Aggression in Acute Inpatient Psychiatric Care: A Survey of Staff Attitudes

Abstract

Introduction Inpatient aggression poses consistent complications for psychiatric hospitals. It can affect patient and staff safety, morale, and quality of care. Research on staff attitudes toward patient aggression is sparse. Purpose The study explored staff attitudes toward patient aggression by hospital position types and years of experience in a psychiatric hospital. We predicted that staff experiencing patient aggression would be related to working in less trained positions, having less psychiatric work experience, and demonstrating attitudes that were consistent with attributes internal to the patient and not external. Methods Fifty-one percent completed online survey using Management of Aggression and Violence Attitude Scale, along with demographics, years of work experience, and number of times staff experienced aggressive event. Results Management of Aggression and Violence Attitude Scale scores, staff position types, and years of experience were related to the number of aggressive interactions. Nurses and psychiatric technicians reported highest number of exposures to patient aggression, followed by physicians; however, support staff reported less patient aggression. More years worked in a psychiatric hospital was associated with more aggressive experience. Conclusion Nurses, psychiatric technicians, and physicians reported greater exposure to patients’ aggression than support staff. Training programs, developed specifically to individual position types, focusing on recognition of sources of aggression, integrated into staff training, might reduce patient on staff aggression in psychiatric hospitals.

Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature

“…Five studies did not find any significant association [28,29,129,130,142]. In the remaining studies, the results are contradictory; increased risk for aggression or assault was found with more years of experience (z = 3.05; p < .002) [128] or OR = 0.95 (95% CI not provided; p = .001) [120], as well as with fewer years of experience (ARR = 1.23; 95% CI = 1.32-1.18 [141] and ARR = 3.08; 95% CI = 1.47-6.44 [140]). The contradictory results can not be explained by methodological differences, while both high and low scores on the OSQE were present for the different outcomes.…”

Safewards: An integrative review of the literature within inpatient and forensic mental health units

“…The way in which aggression and violence is perceived can both impact on how aggressive incidents manifest, and the subsequent staff response (Ezeobele et al . 2019). Specifically, ambivalence about the effectiveness of Safewards may reflect a belief that consumer safety cannot be influenced (Higgins et al .…”

“…More recently, the discourse has started to shift beyond the idea that consumers are responsible for creating risk, to recognizing ways in which the healthcare system itself may be responsible for harm towards consumers (Muir-Cochrane & Duxbury 2017). The way in which aggression and violence is perceived can both impact on how aggressive incidents manifest, and the subsequent staff response (Ezeobele et al 2019). Specifically, ambivalence about the effectiveness of Safewards may reflect a belief that consumer safety cannot be influenced (Higgins et al 2018) and a lack of confidence in utilizing non-restrictive practices to manage acute distress (Lim et al 2019;Maguire et al 2017).…”

Patient-on-Staff Assaults: Perspectives of Mental Health Staff at an Acute Inpatient Psychiatric Teaching Hospital in the United States

“…Mental health staff (MHS) are faced with the possibility of encountering assaultive events during their day-to-day activities with psychiatric patients. Psychiatric patients' assaults against staff are one of the greatest concerns facing inpatient psychiatric hospitals (Ezeobele, McBride, Engstrom, & Lane, 2019;Hackethal, 2016). Studies have shown that the assaulted staff experienced immediate physical and long-lasting psychological trauma, which may likely impact their professional and personal lives (Holleran & Mars, 2006;Jacobowitz, 2013;Jansen, Dassen, & Jebbink, 2005).…”

“…Some studies found that physicians at all levels were potentially exposed to workplace assault (Kowalenko et al, 2013;Phillips, 2016). The results from a study conducted in the United States on aggression and staff attitudes indicated that 13% participants reported they had experienced verbal abuse, 35% reported physical abuse, and 45% reported they had experienced both verbal and physical abuse (Ezeobele et al, 2019).…”