Table 2.

Experiences and Characteristics of Acute Agitation Care

Theme	Exemplar Physician and Nurse Quotes	Exemplar Parent and Adolescent Quotes
Identifying risk factors for acute agitation	“I think the kids with certain associated developmental disorders including autism seem to have a greater propensity or risk potential for agitation in part because it’s difficult to deploy some of the standard techniques.” (Physician)	“People asking her the same thing over and over, she gets agitated when she’s in pain… The wait time most definitely took a number one major role in it.’ (Parent) “Sometimes it can be as simple as being overtired or being hungry, but other times it seems to be random.” (Parent)
Worrying about safety and the risk of injury	“Some of these kids are 16, 17-years-old and larger than me. And if you’re literally stuck in this room by yourself and things go south that’s a really not great scenario.” (Physician) “Multiple times as we’re restraining… the patient lifts their head up and takes a big bite out of somebody.” (Physician)	“It makes it very difficult to both protect yourself, protect your child, and protect your things from incurring damages at the hands of your child.” (Parent)
Feeling moral distress	“Emergency department nurses like to fix things and make them better… It’s not like a popsicle is going to make this better.” (Nurse) “When you have four people on every limb of an eleven-year-old, it’s disturbing. There’s got to be another way.” (Nurse) “I think that we fail these patients, sadly.” (Nurse)	“The security puts me in the quiet room, and then when I calm down, let me out… Annoying. I hate them… I don’t know if they should pin down kids because that’s just brutal.” (Adolescent)
Shifting the culture towards patient-centered, trauma-informed care	“I’m old enough to [remember when] it was much more punitive, right?… It wasn’t a patient-centered approach… We also were not kind. It’s sad to say. It’s not something you want to look back on and I’m happy to see things have changed.” (Physician) “These behaviors are born out of being scared and it’s a trauma response, they don’t trust anyone and I think… most of these kids have really, really good reasons for that.” (Nurse)	“I specifically wanted a pediatric hospital. I love that this is so child-focused and child-centered.” (Parent)