Managing aggression in mental health hospitals is an important and challenging task for clinical nursing staff. Insufficient knowledge and skills about interacting with patients in a non-confrontational manner can initiate a vicious cycle, where restrictive interventions, such as limit setting, provoke further violence. De-escalation is recommended as an intervention that can avoid violence through psychosocial and verbal interventions. However, there is limited knowledge about what de-escalation and de-escalation processes are.

An integrative review using Whittemore and Knafl’s framework was undertaken to explore how the research literature defined and described de-escalation processes. De-escalation was described as experience based knowledge that could be organised under four themes: 1) Definitions and understanding, 2) Actions and strategies, 3) Competences and skills, and 4) Education and learning. These themes highlighted an emerging common understanding of de-escalation as a graduated solution of potential violence where staff members express empathy and solidarity with the patient. However, knowledge about how staff members learn de-escalation remains limited and more research is needed in order to develop efficient learning programs.

Keywords: De-escalation, integrative review, mental health, nursing, psychiatry, violence