Working with psychologically ill patients requires special training, which nurses should carry out at the stage of their training and during direct operational activities. In some cases, patients may show aggression, and nurses should be able to cope with such risks. This problem can lead to burnout and other mental ailments for qualified medical personnel without proper psychological preparation. Given that the U.S. has experienced an acute shortage of medical professionals since the pandemic, despite solid industry funding, this issue is highly relevant (Flaherty & Bartels, 2019; Chirico et al., 2021). Accordingly, it is required to develop a project at the system level to minimize the risks of burnout for nurses and provide them with constant and practical support in difficult situations of caring for potentially aggressive patients.
Accordingly, this project will include implementing standardized activities to help nurses work with mentally ill patients to increase the safety of their mental health. Such a set of measures should include preliminary training in specialized institutions where nurses work with potentially aggressive patients, as well as the introduction of permanent reminders and other aspects to create a safe environment. According to studies, such proactive actions are pretty effective and can protect nurses from burnout to the extent necessary and reduce the percentage of mental health disorders (Drukker, 2021; Trifu et al., 2020; Ulrich et al. 2018). Research has proven educational interventions in many settings and has increased nurses’ sense of security, leading to more confident and professional work (Fröhlich et al., 2018). Accordingly, changes need to be made at the systemic level so that practices that have already been proven to have a positive effect by research are implemented in caring for patients with mental disorders. This paper is responsible for describing the process of these changes, identifying the main goals, direction, and sources of funding, and applying the principles of management and leadership competencies to the practical aspect of nursing care.
Competences
The launch of this project requires exceptional management and specific managerial competencies. According to the Chicago Healthcare Leadership Competency Model, the leading group, in this case, can be identified as human competencies, building interpersonal understanding and relationships, developing human resources, and self-confidence (Broome & Marshall, 2021, p. 188). The leader must, first of all, have at least those communication skills that can help nurses feel safe. When organizing training and the environment of communication with mentally ill patients, the leader must first take into account human qualities. The project aims to preserve the efficiency and well-being of the medical workforce when working with patients: interpersonal relationships are at the heart of the project. Performing competencies according to the same model in this situation is required to effectively organize the training process standardization in creating conditions for a safe environment. These competencies, among other things, imply organizational awareness, which is critical in the ability of nurses to properly build de-escalation relationships with potentially aggressive patients (Brroome & Marshall, 2021, pp. 188-189). Transformational competencies will be required to develop the model, introduce innovative developments, extrapolate to broader coverage.
The Healthcare Leadership Alliance provides the most in-depth picture of the core leadership competencies in healthcare but does not create the motivational conditions that are important to the psychological aspects of the problem. According to Houston’s classification, this project’s critical point of competencies is highlighted: expert decision-making skills based on empirical research (Brome & Marshall, 2021). At the moment, there are many studies where the positive effect of training has been proven, but there is still no universal model for building the educational process. In addition, it is necessary to correctly form different test research processes before implementing the project at a broad level. The first organized interventions should be designed according to most of the known scientific experience, considering the most common scenarios of patient behavior and protective mechanisms for nurses.
Management Principles
The use of evidence to optimize and improve specific processes in medicine is no longer the prerogative of scientific research. The current pace of development in clinical practice must use evidence constantly, implementing exemplary practices almost on the go (Brroome & Marshall, 2021, p. 189). At the same time, a complete transition to quantitative evidence in research is impossible due to the presence of many subjective and qualitative characteristics of the process. For example, despite attempts to create various universal questionnaires, it is not possible to assess various aspects of well-being and mental state in a relatively normal state in nurses (Dagenhardt et al., 2022). For various personal reasons, a nurse may hide, underestimate, or overlook the processes involved in caring for potentially violent patients. The leader’s role is to bridge the gap between quantity and quality to achieve the most optimal balance when building training and organizing a safe environment. In addition, leadership should focus on removing barriers to nursing practitioners accessing research in this area.
This aspect of linking research findings to specific clinical practice is the purview of transformational leadership. From this point of view, a critical positive point stands out: the constant search for innovative approaches (Boamah et al., 2018). In this project, the leader will not only need to find a way to translate research achievements into practice and provide appropriate resources for nurses in a wide range of specialized institutions but also be ready to adapt training and other organized activities constantly. Firstly, each employee has subjective prerequisites for the appearance of burnout problems or mental disorders. Secondly, each patient may show aggression or other negatively influencing behaviors in communication with a nurse in different ways. It is necessary to create universal security conditions at the initial stage and determine the mechanisms for their regulation, the boundaries of action, and weaknesses for further improvement at the system level.
Leadership Theory
The most appropriate leadership theory for this project is the adaptive leadership theory. According to this theory, the leader must solve and rally people to solve adaptive problems with no apparent solution (Kuluski et al., 2021). Even the results of extensive studies had many external factors that, in one way or another, created an error in the quantitative indicators of nurses’ feelings of safety and the manifestation of aggression by patients. The leader of this project must first be flexible in applying preventive measures against mental disorders and burnout. According to the theory, adaptive problems are a source of emotions, most often negative ones, while their solution also includes an emotional background: it is not enough to shield the nurse from communicating with the patient; it is necessary to cure the symptoms of negative influence, to find an approach to both the nurse and the patient in order to solve the problem. This method will give confidence to the healthcare worker and eliminate the possibility of injury (Wang et al., 2018). Therefore, according to the rules of the theory, the nurses do not need to be fenced off from work; they need to be allowed to independently overcome the problem that has arisen and get rid of it completely.
According to the theory of adaptive leadership, creating a safe environment should also take into account the emotional aspect. Indeed, emotional security is fundamental in proactive measures to prevent negative experiences and burnout and maintain an ethical and highly professional attitude towards the patient. As a rule, other leadership theories focus on employees’ effectiveness precisely from the point of view of medical professionalism. However, the aspects of motivation, inspiration, search for moral strength are deprived of due attention or the existence of effective mechanisms at the system level. Adaptive leadership also involves attentive contact between the leader and subordinate employees: the focus of value is on human resources.
Project Plan and Evaluation
Accordingly, the project needs to find a funding source at the federal level to implement systemic changes on a large scale. The cost item at the initial stage of the project will include local research in several specialized institutions to take into account possible adaptive tasks in the implementation of training and organization of the environment. First of all, it is necessary to focus on those regions where the problem exists and is known about it to extrapolate the experience with proactive goals further. The costs will be spent on the organization of questionnaires, the involvement of experts for independent evaluation of the results, potential payments to nurses participating in the experiment at the initial stage, the creation of memos, and the development of training by practicing nurses, together with scientific researchers. Revenues are expected as a source of funding for the first stages of the project, creating an established model for organizing a safe communication environment and training for nurses, followed by an expert and personal assessment of their mental state.
The economic efficiency of this project in a positive aspect is manifested indirectly in terms of finance. The benefit of the project, with proper implementation and successful results, is to retain valuable, highly qualified personnel who will receive support that saves them from burnout and mental disorders in critical situations. Otherwise, specialized institutions will lose human resources and the ability to provide medical services in the same volume. A decrease in volume will decrease funding at the federal level, effectively resulting in financial losses. This project offers a financial cost in return for nurses and other healthcare professionals’ constancy, satisfaction, and well-being. The cost-benefit ratio, in this regard, will be pretty difficult to quantify, but the need to implement the project is evident from the qualitative ratio of preventive measures-consequences. No less important is the stage of subsequent evaluation of the project to solve adaptive problems.
By conducting a SWOT analysis of the proposed project, it can be concluded that the strengths include preventing mental disorders and burnout of helpful medical staff in the face of a shortage of staff and, as a result, saving the institution’s budget. It is worth noting that the application of the methodology described above can provide a theoretical basis for an evidence-based approach in conjunction with the theory of adaptive leadership in the field of psychiatric research. With its particular attention to the emotional background of the problem, the project can also make a scientific contribution to the study of this and related problems. At the same time, the weaknesses of the project lie in the subjective aspect of the task and, as a result, the need for irrevocable funding of local research for each institution where it will be implemented. However, for the reasons described above, these costs are justified.
The opportunity that this project opens at the system level is the use of such proactive practices at earlier stages of nurse training, namely in the process of obtaining an education. Simulations of actual cases will replace abstract situations, and nurses will learn about training and support methods much in advance and be more open to help when needed. Preventive measures will spread in education, providing advanced preparation for nurses for critical situations, almost wholly leveling the potential danger. At the same time, there are threats of worsening the situation on an individual basis when using the wrong approach or inadequate training. In this situation, the leader should consider measures to compensate and provide additional assistance to nurses in advance.
Current Situation in Organizational Structure
At this stage, training and the organization of a safe environment take place either privately in individual institutions or as part of research that does not later develop into organizational change. Working in psychiatric hospitals without this problem is associated with a high burden on mental health and stress. The burnout rate for nurses in this area is significantly higher than in others: the situation only changed during the pandemic (De Looff, 2018). With these changes, the organizational structure of these institutions will be more functional in terms of ensuring the well-being of medical staff: satisfaction will contribute to greater involvement in the work process and improve the conditions for patient care and professional growth of the nurse.
Ideally, as a result, each institution will receive its unique approach, taking into account all the subjective features of working with specific patients, regional rules, and the current medical team. Delegation of control over these activities to local management is possible only with sufficiently long positive results while retaining the current staff. Each new employee must also undergo training under the supervision of the project manager to avoid forming a new adaptive task due to unaccounted-for subjective characteristics of the specialist. Attracting the attention of the project management is also necessary when new mentally ill patients with the threat of aggressive behavior are admitted. This case-by-case focus will help build an evidence base for modeling a comfortable and safe working environment for nurses in psychiatric settings. A decrease in activity in the managerial activities of the project is possible only after implementing universal methods in educational institutions and creating constantly functioning measures of proactive and reactive support for nurses in this area.
Organizational Systems Impact
The organizational system will need to receive an additional standardized process for training and providing a safe environment for a nurse caring for a potentially violent mentally ill patient. A further extrapolation of the positive application of this process includes the impact not only on the organizational structure of psychiatric hospitals but also on educational institutions. The system of medicine as a whole will receive a mechanism that helps reduce the likelihood of burnout of critical specialists, which will increase their service life and, in the future, will help reduce the percentage of staff shortages both in this industry and in medicine as a whole.
References
Broome, M. E., & Marshall, E. S. (2021). Transformational leadership in nursing. Springer.
Boamah, S. A., Laschinger, H. K. S., Wong, C., & Clarke, S. (2018). Effect of transformational leadership on job satisfaction and patient safety outcomes. Nursing Outlook, 66(2), 180-189.
Chirico, F., Nucera, G., & Magnavita, N. (2021). Protecting the mental health of healthcare workers during the COVID-19 emergency.BJPsych International, 18(1).
Dagenhardt, R. D., Heideman, A., Knoche, V., & Freiburger, T. (2022). An evaluation of a de-escalation conflict management training in a behavioral health hospital setting. International Journal of Conflict Management, 33(1), 84-110.
De Looff, P., Nijman, H., Didden, R., & Embregts, P. (2018). Burnout symptoms in forensic psychiatric nurses and their associations with personality, emotional intelligence and client aggression: A cross‐sectional study. Journal of Psychiatric and Mental Health Nursing, 25(8), 506-516.
Drukker, M. (2021). Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. Plos One, 16(10), 1-34.
Flaherty, E., & Bartels, S. J. (2019). Addressing the community‐based geriatric healthcare workforce shortage by leveraging the potential of interprofessional teams.Journal of the American Geriatrics Society, 67(S2), S400-S408.
Fröhlich, D., Rabenschlag, F., Schoppmann, S., Borgwardt, S., Lang, U. E., & Huber, C. G. (2018). Positive effects of an anti-aggression and de-escalation training on ward atmosphere and subjective safety may depend on previous training experience.Frontiers in Psychiatry, 9, 134.
Kuluski, K., Reid, R. J., & Baker, G. R. (2021). Applying the principles of adaptive leadership to person‐centred care for people with complex care needs: Considerations for care providers, patients, caregivers and organizations. Health Expectations, 24(2), 175-181.
Trifu, S. C., Tudor, A., & Radulescu, I. (2020). Aggressive behavior in psychiatric patients in relation to hormonal imbalance.Experimental and Therapeutic Medicine, 20(4), 3483-3487.
Ulrich, R. S., Bogren, L., Gardiner, S. K., & Lundin, S. (2018). Psychiatric ward design can reduce aggressive behavior. Journal of Environmental Psychology, 57, 53-66.
Wang, L., Tao, H., Bowers, B. J., Brown, R., & Zhang, Y. (2018). When nurse emotional intelligence matters: How transformational leadership influences intent to stay. Journal of Nursing Management, 26(4), 358-365.