Nursing practice in intensive psychiatry: moving from rigidity to
Martin Salzmann-Erikson, R.N., MHN, Ph.D.
PICUs provide care for those patients who suffer from the most severe symptoms during the
most acute phase of mental illness. While patient aggression and violence is addressed in the
PICU research literature, other severe symptoms are relevant within the PICU environment.
There is an absence in knowledge regarding how to effectively care for the most ill patients who
demonstrate agitation due to psychosis, delusional talk, and over-activity to mention a few
symptoms that are frequent in PICUs. The strategies that are reported in the research literature
mainly encompass four domains (i) prevention using risk assessment tools, (ii) providing care
with pharmacological interventions, (iii) providing care in terms of the practice of seclusion and
restraints, and (iv) providing care with less restrictive interventions. Research indicates a
discrepancy in ideologies in care. This is centred on whether to use a rigid approach in care and
correct deviant behaviour or to adopt a more flexible approach that includes involving staff in
care and activating patients rather than deactivating and confining..While research has
catalogued what nurses do in PICUs, questions related to how nursing is practiced have been
given less attention, while an investigation of why nursing practice is arranged in certain ways is
almost completely absent. In order to to decrease coercive measures it is important to stress
aspects that relates to care culture and the staff skills such as de-escalation techniques,
environmental factors and close involvement with patients, attitudes changing from control to
negotiation. Should nurses implement an ideology of reduction of stimuli, setting limits and
correcting deviant behaviours or should nurses adopt an ideology of “intensive” focusing upon
the close relationship between staff and patients and engaging in activities rather and the
opposite? In this workshop, the focus will be to discuss and elaborate how to care for those
psychiatric patients who suffers from the most severe symptoms based on Salzmann-Erikson’s
stability working model. The model posit that the overall aim in the care culture is to prevent,
maintain and restore stability when turbulence occurs. The many forms of nursing care that are
projected to intervene with turbulence are termed providing surveillance, being present, soothing,
trading information, maintaining security, and reducing.
Aim: to discuss caring ideology and nursing practice in intensive psychiatry.
Objectives: the objectives of the presenter is establish a framework for nursing and to identify
and clarify content nursing practice in the culture of intensive psychiatry.

Nursing practice in intensive psychiatry: moving from rigidity to