Development of a Competency Enhancement Program for Professional Nurses in Caring for High-Risk Psychiatric and Drug Addiction Patients with Violent Tendencies at Crown Prince Hospital Loeng Nok Tha,Yasothon Province.

Abstract

      This action research aimed to develop a competency enhancement program for professional nurses caring for patients with serious mental illness and a high risk of violence (SMI-V), and compare nurses' competency levels before and after implementation of the developed program. Participants were purposively selected and comprised 12 registered nurses from a male internal medicine ward at Crown Prince Hospital Loeng Nok Tha, Yasothon Province. The study employed the participatory action research framework of Kemmis and McTaggart (1990). Research instruments consisted of a 40-item, seven-domain nursing competency questionnaire (Cronbach’s α = 0.958; Content Validity Index = 1.00) and a 34-item, seven-domain clinical skills observational checklist (CVI = 1.00). Quantitative data were analyzed using descriptive statistics and the Wilcoxon matched-pairs signed-rank test, while qualitative data were analyzed through content analysis.

      The findings revealed that the competency enhancement program for professional nurses caring for SMI-V patients at Crown Prince Hospital Loeng Nok Tha, Yasothon Province, comprised a four-phase developmental process as follows: 1) Planning Phase: situational analysis was conducted through focus group discussions, in-depth interviews, and systematic review of risk incidents using Root Cause Analysis, which revealed that nurses lacked knowledge and skills in violence risk assessment, de-escalation techniques, and systematic SMI-V patient management. A competency enhancement program was then collaboratively designed, consisting of a two-day theoretical training module and a five-day individually supervised clinical practicum. 2) Action Phase: the developed program was implemented through a blended online and on-site format, with a designated nurse competency developer responsible for demonstration, supervision, and provision of real-time feedback in the clinical environment. 3) Observation and Evaluation Phase: overall nursing competency following program participation was significantly higher than before participation at the .05 level of statistical significance (Z = −2.824, p = 0.002). The most pronounced improvement was observed in the Knowledge domain (Z = −2.934, p = 0.001), followed by Psychiatric Nursing Practice (Z = −2.845, p = 0.002), Personality Attributes (Z = −2.223, p = 0.024), and Cognitive Skills (Z = −2.312, p = 0.018). Post-program observational assessment further revealed that Communication and Therapeutic Relationship skills attained a very high performance level (mean = 2.94), while Environmental Management and Patient Safety reached a high level (mean = 2.71). 4) Reflection Phase: outcomes were discussed and synthesized into a finalized competency enhancement program for professional nurses caring for SMI-V patients, which is applicable to and effective in community hospital settings that lack dedicated psychiatric inpatient units.