Minimising formal coercion, such as seclusion, physical restraint, and forced medication, remains a global priority in acute mental health units. However, key drivers beyond individual-level features are poorly understood. This exploratory analysis was intended to identify the top functional, contextual, and interventional features linked to formal coercion in three Australian acute adult mental health inpatient units. Nested within a mixed concurrent control study, this feature analysis examined nurses' reports of 2955 de-escalation events over 324 days, from March 2024 to April 2025, including nurses' commentaries on the behavioural functions that triggered de-escalations. Fifteen inductively coded functional features were analysed alongside 15 contextual and 16 interventional features. Studied target variables included seclusion and physical restraint events and their durations, as-needed intramuscular psychotropic events, physical injury events, and Code Black activations. Features were analysed using bivariate statistics and machine learning techniques, including the Boruta algorithm for feature selection and random forest regressions for predictive modelling. Top drivers for the use of formal coercion included behavioural 'Responses to Challenging, Physical and External Stimuli,' incidents of self-harm, incidents directed towards nurses, and the application of specific de-escalation techniques. A hierarchy of behavioural functions is proposed as a by-product of this analysis. These findings provide nuanced insights into the drivers of formal coercion and the underlying value arrangements, as well as elevate the merit of ecological, bottom-up approaches in early warning signs work.

Children with unmet mental health needs from regional and rural settings experience compromised service access. A lack of skilled workforce is a key driver of this problem. This Australian-based two-phase mental health nurse led study aimed to co-design, develop and then trial the helpfulness of a six-week capability development training called the Lighthouse Project for supporters of rural children experiencing mental health challenges. Phase One of the study involved a co-design focus group of stakeholders (N = 20) with Phase Two being qualitative survey responses from supporter participants. Phase One group data confirmed lived experiences of restricted service access to mental health services. Core content and enabling mechanisms for the training to help mitigate that challenge were subsequently developed. Phase Two data (N = 79) reported four themes: (1) New knowledge and attitudes, (2) Practical application of learning, (3) Positive participant subjective experiences, and (4) Mechanisms supporting or hindering outcomes. Co-designed online capability training enables effective role shifting of introductory yet specialised child mental health interventions to rural parents, carers and other supporters. Mental health nurses can undertake key roles in delivering primary mental health interventions such as the Lighthouse project in the context of diminishing practice roles outside of tertiary mental health settings. This study was conducted under a small rural mental health grant from the Peregrine Centre.

Interventions aimed at reducing restrictive practices are also designed to enhance the service experience in acute mental health units. However, people with experience of coercive engagement with these services are seldom involved as active contributors in evaluative research on interventions to reduce restrictive practices. With the meaningful involvement of lived experience practitioners, this research was aimed at examining care recipients' service experiences and perspectives on nurses' therapeutic responses during the implementation of a de-escalation intervention in three adult inpatient units within New South Wales, Australia, from March 2024 to April 2025. Nested within a larger study employing a mixed concurrent control design, this research evaluated the effectiveness and process of the Safe Steps for De-escalation through comparisons of unmatched measures of empowerment, dehumanisation, and staff actions on violence prevention across three time points, as well as through a reflective thematic analysis of semi-structured interviews. Safe Steps is a structured approach for therapeutic responding, targeting nurses' relationship-promotion behaviours to increase focus on minimising the use of restrictive practices. Eighty-six inpatients completed the unmatched measures, with nine participating in interviews following discharge. No significant changes were noted in quantitative measures over time. Five themes emerged from the qualitative analysis: (i) Clarity calms; confusion harms, (ii) Control cuts deep, (iii) Systems strain; people break, (iv) Connection is treatment in itself, and (v) Meaning-making outweighs medicine. These findings cast acute inpatient units in a light akin to a power circuit, elevating the need to make inpatient admissions more reflective of everyday life outside the units.

Introduction Efforts to reduce restrictive practices in acute mental health units require more than operational reform; they also need to give voice to clinicians who implement these changes.Aim This paper forms part of a broader evaluation of the Safe Steps for De-escalation, which was aimed at investigating the impact of the Safe Steps implementation on the perceived professional quality of life of the nurse participants. This paper also presents a qualitative assessment of the process, aimed at identifying the factors that influence the successful implementation of the Safe Steps from the perspective of the nurse participants.Methods Safe Steps is a structured approach for de-escalation, intended to reduce restrictive practices and promote the development and maintenance of therapeutic relationships, as well as individuals' self-management. It was implemented in three adult inpatient units in New South Wales, Australia, from March 2024 to April 2025. This paper was nested within a mixed concurrent control study and was informed by a pragmatic and complex intervention research framework. Nurse focus group discussions were analysed using reflexive thematic analysis. Paired measures of compassion satisfaction, burnout, and compassion fatigue before and after one-year implementation were compared.Results Scores after implementation indicated a decline in compassion satisfaction and an increase in burnout, compared to the baseline. Two superordinate themes were identified from seven focus groups, with twenty-six nurse participants: (i) de-escalation is a relational, adaptive, and collective nursing practice, and (ii) ecological pressures shape the practice of de-escalation. These superordinate themes were developed from seven subordinate themes.Discussion A cautious interpretation of the quantitative measures is warranted, given the challenges of obtaining follow-up responses in busy, under-resourced inpatient units. The thematic findings suggest that successful implementation depends on the organisational and relational contexts in which interventions are deployed.Recommendations Future evaluations of the Safe Steps need to consider extending beyond nurses' relational capabilities to encompass the relational responsiveness of multidisciplinary teams.

This paper presents a reflective account of the implementation of the Safe Steps for De-escalation practice model over a 12-month period across three acute mental health units. It describes the implementation process of the model, designed to reduce restrictive practices in acute mental health settings. The Safe Steps model is a mental health nurse-designed and led approach for person-centred, structured and relational de-escalation. It positions therapeutic engagement, emotional attunement, and psychological safety as central components of effective responding, particularly during high-stress situations. The model offers a practical and adaptable resource for diverse acute care environments. This paper examines the implementation process and lessons learned from a multi-site evaluation of the Safe Steps model in a number of acute mental health units. The evaluation was guided by the complexity model of Skivington et al. (2021), which emphasises multifaceted real-world approaches to evaluation. Drawing on reflective accounts from the research and implementation leads, using practice-informed insights, the paper explores the opportunities, challenges and lessons learned in embedding a relational de-escalation model into everyday clinical practice. Particular attention is given to capability building, scenario-based learning, and team-based support strategies that facilitated implementation. The findings highlight the importance of leadership, emotional safety, and inclusion of the consumer voice in sustaining reductions in coercive practices. The paper offers practical insights for clinicians and researchers seeking to implement relational and trauma-informed approaches in acute mental health services.

A structured process of reviewing incidents of seclusion and physical restraint supports nurses in managing the emotional and relational impact of restrictive practices. However, these reviews are not a routine feature of everyday acute care provision, and have historically been influenced by practices that reflect a managerial or disciplinary focus. A retrospective before-and-after study was conducted in an adult acute mental health inpatient unit in regional New South Wales, Australia. The goal was to determine the impact of strengths-based restrictive practice review meetings from January 2019 to March 2020, with an equivalent timeframe before its implementation (October 2017-December 2018). The events of seclusion, physical restraint, and Code Blacks (emergency codes requiring security personnel in response to personal safety threats) were compared before and after the implementation of review meetings, with covariate balancing applied to enhance comparability. The reduction in the rate of seclusion was statistically significant post-implementation (incidence rate ratios [IRR] = 0.37, 95% CI [0.24, 0.57], p < 0.001). At the same time, physical restraint showed a statistically insignificant reduction (IRR = 0.76, 95% CI [0.53, 1.09], p = 0.14). Code Black incidents remained stable (IRR = 1.02, 95% CI [0.70, 1.49], p = 0.91). These mixed results indicate that strengths-based reviews play a role in reducing coercion, although additional strategies may be needed to achieve significant reductions in restrictive practice outcomes. Intervention development requires broader service-level changes, with open and robust evaluations that enhance accountability and capture key influencing factors.

ObjectivesDe-escalation is widely endorsed as an intentional strategy to replace and reduce restrictive practices in acute mental health units. However, high-quality evidence for its effective implementation remains limited. In response, a pragmatic, complexity-informed evaluation was undertaken to generate empirical support for the impact of an intervention, Safe Steps for De-escalation, on restrictive practices. The intervention centres on a four-step framework for therapeutic responding, with implementation supported by co-designed training and restrictive practice reviews.MethodsA mixed concurrent control study was conducted in three adult inpatient units in New South Wales, Australia, from March 2023 to April 2025. A priori weighted linear, linear mixed-effects, and generalised linear mixed-effects models were fitted between and within groups, to assess the impact of the intervention on restrictive practice events, including seclusion, physical restraint, as-needed intramuscular psychotropics, event duration, and physical injury. A priori hierarchical cluster analysis and between-cluster comparison were used to examine the most active de-escalation response components and any associated concurrent supplementary strategies contributing to the overall impact.ResultsCompared to three control sites, implementation sites had a lower total restrictive practice event rate (incidence rate ratio [IRR] = 0.65, 95% CI [0.60, 0.69], p <.001) over a twelve-month intervention period. At a granular level, implementation sites had lower IRRs for seclusion and as-needed intramuscular psychotropics than controls; however, within-group rates fluctuated over the year. Two clusters of de-escalation responses and additional supplementary strategies (including stimulus reduction, music, and one-on-one staff time) were noted. The differential associations between clusters and the outcomes were insignificant.ConclusionDespite mixed results, the evaluation offers support that structured therapeutic responding helps minimise restrictive practices, without evidence suggesting a substitution of one form of coercion for another.

There is a shared goal of organising reform efforts in mental health services to eliminate restrictive practices and improve therapeutic relationships. However, evidence on high-quality, culturally safe, co-produced, and strengths-based interventions and evaluations is limited, especially for complex interventions centred on therapeutic responding. In response, a multi-centre, mixed concurrent control study is underway to evaluate the Safe Steps for De-escalation, a multi-component intervention focused on a structured framework for mental health nurses' therapeutic responses to emotional distress and interpersonal conflict in acute adult mental health inpatient units. The aims of this evaluation were: 1) What is the effectiveness of Safe Steps in reducing restrictive practice events and duration and physical injuries? 2) Does Safe Steps improve people's service experience, perceived staff action towards violence prevention, and nurses' professional quality of life and emotionally intelligent workplace behaviours? 3) What factors influence the successful implementation of Safe Steps? It is hypothesised that: a) intervention sites will demonstrate more significant decreases in restrictive practice events and duration and physical injuries, compared to within-group baseline and control group, and b) measures of people's experiences and perceptions and nurses' outcomes and behaviours will improve, compared to within-group baseline. Safe Steps has three components: i) a structured de-escalation framework, ii) an in-person and online training programme, and iii) a regular conduct of strengths-based, data-informed restrictive practice review meetings. The control group will be usual care. Other outcomes include nursing intervention clusters, their associations with various outcomes, and factors influencing intervention implementation and restrictive practice use. There is no randomisation, but inverse probability weighting will be applied. The sample sizes were determined through power analyses and supporting evidence on saturation in qualitative research. Various quantitative and qualitative data treatments and measures will be undertaken to minimise research biases.

AIM:An analysis of mental health nursing de-escalation logs for 249 days from a regional adult inpatient unit in New South Wales, Australia, was completed to identify groups of cooccurring nursing therapeutic responses to aggression and examine their associations with reductions in restrictive practices and situational aggression. DESIGN:A single-centre retrospective study was undertaken. METHOD:Hierarchical clustering of nursing interventions established groups of cooccurring nursing responses. Poisson mixed-effect models were then used to determine the associations of the intervention clusters with restrictive practices. RESULTS:Two intervention clusters emerged: Cluster 1 involved verbal de-escalation with active listening and rapport building, whereas Cluster 2 included additional limit setting and problem-solving, distraction, sensory modulation, environmental change and individual staff time. Cluster 1 was linked with a reduction in seclusion use by 83% [IRR = 0.17, 95% CI (0.07, 0.41), p < 0.001], physical restraint by 79% [IRR = 0.21, 95% CI (0.11, 0.40), p < 0.001] and average judged situational aggression by 1.56 [95% CI (0.86, 2.25), p < 0.001]. Cluster 2 was related to statistically insignificant increases in the three studied outcomes. CONCLUSIONS:The intervention clusters prove the value of supplementary tools in surfacing nurses' therapeutic potential. The differences in restrictive practice use between intervention clusters signal the structure and progression of forming therapeutic relationships in aid of de-escalation and the possibility of assessing de-escalation components robustly. RELEVANCE TO CLINICAL PRACTICE:Acknowledging and supporting nurses' therapeutic work support the development of recovery-oriented care and a positive professional identity for nurses. REPORTING METHOD:This study followed the applicable STROBE guidelines. PATIENT OR PUBLIC INVOLVEMENT:Due to the study's retrospective nature, there was no service user or public involvement.

Mental health nurses are increasingly part of consultation-liaison psychiatry teams, yet their roles are not well documented. This is the second of a two-part paper examining a consultation-liaison psychiatry team consisting of medical, nursing and psychology staff within a major metropolitan health service in Victoria, Australia. An exploratory-descriptive qualitative design was used to examine the tri-disciplinary team (Part 1) and the mental health nursing role within it (Part 2) as documented by the organisation and articulated by team members. An audit of consultation-liaison psychiatry-related documents was conducted, and the content was analysed for references to the nursing role. Perspectives of team members were obtained through a focus group, and individual interviews, and examined using thematic analysis. The findings indicate the nurses practice at an advanced level with general and specialist mental health nursing expertise and are an integral part of the team. Two related themes were identified: mental health nurse consultants as an expert resource and a consistent presence. These themes converged into a central theme of conduit reflecting their connecting role both within the team and between the team and the nurses. Within the team, they made themselves available to orientate, educate and support team members. With the nurses, they shared a common identity and communication style, were trusted, and worked collaboratively with them in providing care. The study affirms the value of including mental health nurses as core members of CLP teams and their consistent presence positions them to lead improvements in mental health nursing practice.

Background Research in nursing and midwifery continues to grow and inform evidence-based practice. However, intentions to pursue an academic research pathway and heavy teaching workloads impede research outcomes in academia, with the nursing and midwifery academic workforce being at particular risk. Aim Determine research activity among the nursing and midwifery academic Australian workforce and explore how academic roles, qualifications, tenure, and workload profiles influence research engagement, productivity, and outcomes. Methods An online survey was circulated throughout Australian universities, social media platforms, and professional websites. Data were analysed using descriptive and inferential statistics. Results Of the 250 respondents, the majority (n=164) were research-active and were employed in blended teaching and research roles (n = 126). Tenured academics reported a significantly higher rate of research-active status (p <= 0.001). The mean number of papers published in the previous 12 months was 3.31 (Standard Deviation [SD] 2.28), with a career mean of 26.47 (SD 46.25). Respondents who were research active were engaged in Higher Degree Research (HDR) supervision, and research-active academics were more likely to apply for and be successful in grant outcomes (p<.001); however, they had lower levels of satisfaction with workload. Discussion Job security through tenure is significantly associated with research activity, indicating that research productivity may be lost through non-tenured positions. Whilst research-active respondents were engaged in HDR supervision, which is essential for workforce growth and scholarship, a significant portion were not, placing the workforce pipeline at risk. Conclusion Research activity in academia is essential for tenure and to support evidence-based practice. By fostering enabling research environments, the contribution of nursing and midwifery academics to support evidence-based practice and scholarship can be enhanced. (c) 2025 The Author(s). Published by Elsevier Ltd on behalf of Australian College of Nursing Ltd. This is an open access article under the CC BY-NC-ND license.

Aim: To identify the strategies that clinical champions implemented within emergency departments to initiate and sustain routine intimate partner violence (IPV) screening. Background: For effective IPV identification and responses to occur within healthcare settings, new attitudinal and practice changes are required. This paper adds to the body of knowledge about champions and their role within healthcare settings to achieve this end. Design: This qualitative study involved semistructured interviews with 23 individuals over a 2-year period who identified as champions and worked to introduce routine IPV screening in two hospital emergency departments. Data from transcribed interviews were analysed thematically using an interpretive framework and a process of constant comparison. Results: Champions detailed a range of strategies they employed to foster practice change. The primary strategies were as follows: normalising enquiring about IPV through narrative practice, building understanding and ownership, providing accompaniment, serving as an educator and resource person, and managing resistance. Conclusions and Implications: This paper highlights the specific complexities champions face when bringing about practice change in the area of IPV. The findings suggest nurse champions, particularly those working in the IPV space, adopt unique strategies compared to those described in the mainstream literature on champions. This evidence has implications for best practice and can ensure that the champion role is more effectively utilised by health services to better meet the needs of individuals experiencing IPV. It is recommended that champions be established as part of any IPV practice change process. Introduction of IPV education into nursing undergraduate and postgraduate education and workplace ongoing education and training is also recommended to strengthen the capacity of nursing staff to serve as IPV practice change champions.

The body acquires knowledge through interactions with the world. This knowledge resides in the body and shapes our physical, social and emotional experiences. Older adults possess extensive embodied knowledge, but its expression can be suppressed by environmental and social change, such as relocating to a residential care home (RCH). Dancing is more than movement; it is an embodied activity that involves complex interactions among the body, space, time and other people. Dance has been shown to benefit older adults, yet existing research often focuses on physical and cognitive outcomes, with limited attention to dance as an embodied lived experience, especially in an RCH context. This study explores six older adults' lived experiences of dancing. Its interpretative phenomenological analysis reveals that participants possessed a vast reserve of embodied knowledge which emerged when they participated in synchronised seated dance. Two superordinate themes - embodied musicality and rekindled connections to the lifeworld - detail how older adults expressed embodied knowledge during dance, becoming connected with their body, space, time and others, nurturing a sense of self. Dancing also helped participants navigate the changes in their body and environment, enriching their living experience in an RCH. The findings contribute to the broader field of dance research, demonstrating how seated dance facilitates accessing and expressing embodied knowledge later in life, and to the limited research on dance in RCHs, positioning dance as a meaningful mode of self-expression and continuity for older adults, supporting their transition to these settings with rich emotional experiences.