Show no fear
: an analysis of staff communication during conflict management in acute adult inpatient mental health settings

  • Ciara O'Neill

Student thesis: Doctoral Thesis › Doctorate in Clinical Psychology

Abstract

Background. Staff are instructed to use de-escalation techniques when responding to aggression. Training emphasises staff must control their emotional expressions, especially fear, yet little is known about how this is applied in practice during de-escalation. Aims. This exploratory study aims to examine the impact of mental health staff's experience of workplace violence and their fear of future violence on nonverbal communication during de-escalation incidents. This study will focus exclusively on staffs’ hand movements and gestures. Methods. Mixed method analysis of video recorded de-escalation interactions (n=37) and questionnaires measuring staffs’ experience of violence at work and fear of future violence (n=46). Results. Staffs’ experience of violence is associated with their fear of future violence (p<.001). When de-escalating patients, staff most commonly displayed co-speech gestures, adaptor hand movements and emblem gestures. Less frequently observed behaviours included therapeutic touch. Quantitative analysis revealed no statistically significant relationships between staff’s fear of future violence and any hand movements during de-escalation. However, therapeutic touch was exclusively displayed by staff with low levels of fear of future violence. Micro-analysis of communication during de-escalation incidents revealed staff with high fear react to a patient escalation, displaying emblems signalling ‘stop’, halting communication, whereas staff with low fear responded with continued co-speech gesture designed to facilitate communication. Conclusions. Fear may hinder staff adherence to de-escalation training principles, potentially impacting their interactions with escalating patients.

Thesis is embargoed until 31 December 2025.
Date of AwardDec 2024
Original languageEnglish
Awarding Institution
  • Queen's University Belfast
SupervisorBenjamin Brew (Supervisor) & Mary Lavelle (Supervisor)

Keywords

  • de-escalation
  • communication
  • conflict management
  • staff-patient interaction
  • inpatient mental health
  • violence
  • fear

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