Write a comprehensive conclusion that incorporates key points from each paragraph.

Step 1

Psychiatric facilities are filled with patients who readily exhibit aggressive, violent, and self-harming behaviors, all of which place the safety of patients and staff at risk (Paul et al., 2024). The problem stems from the widespread and frequent use of physical restraints in psychiatric patients to manage aggressive behaviors in acute psychiatric settings, although clinical guidelines recommend physical restraint use as a final resort due to its ability to cause anger, fear, frustration, physical harm, and psychological distress in psychiatric patients (Celofiga et al., 2022; Paul et al., 2024). Research findings recommend de-escalation strategies and techniques as the first choice in managing aggressive behaviors in psychiatric patients; however, there are limited research findings on the effectiveness of de-escalation techniques (Celofiga et al., 202). A further examination is needed to add to the body of knowledge and research literature regarding the effectiveness of de-escalation techniques in improving patient behaviors. Our proposed PICO question will further advance the current evidence-based knowledge in this area by closing the gap in research literature and providing a comprehensive understanding of the importance of effectively using de-escalation to improve patient behaviors (aggression, violence, and self-harming behaviors) and staff safety, thereby highlighting best clinical practices clinical guidelines to manage aggression in psychiatric patients. The PICO question of interest is: (P) adult patients hospitalized in an acute psychiatric facility; (I) de-escalation techniques; (C) compared to the use of physical restraints; (O) positive patient behaviors and improved staff safety. The PICO question written concisely seeks to address: In adult patients hospitalized in an acute psychiatric facility, does the use of de-escalation techniques result in having a positive impact on patient behavioral outcomes and staff safety when compared to traditional physical restraints?

History

Clinical nursing research guides nursing practice and improves the patient's quality of life (Polit et al., 2021). Research in nursing is formulated to produce evidence about important issues within the nursing profession, including nursing practice, informatics, education, and administration (Polit et al., 2021). Nursing research continues to grow over the past few decades and provides nurses with an evidence-based practice foundation (Pilot et al., 2023). Masters (2016) states psychiatric patients' being managed by restraints dates back at least 300 years. In the mid 1900's it became apparent that this may be a violation of a patient's civil rights (Masters, 2016). Cohen et al. (2024) expresses a solution to alleviate violating patients' rights is a structured physical restraint protocol, with clear indications and medical instructions for restraint. Ethical dilemma regarding appropriate physical restraint use is a socio-political issue related to nursing practice. The ethical principle at risk with restraints is respect for human dignity. Polit et al. (2021) states humans have the right to self-determination and right to full disclosure. This means the patient should be able to voluntarily decide whether to take part in a restraint (Polit et al., 2021). But when safety of staff or patient is at risk, using restraint becomes an ethical dilemma (Polit et al., 2021). From an ethical standpoint we do not want to remove a patient's autonomy and choice, but we need to keep the patient and staff safe.

Quality and Safety

In psychiatric nursing, creating a therapeutic and safe environment is central to quality care. Using non-restrictive approaches such as verbal de-escalation allows psychiatric nurses to manage behavioral crises while preserving patient autonomy and reducing the risk of retraumatization. These interventions are especially important for individuals with a history of trauma, as physical restraints can trigger fear, aggression, or psychological distress. The American Nurses Association (2023) emphasizes that fostering a culture of safety requires evidence-based, patient-centered practices that minimize harmvalues that align closely with the core principles of psychiatric nursing.

For psychiatric nurses, safety also means protecting themselves and their colleagues from workplace violence, which is a significant concern in acute mental health settings. By implementing de-escalation techniques, nurses are better equipped to respond to escalating behaviors calmly and effectively, which not only helps stabilize the patient but also prevents injury to staff. The ANA highlights the importance of proactive safety strategies, including communication training and interdisciplinary teamwork, to ensure safer outcomes for both patients and caregivers. These approaches empower psychiatric nurses to build trust, maintain control in high-stress situations, and support recovery-oriented care (American Nurses Association, 2023).

Nursing Theory

In considering theoretical frameworks relevant to the research, Roy's Adaptation Model provides empirical support, as it conceptualizes humans as biopsychosocial adaptive systems that utilize adaptive methods to cope with environmental stimuli (Flanagan & Beck, 2025). The primary objective of this model is to promote adaptation through modifying stimuli, which aligns with the research's focus of fostering a safer environment by altering the stimuli through encouraging the use of nonphysical de-escalation methods (Hosseini & Soltanian, 2022). Likewise, Roy's Adaptation Model consists of four subsystems of coping with environmental stimuli, consisting of physiological and physical responses, self-concept and group identify, role function, and interdependence (Flanagan & Beck, 2025). The physiological adaptive modes are relevant, as physical restraints are associated with physical injury and psychological distress, whereas nonphysical techniques aim to minimize emotional harm, mitigate physical repercussions, and promote self-regulation (Douglas et al., 2022). In reference to self-concept and group identity, nonphysical de-escalation approaches preserve patient autonomy and dignity, in contrast to physical restraints, which is often associated with diminished self-esteem and social isolation (Douglas et al., 2022). Roy's Adaptation Model also aligns with the study as the role function adaptive mode supports implementing nonphysical de-escalation methods that permit individuals to demonstrate how they would adapt in society (Douglas et al., 2022). The interdependence adaptive mode highlights the study's emphasis on minimizing physical restraint use while promoting nonphysical interventions to encourage patients to adapt to environmental stimuli through their own regulation methods (Hosseini & Soltanian, 2022). Moreover, Roy's Adaptation Model supports the implementation of nonphysical de-escalation methods through reinforcing biopsychosocial adaptive mechanisms to environmental stimuli (Flanagan & Beck, 2025).

Conclusion