The impact of a discarded diagnosis and focus on early warning signs of aggression on relations between user and municipal service providers: a narrative of a complex case

By means of a nurse-driven risk management strategy, a community mental health nursing team was assisted in their struggles to cope in the care of a very aggressive and disturbed patient. The aim of this study was to discuss how a wrong diagnosis lead to relational consequences in care and how applying the Early Recognition Method (ERM) contributed to a relational change. Self psychology concepts were used to analyze and understand the underlying psychological process in the interaction between the nurses and patient. This case narrative illustrates qualitative research strategies through the lens of the theoretical framework of symbolic interactionism. Nurses gained a better understanding of the complexity of the patient and the nature and effects of their interactions with her. The patient’s diagnosis was adjusted, resulting in perspectives that allowed for meaningful interactions and stabilization of aggressive behaviors. The most prominent result was the nurses becoming more confident and competent in their management of the care process. Nurses in community mental health care benefit from structured risk management strategies in unraveling the complexity of severe aggression. Self psychology is a meaningful lens by which to better understand the underlying psychological process in the interaction between nurses and a complex patient.