The Effect of a Care Bundle on Aggression Management in Patients with Psychotic Disorders: A Randomized Controlled Trial
M. Bulut, N. YıldırımIntroduction
There is a clear gap between international guidelines, which recommend replacing coercive aggression management methods with alternative interventions, and their inconsistent and unsystematic implementation in clinical practice. This situation underscores the need for evidence-based aggression management strategies. The care bundle approach, designed to standardize care and improve outcomes, is a promising solution.
Objectives
This study aimed to develop a care bundle for the management of aggression in patients diagnosed with schizophrenia and receiving inpatient treatment and to evaluate its clinical outcomes.
Methods
The study was conducted in two phases. 1) the aggression management care bundle was developed by conducting a systematic literature review according to the Bundle Design Guidelines. 2) the six-element care bundle was implemented in a male psychiatric ward of a regional hospital using a sequential randomized controlled trial design, and the outcomes were evaluated (Figure 1). The study was conducted with 24 patients (12 in the experimental group and 12 in the control group). Data were collected using the Patient Information Form, Buss-Perry Aggression Scale, Brøset Violence Checklist, Overt Aggression Scale, and Care Bundle Compliance Follow-up Schedule. Data were analyzed using Pearson’s chi-square test, independent samples t-test, Mann-Whitney U test, paired samples t-test, two-way ANOVA for multifactor analyses, and linear mixed model analyses for mixed models.
Results
Findings indicated a significant reduction in the experimental group’s total Buss-Perry Aggression Scale score and all subdimensions following care bundle implementation (p=0,001). The control group also exhibited decreases in total aggression (p=0,007), physical aggression (p=0,001), and anger scores (p=0,001). Intergroup pre-test–post-test differences were statistically significant in favor of the experimental group (p<0,001). Although Brøset Violence Checklist scores declined over time in both groups, no significant intergroup difference was observed (p>0,05). It was found that the BVC total score, irritability, boisterous, physical threat, and attack on objects sub-dimensions were affected by daily/momentary changes, while the confusion and verbal threat sub-dimensions were affected by the patient’s standard/permanent characteristics. According to the Overt Aggression Scale, aggressive incidents (control: 9, experimental: 6) and interventions applied did not differ significantly between groups (p>0,05). The care bundle demonstrated high clinical utility, with a 90,15% compliance rate.
Image 1: Long description.