Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review

Aim. This paper reports a study of staff and patient perspectives on the causes of patient aggression and the way it is managed.

Background.  The incidence of aggression in healthcare is reportedly on the increase, and concerns about the management of this problem are growing.

Method.  A convenience sample of 80 patients and 82 nurses from three inpatient mental healthcare wards were surveyed using The Management of Aggression and Violence Attitude Scale. A further five patients and five nurses from the same sample participated in a number of follow-up interviews.

Results.  Patients perceived environmental conditions and poor communication to be a significant precursor of aggressive behaviour. Nurses, in comparison, viewed the patients’ mental illnesses to be the main reason for aggression, although the negative impact of the inpatient environment was recognized. From interview responses, it was evident that both sets of respondents were dissatisfied with a restrictive and under-resourced provision that leads to interpersonal tensions.

Conclusion.  There are differences between the views of staff and patients about reasons for aggression and its management. Future approaches therefore need to be developed that address these opposing views. For example, training in the use of fundamental therapeutic communication skills was advocated by patients, whilst the need for greater attention to organizational deficits was advocated by nurses. A move away from reliance on the use of medication was also felt to be necessary. Evaluation of local needs and practices must be an integral part of this process.

Causes and management of patient aggression and violence: staff and patient perspectives

Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial

Background. Auditory hallucinations in psychosis often contain critical evaluations of the voice-hearer (for example, attacks on self-worth). A voice-hearer's experience with their dominant voice is a mirror of their social relationships in general, with experiences of feeling low in rank to both voices and others being associated with depression. However, the direction of the relationship between psychosis, depression and feeling subordinate is unclear.Method. Covariance structural equation modelling was used with data from 125 participants diagnosed with schizophrenia to compare three ‘causal’ models: (1) that depression leads to the appraisal of low social rank, voice power and distress; (2) that psychotic illness leads to voice activity (frequency, audibility), which in turn leads to depression and the appraisal of voices' power; (3) our hypothesized model, that perceptions of social rank and social power lead to the appraisal of voice power, distress and depression.Results. Findings supported model 3, suggesting that the appraisal of social power and rank are primary organizing schema underlying the appraisal of voice power, and the distress of voices.Conclusions. Voices can be seen to operate like external social relationships. Voice content and experience can mirror a person's social sense of being powerless and controlled by others. These findings suggest important new targets for intervention with cognitive and social therapy.

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/S0033291704002636

Interpersonal and role-related schema influence the relationship with the dominant 'voice ' in schizophrenia : a comparison of three models

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.

/pdf/dissociation-trauma-and-the-role-of-lived-experience-toward-yibb08x3co.pdf

Dissociation, Trauma, and the Role of Lived Experience: Toward a New Conceptualization of Voice Hearing.

A postal questionnaire survey was employed in regional secure and psychiatric intensive care units in England and Wales, in respect of mental health nurses' training in the use of physical restraint. The nurses' views were sought relating to their last experience of implementing the procedure. Whilst most nurses (n = 259, 96.3%) reported positive outcomes in so far that the incident was brought under control, the views of the aftereffects of the procedure were of concern and ambivalence. The literature suggests that service users did not necessarily hold the same positive views. A range of alternatives, which were consistent with the literature, was made by staff to improve intervention in the management of violence. Negative aspects relating to the use of physical restraint were also highlighted. They included procedural, injury, clinical and management issues. Some respondents also expressed concerns about the negative attitudes of their colleagues. The findings of this aspect of the survey highlights that the therapeutic value of physical restraint can only be achieved with appropriate monitoring and with emphasis on psychological intervention in the prevention and management of violence.

Views of nursing staff on the use of physical restraint

Journal of Advanced Nursing 31(5),1199–1205Beliefs about voices and their effects on coping strategiesCognitive behavioural techniques are increasingly used as adjuncts to medica-tion in the treatment of auditory hallucinations for people with schizophrenia.There are now literally hundreds of nurses trained in the use of cognitivebehavioural interventions for psychosis. However, there is still disagreementabout the nature of the cognitive processes that lead to deﬁcits or biases inpatients’ processing of information about their psychotic experiences. UsingChadwick & Birchwood’s Beliefs About Voices Questionnaire (BAVQ), theinvestigator collected data regarding voices from a sample of men and womenbeing treated for schizophrenia by secondary mental health services. Theinvestigator then carried out a cross-lagged panel analysis of the data. Theinvestigator found, as predicted, positive relationships between a resistivecoping style and an attribution of malevolence to voices, and between anengaging coping style and an attribution of benevolence to voices. Coping andattributional styles were not necessarily stable over time. There was anon-signiﬁcant difference between women’s and men’s attributions and copingstyles. There was less ﬂuctuation over time in the women’s scores on the BAVQ.This research shows that one cannot assume that either coping or attributionalstyle becomes more stable over time. However, while there are strongrelationships between attributions and coping styles, and particularly betweenmalevolence and resistance and benevolence and engagement, theserelationships are not necessarily mutually exclusive and some people in thestudy believe their voices to be both malevolent and benevolent. These ﬁndingssuggest that clinicians need to make a very careful assessment of attribution andcoping with regard to hallucinations and that systematic reassessment is veryimportant. Further research is necessary in both the phenomenology of

/pdf/beliefs-about-voices-and-their-effects-on-coping-strategies-52ev0r5b2p.pdf

Beliefs about voices and their effects on coping strategies

Background: The physical management of violence in psychiatric in-patient settings is of great concern and interest. However, there are no guidelines concerning training providers, course content, or course length, and little is known about injuries to staff during training. Aim: To investigate training in physical restraint in Psychiatric Intensive Care Units (PICUs) and Regional Secure Units (RSUs) in England and Wales, with a view to comparing course content and length, and injuries in training across the training providers cited by respondents. Method: Questionnaires were completed by randomly selected PICU and RSU nursing staff on 63 participating wards (of a total of 112 such wards in England and Wales). Results: 338 nurses (47% response rate) replied. Training in a wide variety of techniques was reported, although in practice a core curriculum can be identified. Few respondents were able to state which provider conducted their initial training. The reported length of initial training courses and re...

Physical restraint training for nurses in English and Welsh psychiatric intensive care and regional secure units

The survey examined training and practice in the prevention and management of violence in nurses working in acute in-patient psychiatric services throughout the UK Out of 2,152 questionnaires sent out, 771 completed responses were returned (36%) While the response rate was low, there were no obvious biases affecting it, and a high level of statistical power was attained The study is the largest survey of training in the prevention and management of violence in this population conducted so far Most respondents reported an acceptable ratio of theoretical input to practical skills training, although some important theoretical aspects received insufficient attention The use of wrist flexion and pain compliance elements in the restraining holds taught were frequently reported In clinical practice, breakaway techniques were reported as more frequently used than has been suggested in earlier research Some redundancies in restraint training were also found, with some commonly-taught techniques being seldom

Breakaway and physical restraint techniques in acute psychiatric nursing: Results from a national survey of training and practice

The content of management of violence policy documents in United Kingdom acute inpatient mental health services



Aim of the study. The aim of the study was to examine the content of Trust policies concerning the prevention and management of violence in acute in-patient settings in order to establish their usefulness as guidance for staff in this difficult, complex, and controversial aspect of inpatient psychiatric care.



Background. Violence is a commonly encountered problem in inpatient psychiatric settings. There are legal requirements for workplaces in general and mental health care facilities in particular to develop safe systems of work based upon the findings of assessments of this risk. Policies have a key role to play in making explicit the responsibilities of both employer and employees, and specifying standards of acceptable practice.



Design. A cross-sectional survey methodology was used, which entailed examination of the content of management of violence policies that had been forwarded to the authors from 40 Trusts providing acute inpatient psychiatric care throughout England, Scotland, Wales, and Northern Ireland.



Findings. Policies were found to vary widely in their content, and serious shortcomings were noted in the extent to which policies included information regarding their status and review, advice on the prevention of violence, the management of violent incidents, and postincident action.



Conclusions. Further research is needed to tease out the extent to policies which are lacking in content, reflect shortcomings in the organizational approach to the prevention and management of violence by Trusts, and the extent to which such shortcomings result in harm being suffered by staff and/or patients. An alternative format for the presentation of management of violence policies is discussed, and items that should be included in inpatient units' management of violence policies are suggested.

Jane Sayer

Papers

Views of nursing staff on the use of physical restraint

Beliefs about voices and their effects on coping strategies

Physical restraint training for nurses in English and Welsh psychiatric intensive care and regional secure units

Breakaway and physical restraint techniques in acute psychiatric nursing: Results from a national survey of training and practice

The content of management of violence policy documents in United Kingdom acute inpatient mental health services.