses' feelings, the reasons for their fear and the importance of effective team working during a crisis. ABSTRACT: This paper reports on a qualitative study to identify Italian nurses' feelings and emotions towards the management of distressed and disturbed psychiatric patients in acute inpatient settings. Four focus groups were carried out involving 33 nurses from seven acute psychiatric services in a region of Italy. Data were analysed using content analysis. Findings highlight that fear is the prevailing feeling experienced by nurses in the management of distressed patients. This includes both fear of being physically harmed and concerns about doing harm or damage to patients. The unpredictability of aggressive behaviour from unknown patients was described as especially frightening. Known patients, namely those previously admitted to the unit, induced less fear, as their behaviour was considered more predictable. Patients with dual diagnosis were also a worry for many nurses, who considered themselves lacking in the personal relational skills needed to manage an individual in crisis. Nurses reported that they try to understand the reasons for a patient's aggressive behaviour and are empathetic to his or her suffering. When such empathy is lacking, nurses experience conflicting feelings of counter-aggressiveness. The paper concludes by emphasizing the need to increase availability of education related to patient management, in particular team working and its internal relationships.