Sex differences in aggressive incidents towards staff in secure services

Knowles, Susan Frances; Coyne, Sarah M.; Brown, Stephen L.

doi:10.1080/14789940801962130

Cited by 7 publications

(4 citation statements)

References 29 publications

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“…On the whole, the female service users seem to present with the most untoward incidents in terms of hostility, self‐harm, self‐harm urges, violent urges, suicide ideation and suicidal attempts. The aim of this study was not to compare sex differences per se in untoward incidents, so these data were not subject to any formal statistical analysis but the general pattern reported here is in line with sex differences reported elsewhere for male and female service users in medium secure settings (Knowles et al , 2008).…”

Section: Resultssupporting

confidence: 56%

Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings

Bagshaw

Lewis

Watt

2012

The Journal of Mental Health Training, Education and Practice

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PurposeThe aim is to determine whether staff ratings of service user attachment style are associated with service user misconduct during inpatient treatment in a medium secure mental health unit; also, to gauge whether staff can evaluate attachment style reliably.Design/methodology/approachRetrospective case note analysis on 55 inpatient treatment episodes were supplemented with staff ratings of service user attachment style. Records of untoward incidents were centrally retrieved. Kappa statistics were used to analyse levels of staff agreement regarding service user attachment style.FindingsAttachment style was associated with hostile episodes, treatment non‐compliance and service user aggression. Post hoc analysis on a subset of data yielded poor overall agreement in ratings of attachment style (Kappa=0.2). Further analysis revealed a sex‐based asymmetry with high consistency in ratings of female service users (Kappa=0.79) and very low inter‐rater reliability for male service users (Kappa=−0.05). It is important to note that the staff included in the interrater reliability analysis were female.Research limitations/implicationsThe sample was small, the observation period was short and staff conducting the ratings had no special training in the rating tool.Practical implicationsAttachment style per se played a significant part in the success and/or failure of service user treatment (when measured by misconduct). However, the validity of staffs' ratings of attachment style may interact systematically with the sex of staff and service users. These findings have important implications for the application of the concept of attachment in clinical settings.Social implicationsMental health professionals place central importance on the establishment of therapeutic relationships between clinicians and service users. Service user attachment style is assumed to play a role in mediating the success, or failure, of relationships with clinicians.Originality/valueThis study makes a novel contribution to the application of attachment theory to secure mental health care, it also demonstrates that gender is an important factor in staff appraisals of service users' approach to treatment.

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Section: Resultssupporting

confidence: 56%

Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings

Bagshaw

Lewis

Watt

2012

The Journal of Mental Health Training, Education and Practice

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“…Communication diffi culties are important triggers for aggression (Bjorkly, 1999). In a more recent study, patients in a medium-secure unit were found to be more likely to be aggressive towards a same-sex member of staff, although this depended upon the staff male-to-female ratio (Knowles et al, 2008), so gender mix as well as staffi ng levels require attention. Policies and staff training will also require further practical and research attention.…”

Section: Discussionmentioning

confidence: 98%

Recorded incidents in a high‐secure hospital: A descriptive analysis

Uppal

McMurran

2009

Criminal Behav Ment Health

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“…Yu and Holbeach (2021) related aggression to unplanned nursing staff leave and found a negative moderate correlation between RAGE scores and UNSL ( r = −.34). The effect of nurse gender on aggression was also explored with Knowles et al (2008) finding that male patients were more likely to assault male staff (after controlling for staff gender ratio). Virtanen et al (2011) found that male staff gender was associated with increased odds of assault on ward property (OR = 1.57, 95% CI: 1.26, 1.96).…”

Section: Resultsmentioning

confidence: 99%

“…Other variables that were investigated for their relationship with aggression were nurse experience, where Chou et al (2002) found that less experience was associated with increased experience of being assaulted (OR = .92, 95% CI: .91, .99), while more training was associated with decreased experience of assault (OR = 11.70, 95% CI: 1.18, 54.36). However, Ridenour et al (2015) reported that less time in the job was associated with less expe- The effect of nurse gender on aggression was also explored with Knowles et al (2008) finding that male patients were more likely to assault male staff (after controlling for staff gender ratio). Virtanen et al (2011) found that male staff gender was associated with increased odds of assault on ward property (OR = 1.57, 95% CI: 1.26, 1.96).…”

Section: Aggressionmentioning

confidence: 99%

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

Ngune

Myers

Cole

et al. 2023

Journal of Clinical Nursing

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BackgroundWhile nurse‐sensitive outcomes (NSOs) are well established in numerous health settings, to date there is no indicator suite of NSOs for inpatient mental health settings.AimTo assess the relationship between nursing variables and patient outcomes in acute inpatient mental health settings to determine which outcomes can be used as indicators of the quality of nursing care.MethodsDatabases accessed were CINAHL, MEDLINE, PsycINFO and EMBASE, last searched in May 2022. The review followed the 2020 PRISMA checklist for systematic reviews. Papers published between 1995 and 2022, conducted in acute mental health care units were included. The quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool. A meta‐analysis was not possible because of the large number of variables and measurement inconsistencies.ResultsA total of 57 studies were reviewed. Studies were categorised according to whether they found a significant or non‐significant relationship between nurse variables and patient outcomes. Seven outcomes—aggression, seclusion, restraint, absconding, pro‐re‐nata medications, special observations and self‐harm—were identified. For each outcome, there were significant findings for several nurse variables indicating that all included outcomes could be used as NSOs. However, evidence for aggression, seclusion and restraint use as suitable NSOs was more robust than the evidence for self‐harm, absconding, pro‐re‐nata medications and special observations.ConclusionAll the seven outcomes can all be used to develop an NSO indicator suite in mental health inpatient settings. More work is needed to establish high‐quality studies to clearly demonstrate the relationship between these outcome measures and changes in nurse variables such as nurse staffing, skill mix, work environment, nurse education and nurse experience.Patient and Public ContributionPatient or public contribution was not possible because of the type of the variables being explored.

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Sex differences in aggressive incidents towards staff in secure services

Cited by 7 publications

References 29 publications

Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings

Attachment theory‐based approaches to treatment and problem behaviour in a medium secure hospital: effects of staff gender on ratings

Recorded incidents in a high‐secure hospital: A descriptive analysis

Developing nurse‐sensitive outcomes in acute inpatient mental health settings—A systematic review

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