Pediatric psychiatric inpatients' perspectives of aggression management: Discernment in the doorway.

Problem: Aggressive behavior is common on psychiatric inpatient units. Seclusion and restraint interventions to manage patients' aggressive behavior may have the consequence of being traumatizing for patients. Pediatric psychiatric patients' perspective on the use of seclusion and restraint interventions is not present in the literature. Methods: This hermeneutic nursing research study asked the question, "How might we understand children's experiences of seclusion and restraints on an inpatient psychiatric unit?" Four past pediatric psychiatric inpatients shared their hospitalization experiences that occurred within the previous year when they were 10 years old. The texts of the research interviews were compared to Attachment Theory for a deeper understanding of the meaning of the message. Findings: Participants commonly described experiences with seclusion and restraints as feeling trapped and alone in a dark room. They recommended the nurses step into the room with them to help them heal. Interpretively, the rooms on inpatient units could be considered as actual and metaphorical spaces of possible harm or healing. Conclusion: The participant's voices expand understanding of nurse's use of discernment at the doorway of a patient room to ensure the most therapeutic care is provided to the patient in these spaces through a secure nurse–patient relationship. Key Practitioner's Message: The pediatric psychiatric inpatient's perspective has not been included in the literature regarding the use of seclusion and restraints, so this research study was designed to understand their point of view on aggression management interventions.The participants in the research study expressed their views of preferred care with the united message that they do not want nurses to use secure rooms or security guards; instead, they need nurses to develop secure relationships with the patients to support them with their overwhelming feelings, to help them learn to cope, and to assist them to heal from their trauma.The nursing implication is for a nurse to discern in the doorway of the pediatric inpatient's room how they will interact with a child to ensure a therapeutic encounter of support and healing from trauma occurs within the secure nurse‐patient relationship. [ABSTRACT FROM AUTHOR]