Comparison of patients’ and staff’s perspectives on the causes of violence and aggression in psychiatric inpatient settings: An integrative review

Abstract

What is known on the subject?• Aggression and violence are persistent problems in psychiatric inpatient units.• Violence preventive factors have been identified from both staff's and patients' perspectives.• Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. What this paper adds to existing knowledge?• This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture.• The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence.• The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. What are the implications for practice?• While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture.• Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion.• Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses.

What evidence supports the use of Body Worn Cameras in mental health inpatient wards? A systematic review and narrative synthesis of the effects of Body Worn Cameras in public sector services

“…However, conflict and violence in mental health wards is a complex issue that affects both staff and patients (Bowers 2014 ; Fletcher et al . 2021 ; Kumar et al . 2001 ).…”

“…However, conflict and violence in mental health wards is a complex issue that affects both staff and patients (Bowers 2014;Fletcher et al 2021;Kumar et al 2001). Research and audits conducted in inpatient services in England revealed patients often experience verbal abuse, fighting, bullying, theft, racism, and sexual assault (Care Quality Commission 2018;Jones et al 2010).…”

Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers

“…The findings of the study reflect the results of a document analysis from Hong Kong, which revealed that the local hospital guidelines may not support international standards regarding the reduced use of restrictive interventions [ 37 ]. Therefore, understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings [ 10 ].…”

“…Current explanation of reasons for aggression is a combination of factors embodied in patients, staff and the ward environment [ 7 ]. On the other hand, aggressive inpatient incidents have not been adequately explained in research [ 10 ]. When management of aggression is a focus of treatment, opinions for aggression should be shared from different points of view, including those of clinicians, patients, and families [ 8 ].…”

Psychiatry and/or recovery: a critical analysis

“…Alongside concerns regarding the validity of risk assessment in predicting suicide, there is also a strong argument that such practices implemented by health services to manage risk, such as formal observations, can be countertherapeutic and carry many costs to those with lived experience (Manuel et al 2018). A key determinant in the process of risk assessment is the person's psychiatric diagnosis; however, those with lived experience have suggested that increase in the risk of harm is linked to the clinical culture (Fletcher et al 2021).…”