In psychiatric care, with its many diverse and complicated challenges, continuous professional development is not just beneficial—it's essential. This truth was recently underscored at the University Psychiatric Clinic of Ljubljana, Slovenia, where a group of experienced nursing staff participated in an intensive 5-day training course in conflict, personal safety and physical intervention skills.

The programme, delivered by Dynamis, was commissioned in response to staff requests for more in-depth training, aimed to equip these frontline healthcare professionals with enhanced skills to manage the most vulnerable and potentially volatile patients in the country's psychiatric services.

What were staff perspectives on the training's value?

In comments derived from over one hour of reflective discussion post-course, the overwhelming consensus among participants was clear: the training was not just valuable—it was transformative.

Staff members consistently expressed surprise at the depth and practicality of the course, emphasising that it exceeded their expectations in numerous ways.

How did the course impact staff and exceed expectations?

1. A practical, hands-on approach

One of the most appreciated aspects of the training was its practical nature. Participants highlighted the hands-on scenarios and role-playing exercises that allowed them to apply theoretical knowledge in simulated real-world situations. This approach was particularly praised for its effectiveness in reinforcing learning and building confidence.

As one staff member noted, "We'd like to see more of this and maintain contact with the instructor. He really met and exceeded expectations, because we worked on practical examples, not just sitting around or looking at slides."

2. Comprehensive coverage of de-escalation techniques

The course placed significant emphasis on de-escalation techniques, an area of critical importance in psychiatric care. Staff members reported gaining new insights into verbal de-escalation, body language, and initial patient approach strategies.

"De-escalation is, as always, the most important point," one participant reflected. "The approach, proper communication, proper posture, and facial expressions—those make a big difference. I think the most crucial is the first approach the patient sees."

3. Enhanced self-protection strategies

An unexpected but highly valued component of the training was the focus on self-protection techniques. Many staff members expressed that this was entirely new knowledge for them, highlighting a critical gap in their previous training.

"This is completely new knowledge to me—this self-protection technique. We never even thought about needing to protect ourselves in such a way," shared one participant, underscoring the importance of staff safety in psychiatric care settings.

Dynamis Lead Trainer Gerard O'Dea is well-known for emphasising that when staff are truly confident in being able to protect themselves from injury under a sudden assault, they will be more creative and persevere longer in the de-escalation phase of an encounter with a volatile patient, so improving outcomes for patient-staff relationships and the reduction of alarm-calls to other staff. As a result, the number of restraint incidents in a service reduces.

Our often-repeated "Oxygen-Mask" concept is that "in an aircraft emergency, the advice is always to ensure your own safety before engaging to help others". In the same way, staff must feel relatively safe if they are to effectively defuse a volatile person.

4. A patient centred approach

The training challenged staff to shift their perspective from task-oriented care to a more patient-centred approach. This paradigm shift was eye-opening for many participants, who recognised the potential for improved patient outcomes and cooperation.

"It opened our eyes to the fact that in the name of efficiency, we might be doing some things wrong, making the patient's treatment less pleasant and them less motivated to cooperate," one staff member reflected.

5. Legal and ethical considerations

Participants appreciated the course's emphasis on legal and ethical aspects of patient care. The training provided a framework for decision-making that prioritises patient rights while ensuring staff actions are defensible in a legal context.

"I really liked how we worked with the patient as if we were presenting our case in court. Always working according to the law, protecting ourselves and the patient," a participant noted.

As a European country the laws and guidelines in Slovenia adhere to shared key principles of dignity, respect and rights for those under care.

An interesting component of our approach (whether in the Middle East, Caribbean or Eastern Europe) is our ability to research and apply knowledge of local laws to the training content we are delivering to the staff team. We make this effort every time we work across country borders because as the research informs us, policies and procedures which support the staff are critical to transfer skills from the classroom into the corridors of the hospital.

What longer-term recommendations emerged that could improve psychiatric care?

While the immediate value of the training was clear, staff also recognised its potential for long-term impact on their practice and the broader psychiatric care system in Slovenia.

1. Provide regular refresher training to maintain build skills

Many participants emphasised the need for regular refresher courses to maintain and build upon the skills learned. They drew comparisons to international best practices, noting that some psychiatric facilities require annual training for all staff.

"It's very important to keep this knowledge fresh," one staff member emphasised. "I was surprised when our instructor mentioned that at psychiatric hospitals in the United Kingdom, before employees even start their job, they must go through training like this, and then they refresh it every year."

2. Expand de-escalation, personal safety and physical intervention training to all staff

Participants strongly recommended extending the training to all staff members, including doctors and administrative personnel. They believed this would create a more cohesive, patient-centred approach across the entire facility.

"For the future, I think everyone employed here should go through this. Not just the nursing staff, but the doctors too," suggested one participant. "It would prevent many incidents and injuries, and the approach to patients would become much friendlier."

3. Implement effective new protocols that emerge in training scenarios

The training highlighted areas where new protocols could enhance patient care and staff safety. Participants expressed hope that management would consider implementing some of the strategies learned during the course.

"The clinic should maybe think about that. After this training, it would be good to have a conversation about this and set some guidelines for the clinic because we've learned a lot," one staff member proposed.

4. Identify continuous improvement mechanisms from live training situations

Inspired by the training, staff members suggested implementing a system for continuous improvement, where they could anonymously report issues and collaborate on solutions without fear of blame.

"I thought it was great when the instructor said that while we have a department for quality and safety, we need someone to whom we can turn with our issues when we see problems on the ward. Together, we could look for solutions," a participant shared.

Is training with Dynamis a worthwhile investment in staff and patient care?

The resoundingly positive feedback from the University Psychiatric Clinic of Ljubljana staff underscores the significant value of this 5-day training course in managing conflict, personal safety and physical intervention skills.

By addressing crucial areas such as de-escalation techniques, self-protection strategies, patient-centred care, and legal considerations, the course has equipped these healthcare professionals with enhanced skills and renewed confidence in their ability to provide high-quality care to some of Slovenia's most vulnerable patients.

Moreover, the enthusiasm and insights shared by the participants highlight the broader implications of such training initiatives. They point to the potential for systemic improvements in psychiatric care delivery, emphasising the need for ongoing education, protocol refinement, and a culture of continuous improvement.

As one participant aptly summarised, "We gained a lot of knowledge, but we need to keep refreshing it, especially practically." This sentiment encapsulates the dual nature of the training's success: immediate skill enhancement coupled with a long-term vision for improved psychiatric care.

The management's decision to commission this course in response to staff requests demonstrates a commendable commitment to employee development and patient care quality. Such investments in staff training and empowerment will undoubtedly play a crucial role in shaping more effective, compassionate, and safe mental health services.

The very positive response to this training course serves as a powerful testament to the value of targeted, practical professional development in healthcare settings. It stands as a model for other institutions seeking to enhance their staff's capabilities and, ultimately, the quality of care provided to those in need of psychiatric services.