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Identifying mitigating and challenging beliefs in dealing with threatening patients: an analysis of experiences of clinicians working in a psychiatric intensive care unit

Published online by Cambridge University Press:  17 January 2012

Rachel E Evans  and
Soren Petter
Rachel E Evans*
Affiliation:
Trainee Clinical Psychologist, University College London, UK
Soren Petter
Affiliation:
HPC Registered Practitioner Psychologist, Lecturer in Psychology, School of Counselling Psychology and Psychotherapy, Regent’s College, London, UK
*
Correspondence to: Rachel Evans, Department of Clinical Psychology, 4th Floor, 1–19 Torrington Place, London, WC1E 7HB. E-mail: [email protected]
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Abstract

Background: Staff working on psychiatric intensive care units (PICUs) are routinely exposed to aggression or threats of aggression from the patients they care for. This phenomenon is identified as an ongoing factor that influences both work performance as well as staff sickness, and as such requires understanding and management.

Aims & method: This study utilized questionnaires assessing the extent to which PICU staff thought violence was a problem and how safe and supported they felt. Semi-structured interviews were conducted with five nurses to gather in-depth information on the factors involved in perceptions of safety and support.

Results: The analysis indicated that as a whole, staff feel safe and supported by their immediate team. Interview analysis produced two main domains and ten sub-domains of experiences that contribute to managing threats, these being grouped in either personal or systemic factors. It particularly highlighted that although patient aggression is a concern, the perception of threat most directly relates to beliefs about a lack of support from other teams and senior management, not the patients themselves.

Conclusions: More research and attention is needed on systemic factors in the management of threatening patients.

Keywords

PatientaggressionPICUstaff-supportsafetysystemic
Type
Original Research Article
Information
Journal of Psychiatric Intensive Care , Volume 8 , Issue 2 , August 2012 , pp. 113 - 119
Copyright
Copyright © NAPICU 2012

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References

Barker, C., Pistrang, N. and Elliott, R. (2002) Research Methods in Clinical Psychology: An Introduction For Students and Practitioners, 2nd ed. Chichester, Wiley.CrossRefGoogle Scholar
Benson, A., Secker, J., Balfe, E., Lipsedge, M., Robinson, S. and Walker, J. (2003) Discourses of blame: accounting for aggression and violence on an acute mental health inpatient unit. Social Science and Medicine. 57: 917–926.CrossRefGoogle Scholar
Boyatzis, R. E. (1998) Transforming Qualitative Information: Thematic Analysis and Code Development. London, Sage.Google Scholar
Chen, S.-C., Hwu, H.-G. and Williams, R. A. (2005) Psychiatric nurses' anxiety and cognition in managing psychiatric patients' aggression. Archives of Psychiatric Nursing. 19(3): 141–149.CrossRefGoogle ScholarPubMed
Currid, T. J. (2008) The lived experience and meaning of stress in acute mental health nurses. British Journal of Nursing. 17(14): 880–884.CrossRefGoogle ScholarPubMed
Cutcliffe, J. R. (1999) Qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems: a hermeneutic study. International Journal of Nursing Studies. 36(2): 105–116.CrossRefGoogle ScholarPubMed
Duxbury, J. and Whittington, R. (2005) Issues and innovations in nursing practice: causes and management of patient aggression and violence: staff and patient perspectives. Journal of Advanced Nursing. 50(5): 469–478.CrossRefGoogle Scholar
Ferns, T. (2006) Under-reporting of violent incidents against nursing staff. Nursing Standard. 20(40): 41–45.CrossRefGoogle ScholarPubMed
Flannery, R. B., Hanson, A. and Penk, W. (1995) Patients' threats: expanded definition of assault. General Hospital Psychiatry. 17: 451–453.CrossRefGoogle ScholarPubMed
Foster, C., Bowers, L. and Nijman, H. (2007) Aggressive behaviour on acute psychiatric wards: prevalence, severity and management. Journal of Advanced Nursing. 58(2): 140–149.CrossRefGoogle ScholarPubMed
Hatch-Maillette, M. A. and Scalora, M. J. (2002) Gender, sexual harassment, workplace violence, and risk assessment: convergence around psychiatric staff's perceptions of personal safety. Aggression and Violent Behaviour. 7: 271–291.CrossRefGoogle Scholar
Jonker, E. J., Goossens, P. J. J., Steenhuis, I. H. M. and Oud, N. E. (2008) Patient aggression in clinical psychiatry: perceptions of mental health nurses. Journal of Psychiatric and Mental Health Nursing. 15: 492–499.CrossRefGoogle ScholarPubMed
Lepping, P., Steinert, T., Needham, I., Abderhalden, C., Flammer, E. and Schmid, P. (2009) Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence. Journal of Psychiatric and Mental Health Nursing. 16: 629–635.CrossRefGoogle ScholarPubMed
Martin, T. and Daffern, M. (2006) Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting. Journal of Psychiatric and Mental Health Nursing. 13: 90–99.CrossRefGoogle Scholar
Menzies, I. E. P. (1960) A case-study in the functioning of social systems as a defence against anxiety: a report on a study of the nursing service of a general hospital. Human Relations. 13: 95–121.CrossRefGoogle Scholar
Paterson, B., Leadbetter, D., Miller, G. and Bowie, V. (2010) Re-framing the problem of workplace violence directed towards nurses in mental health services in the UK: a Work in progress. International Journal of Social Psychiatry. 56(3): 310–320.CrossRefGoogle Scholar
Pedro, A., Corace, K. M., Endler, N. S. and Calvo, M. G. (2003) Coping styles and threat processing. Personality and Individual Differences. 35: 843–861.Google Scholar
Pistrang, N. and Barker, C. (2010) Scientific, practical and personal decisions in selecting qualitative methods. In: Barkham, M., Hardy, G. E., Mellor-Clark, (eds) Developing and Delivering Practice-Based Evidence: A Guide for Psychological Therapies. Chichester, Wiley, pp. 65–90.Google Scholar
Privitera, M., Weisman, R., Cerulli, C., Tu, X. and Groman, A. (2005) Violence toward mental health staff and safety in the work environment. Occupational Medicine. 55: 480–486.CrossRefGoogle ScholarPubMed
Rossberg, J. I. and Friis, S. (2003) Staff members emotional reactions to aggressive and suicidal behaviour of inpatients. Psychiatric Services. 54(10): 1388–1394.CrossRefGoogle ScholarPubMed
Smith, J. A., Flowers, P. and Larkin, M. (2009) Interpretative Phenomenological Analysis: Theory Method and Research. London: Sage.Google Scholar
Wand, T. C. and Coulson, K. (2006) Zero tolerance: a policy in conflict with current opinion on aggression and violence management in health care. Australian Emergency Nursing Journal. 9: 163–170.CrossRefGoogle Scholar
Wykes, T. and Whittington, R. (1998) Prevalence and predictors of early traumatic stress reactions in assaulted psychiatric nurses. Journal of Forensic Psychiatry & Psychology. 9(3): 643–658.Google Scholar
Yardley, L. (2000). Dilemmas in qualitative health research. Psychology and Health. 15: 215–228.CrossRefGoogle Scholar