Table 3 Development ideas from nurses, patients and informal caregivers

Helping attitude

“...understand what the patient needs” (Nurse, Group 1)

“I think ward staff should be more considerate towards patients.” (Patient, Group 1)

“...nurses should...understand their problems, why they would do so” (Informal caregiver, Group 1)

Communication

“For prevention, firstly, to the patients, some education, like public education, or let them have more understanding about the ward, the routine, environment, facilities, let them know their rights and obligations, regulations.” (Nurse, Group 1)

“When the nurse found that that patient started to behave differently, they would approach her, talk with her, find out the current condition…” (Patient, Group 1)

“I support the idea that talking with patients is very important, more time to talk with the patients is highly recommended.” (Informal caregiver, Group 1)

Structural changes

“To improve the environment, a better environment for the patient. Now it is so congested having 60 patients on the ward and 5 nurses, a 1 to 12 ratio, what kind of care can be expected? Besides staying in such a full ward…how can one be happy?” (Nurse, Group 2)

“Sleeping time could be longer. The sleeping bed is locked after 6.00…sometimes I feel sleepy after medication…actually taking a nap, would not disturb nurses…do not limit every patient’s sleeping time.” (Patient, Group 2)

“There are not enough healthcare professionals to talk with my daughter, like not enough social workers, clinical psychologists to talk with, let her vent out the emotion…just apply restraint when unhappy…need to have more nurses or volunteers, etc. to talk with them.” (Informal caregiver, Group 2)

Restrictive interventions

“Any stimulant or anything leading to less aggressive behaviour should be reduced…” (Nurse, Group 2)

“I think restraining the attacking patient on a bed would calm them down.” (Patient, Group 2)

“Try not to provoke the patient, try your best to accommodate her, not to say something negative.” (Informal caregiver, Group 1)

Self-management

“Need to calm yourself down, emotion management… keep calm” (Nurse, Group 1)

“I have to behave myself if I want to be discharged…if I have aggressive behavior, patients would be under restraint, more medication, delay the time of discharge.” (Patient, Group 1)

“Try not to provoke, try your best to accommodate…” (Informal caregiver, Group 2)

Assessment

“Should regard that patient as an unexpected …patient, so when taking blood pressure with the patient, should be more alert that he would attack others at anytime.” (Nurse, Group 2)

“I will be more cautious of patients’ facial expressions to enhance the alertness in the future.” (Patient, Group 1)

Creative activities

“…newspaper reading, art craft, exercise, iPad to spend time on, make life here less dull. Patients sitting here having different mental illnesses. If there are no activities for them to distract their thinking…would be easier to get more disorder of mind.” (Patient, Group 2)

“I suggest adding like an exercise bike, a treadmill for some patients to use their energy, not to attack others.” (Informal caregiver, Group 2)

Safety measures

“For the patient with violent propensity, a security guard would follow the patient within a 3-m distance.” (Nurse, Group 1)

“Security checks are needed to prevent inappropriate objects in the ward, this is important.” (Informal caregiver, Group 1)