Managers’ perceptions of competence and practice development following education in the prevention and management of staff-directed aggression: promoting person-centred practice

Abstract

Background: Staff-directed aggression and violence may have harmful implications for all parts of a mental health service organisation. In an effort to advance the development of competent practice in community mental health and substance abuse services in Oslo, the municipality has offered various courses in the prevention and management of staff-directed aggression and provided supportive tools for practice development. Aim: To explore managers’ perceptions of how participating in education and applying supportive tools have contributed to the development of competence and practice in their own services. Method: Qualitative interviews with 11 managers working in homebased community mental health services were analysed, using qualitative content analysis. Findings: The findings show education and application of tools contributed to: 1) increased awareness and understanding of the complexities of staff-directed aggression; 2) empowered and collaborative practice through negotiations of power relations; and 3) adjustment of perceived management responsibilities and assignments. Conclusion: The findings indicate that managers not only felt their staff had become more knowledgeable and competent following education, but that participation in education also impacted on collaboration within and outside their own services, as well as directly influencing how they dealt with threatening situations in the workplace. Implications for practice: Staff-directed aggression is a complex phenomenon and efficient practitioners are able to keep in mind a number of relevant aspects of practice simultaneously Collaboration in prevention and management of staff-directed aggression requires staff to acknowledge and accommodate service users’ perspectives regarding practice A levelling of power differentials between community mental health services and specialist mental health services takes place when partaking in the same education and sharing vocabulary and conceptual frameworks regarding risk assessment and management

Users' Perception of Violence and Conflicts With Professionals in Primary Care Centers Before and During COVID-19. A Qualitative Study

“…This paternalistic attitude seems to be defined by a lack of medical information received, lack of listening and little user participation in their own treatment decisions. The changes demanded by the users in our study are in line with those found in other studies in which community health center personnel are asked to change their professional attitude to allow the user to be an active part of his or her own health ( 19 , 46 , 47 ).…”

“…Many previous studies have shown that this type of training is an important factor in improving the work environment in the healthcare sector. The proposals made include training guided by professional psychologists, practical training with patient simulation, empowerment techniques, communication and empathy techniques and burnout prevention, among others ( 19 , 20 , 48 – 51 ). From our results, we also extract a proposal that aims to implement user satisfaction measures.…”

“…The participants in this study refer to demanding or very demanding users as the main cause. The literature points out that this type of users could be the consequence of high levels of stress, deficits in communication skills, advanced age, believing to be the only consumer of the service, family or personal problems, difficulty in following the rules or with severe psychopathology ( 19 , 20 , 24 , 35 ). The main problem with these users is that they cause discomfort and frustration in other users.…”

“…Previous qualitative studies based on health care personnel have provided relevant information on the experiences, needs, feelings and perceptions of professionals. The importance of staff training, the need to inform the user, the fear of aggression, the lack of reporting and the management of conflictive situations have also been evidenced ( 7 , 19 – 21 ).…”

Personal recovery and its challenges in forensic mental health: systematic review and thematic synthesis of the qualitative literature

“…Furthermore, previous studies suggest that optimising autonomy for service users may reduce aggression and violent incidents in forensic hospitals, as well as in general mental health services. [46][47][48]…”