Violence Prevention Climate in General Adult Inpatient Mental Health Units: Validation study of the VPC‐14

Abstract

Ward social climate is an important contributor to patient outcomes in inpatient mental health services. Best understood as the general ‘vibe’ or ‘atmosphere’ on the unit, social climate has been subject to a significant research aimed at its quantification. One aspect of social climate, the violence prevention climate, describes the extent to which the ward is perceived as safe and protective against the occurrence of aggression by both the patients and the staff. The violence prevention climate scale (VPC‐14), developed in a UK forensic setting, was used in this study in a test of its validity in an Australian general mental health setting. The VPC‐14 was administered across eleven wards of one metropolitan Local Health District in Sydney, NSW. N = 213 valid responses from nursing staff and patients were returned (response rates 23.4 and 24.3%, respectively). The VPC‐14 demonstrated good internal reliability, and convergent validity was evidenced through moderate correlations with the WAS's anger and aggression subscale and the GMI total score. Concurrent validity was demonstrated by expected staff–patient differences in VPC‐14 rating and by correlations between incidents of conflict and containment on wards and the VPC‐14 ratings of staff and patients from those wards. Rasch analysis suggested that future tool development should focus on identifying ways to discriminate between ratings at the high end of the scale. The VPC‐14 supplies valid and useful information about the violence prevention climate in general adult mental health wards.

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

“…Scores on the staff actions factor in previously published research in an Australian general mental health inpatient setting ( N = 200 M = 37.1[5.4]) (Dickens et al, 2020) and a United Kingdom forensic mental health setting ( N = 281 M =36.9 [4.3]) (Hallett & Dickens, 2020) were greater than those reported in the current study (34.4[5.6]). Calculation of effect size between mental health and generalist settings (difference in mean scores divided by pooled standard deviation; Cohen (1988) suggests a moderate effect size ( d = 0.51) indicating that mental health staff report stronger agreement that they perform actions which are perceived to be associated with a more positive violence prevention climate (Lakens, 2013).…”

“…Hence, while we can confidently assert that the staff actions factor is measuring something , we can be less confident about whether that something is the violence prevention climate. Note, however, that such validity has been demonstrated in previous studies in mental health settings (Hallett et al, 2018; Dickens et al, 2020). Short‐term stability (test–retest reliability) and medium‐ to longer‐term sensitivity (ability to detect change) were not tested here and will require further examination in future research.…”

“…Factor 1 comprised eight items and accounted for 31.3% of variance in the data. The contributing items to factor 1 (1, 2, 4, 6, 8, 10, 13, 14) were all but one of the nine items found to comprise the staff actions factor in previous research conducted in a psychiatric setting (Dickens et al, 2020; Hallett et al, 2018). The ninth staff actions item (12) cross‐loaded (i.e.…”

“…The Violence Prevention Climate scale has been previously validated in forensic and general acute mental health settings, and there is a lack of appropriately validated instruments for use outside of this setting (Dickens et al, 2020; Hallett et al, 2018).…”

“…The scale consists of 14 items, with two subscales, staff actions and patient actions, answered on a 5‐point Likert scale from strongly agree to strongly disagree, with three reversed scored items (see Table 2; items 7, 9, 13). The scale is considered easy to administer, can be completed by staff and patients and be used to measure the effectiveness of organisational violence prevention policy and procedures (Dickens et al, 2020; Hallett et al, 2018). The Violence Prevention Climate scale was presented to a group of senior generalist healthcare staff ( n = 8) at the facility for face validity where the scale was to be used.…”