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Soenen C, Van Overmeire R, Six S, Bilsen J, De Backer L, Glazemakers I. Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines. J Psychiatr Ment Health Nurs 2023. [PMID: 36708052 DOI: 10.1111/jpm.12904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub-par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de-escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non-coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers is also needed. ABSTRACT INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures. AIM The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. METHOD A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. RESULTS Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. DISCUSSION In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace. IMPLICATIONS FOR PRACTICE Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.
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Affiliation(s)
- Clemens Soenen
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and Odisee University of Applied Sciences, Antwerp, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stefaan Six
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lieve De Backer
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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Nam S, Hong S, Kim H, Wong JYH, Fong DYT. Reliability and validity of the Korean 12-item Perception of Aggression Scale. J Psychiatr Ment Health Nurs 2022; 29:442-450. [PMID: 33780587 DOI: 10.1111/jpm.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The importance of and interest in nurses' attitudes towards and subjective experience with workplace violence in clinical settings is increasing. The prevalence of patient-perpetrated violence against Korean nurses in hospital settings is highly prevalent. Only few instruments are available to measure the nurses' perception of patient aggression in Korea. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to assess the linguistic and psychometric reliability and validity of an instrument that evaluates the attitude of Korean nursing staff towards patient-perpetrated workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This valid and reliable instrument could be used to assess and monitor the nurses' attitudes towards aggressive tendencies in the workplace. The results could contribute to the development of relevant interventions for coping with violence by patients towards nursing staff and the implementation of practical training to cultivate healthy perceptions towards patients to foster therapeutic nurse-patient relationships. ABSTRACT: Introduction Despite the high prevalence of patient-perpetrated violence against Korean nurses globally, reliable and valid measures of patient aggression are lacking in Korean. Aim We translated the 12-item Perception of Aggression Scale (POAS) into Korean and psychometrically assessed its utility in measuring nurses' attitudes towards aggression. Methods The 12-item Korean POAS was obtained through forward-backward translation and cognitive debriefing. It was administered online to 319 nurses (mean age = 32.64 years; females = 96.2%), of which 206 completed it again after two weeks. Confirmatory factor analysis validated the 3-factor structure as hypothesized in the original version. The intra-class correlation coefficient was used to assess the test-retest reliability. Results The originally hypothesized 3-factor structure showed a good fit. The 3 dimensions: aggression as a dysfunctional or undesirable phenomenon, aggression as a functional or comprehensible phenomenon, and aggression as a protective measure had internal consistencies of 0.74, 0.86 and 0.90 and corresponding ICCs of 0.70, 0.86 and 0.90, respectively. Discussion The 12-item Korean POAS is a valid and reliable scale that might aid investigating nurses' attitudes towards patient aggression. Implications for practice The 12-item Korean POAS can help Korean nurses adopt protective behaviours and develop interventions to cope with aggression.
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Affiliation(s)
- Sujin Nam
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Soyun Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Janet Yuen Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Lickiewicz J, Hughes PP, Makara-Studzinska M. Attitudes of psychiatric nurses towards aggression: A polish study. J Psychiatr Ment Health Nurs 2021; 28:856-866. [PMID: 33629500 DOI: 10.1111/jpm.12746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 12/23/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ABOUT THE SUBJECT? (SCIENTIFIC RATIONALE) Mental health care in Poland lags behind that of many other countries, and coercive measures are used on a regular basis. Scant research has been conducted in Poland regarding the treatment of psychiatric patients. The perspectives of Polish psychiatric nurses towards aggression remain unknown. WHAT DOES THIS PAPER ADD TO THE EXISTING KNOWLEDGE?: The translated and validated Attitude Towards Aggression Scale (ATAS) in Polish will serve as an instrument that gauges Polish nurses' attitudes towards aggression. The Polish nurses have unenlightened and negative attitude towards aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is now an instrument in Polish by which we can gauge the attitudes of mental health nurses, which must precede any educational efforts. Polish nurses showed more restrictive and antiquated attitudes about patient violence than nurses in some other parts of the world. With a shift to more positive attitudes, the use of coercion could be reduced, resulting in improved patient care. INTRODUCTION In Poland, the mode and site of patient treatment have changed little in the past 75 years, despite therapeutic advances worldwide. There is limited information regarding attitudes of nurses towards aggression in psychiatric settings in Poland, nor has there been an instrument in Polish to measure it. AIM To translate and validate the Attitudes Towards Aggression Scale (ATAS) for use in Poland, and to assess the attitudes of three groups of nursing personnel towards aggression. METHOD We surveyed 980 psychiatric and general nurses as well as nursing students. We translated the ATAS into Polish, and validated it using exploratory factor analysis. RESULTS The Polish version of the ATAS showed good psychometric properties. We found that Polish nurses perceived patient aggression extremely negatively. DISCUSSION Polish nurses perceive aggression as destructive, negative and not to be tolerated, leading to use of restraints. Among the three groups, psychiatric nurses showed the most negative attitude towards aggression. Thus, education is needed for preservice and inservice nurses alike to address this issue. WHAT THIS STUDY ADDS TO EXISTING EVIDENCE We now have a validated instrument to assess nurses' attitudes about aggression. We also know that Polish nurses have exceedingly negative attitudes towards aggression. IMPLICATIONS FOR PRACTICE The Polish version of ATAS was found valid and reliable. Therefore, we can now measure the attitudes of Polish nurses towards aggression, which was not possible previously. The baseline data provide a starting point from which to determine effects of educational efforts.
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Affiliation(s)
- Jakub Lickiewicz
- Health Psychology, Jagiellonian University Medical College, Krakow, Poland
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Wong WK, Chien WT. Testing psychometric properties of a Chinese version of perception of aggression scale. Asian J Psychiatr 2017; 25:213-217. [PMID: 28262153 DOI: 10.1016/j.ajp.2016.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/14/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
Abstract
AIM This study was to evaluate the psychometric properties of the Chinese version of the 12-item Perception of Aggression Scale (POAS). METHOD It consists of three phases of testing, including (1) translation and back-translation and content validity; (2) semantic equivalence between translated Chinese and original English version; and (3) construct validity, internal consistency and test-retest reliability. RESULTS The translated Chinese and back-translated English version showed excellent similarities and agreements between two independent translators. The Chinese version indicated high item- and scale-level content validity indexes (0.86-1.00) and satisfactory semantic equivalence with the original English language version (weighted kappa=0.48-0.90; intraclass correlation coefficient=0.91). Exploratory factor analysis in 249 nursing students resulted in three components (dysfunctional, functional and protective dimensions), explaining 64% of the total variance, with satisfactory internal consistency (Cronbach's alpha=0.76-0.83) and good 2-week test-retest reliability (Pearson's r=0.87). The Chinese version of POAS was found to be a valid and reliable tool to examine nurses' attitudes towards patient aggression. DISCUSSION Chinese nurses in this study viewed patient aggression to be an undesirable negative behaviour suggestive of uncontrollability behaviour presented by the patient under their care.
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Affiliation(s)
- Wai Kit Wong
- School of Nursing, The Hong Kong Polytechnic University, A102, Hung Hom, Hong Kong.
| | - Wai Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, A102, Hung Hom, Hong Kong
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Knotter MH, Stams GJJM, Moonen XMH, Wissink IB. Correlates of direct care staffs' attitudes towards aggression of persons with intellectual disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2016; 59:294-305. [PMID: 27665412 DOI: 10.1016/j.ridd.2016.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 09/06/2016] [Accepted: 09/11/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND AND AIM To explain direct care staff's attitudes (responsive or rejecting) towards aggression of clients with intellectual disability (ID), data were collected about client characteristics as well as individual and team characteristics of 475 direct care staff members, working in 71 teams. METHOD AND RESULTS Multilevel analyses revealed that a positive team climate was positively associated with both a rejecting and responsive attitude towards aggression. Senior staff members and females showed a less responsive attitude towards aggression, whereas a relatively high percentage of females in a team and a positive attitude towards external professionals were associated with a more responsive attitude towards aggression. Unexpectedly, staff who experienced less verbal and/or physical aggressive incidents of their clients with ID showed a more rejecting attitude towards aggression. Finally, characteristics of the clients with ID accounted for the largest part of the variance in the attitude towards aggression of direct care staff, in particular psychiatric diagnoses. CONCLUSIONS AND IMPLICATIONS Further research is necessary in order to understand how team processes affect the attitude towards aggression of direct care staff. Further it is recommended to provide direct care staff with knowledge about mental disorders in clients with ID.
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Affiliation(s)
- M H Knotter
- De Twentse ZorgCentra, Den Alerdinck 2, 7608 CM Almelo, The Netherlands.
| | - G J J M Stams
- University of Amsterdam, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands
| | - X M H Moonen
- University of Amsterdam, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands; Hogeschool Zuyd, Nieuw Eyckholt 300, 6419 DJ Heerlen, The Netherlands
| | - I B Wissink
- University of Amsterdam, Nieuwe Prinsengracht 130, 1018 VZ Amsterdam, The Netherlands
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Lamanna D, Ninkovic D, Vijayaratnam V, Balderson K, Spivak H, Brook S, Robertson D. Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives. J Ment Health 2016; 25:536-542. [PMID: 27809615 DOI: 10.1080/09638237.2016.1207222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND When the people hospitalized in psychiatric units demonstrate aggression, it harms individuals and creates legal and financial issues for hospitals. Aggression has been linked to inpatient, clinician and environmental characteristics. However, previous work primarily accessed clinicians' perspectives or administrative data and rarely incorporated inpatients' insights. This limits validity of findings and impedes comparisons of inpatient and clinician perspectives. AIMS This study explored and compared inpatient and clinician perspectives on the factors affecting verbal and physical aggression by psychiatric inpatients. METHODS This study used an interpretive theoretical framework. Fourteen inpatients and 10 clinicians were purposefully sampled and completed semi-structured interviews. Data were analyzed using inductive thematic analysis. RESULTS Six themes were identified at personal and organizational levels. The three person-level themes were major life stressors, experience of illness and interpersonal connections with clinicians. The three organization-level themes were physical confinement, behavioural restrictions and disengagement from treatment decisions. CONCLUSIONS Aggression is perceived to have a wide range of origins spanning personal experiences and organizational policies, suggesting that a wide range of prevention strategies are needed.
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Affiliation(s)
- Denise Lamanna
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada
| | - Danijela Ninkovic
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada
| | - Vinothini Vijayaratnam
- b Family and Community Medicine, St. Michael's Hospital , Toronto, Ontario , Canada , and
| | - Ken Balderson
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Harold Spivak
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Shelley Brook
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - David Robertson
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
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Heckemann B, Breimaier HE, Halfens RJ, Schols JM, Hahn S. The participant's perspective: learning from an aggression management training course for nurses. Insights from a qualitative interview study. Scand J Caring Sci 2016; 30:574-85. [DOI: 10.1111/scs.12281] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 07/27/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Birgit Heckemann
- CAPHRI; School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | | | - Ruud J.G. Halfens
- Department of Health Services Research; CAPHRI; School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Jos M.G.A. Schols
- Department of Health Services Research; CAPHRI; School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
- Department of Family Medicine; CAPHRI; School for Public Health and Primary Care; Maastricht University; Maastricht the Netherlands
| | - Sabine Hahn
- Bern University of Applied Sciences; Bern Switzerland
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Verhaeghe S, Duprez V, Beeckman D, Leys J, Van Meijel B, Van Hecke A. Mental Health Nurses' Attitudes and Perceived Self-Efficacy Toward Inpatient Aggression: A Cross-Sectional Study of Associations With Nurse-Related Characteristics. Perspect Psychiatr Care 2016; 52:12-24. [PMID: 25495430 DOI: 10.1111/ppc.12097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/25/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To explore mental health nurses' attitude and self-efficacy to adult inpatient aggression, and to explore the association with nurse-related characteristics. DESIGN AND METHOD Cross-sectional study in a sample of 219 mental health nurses in nine psychiatric hospitals, with stepwise linear regression analysis to detect predictive models. FINDINGS Female and less experienced nurses were less likely to blame patients for their behavior. Gender, burnout, secondary traumatic stress, and compassion satisfaction accounted for 26.2% of the variability in mental health nurses' self-efficacy toward aggression. PRACTICE IMPLICATIONS There needs to be attention to professional quality of life for mental health nurses, to provide them with of self-efficacy and a positive attitude toward coping with aggression.
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Affiliation(s)
- Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nursing, Vives University College Leuven, Roeselare, Belgium
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Joris Leys
- Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Berno Van Meijel
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Nursing Science, University Hospital Ghent, Ghent, Belgium
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Laiho T, Lindberg N, Joffe G, Putkonen H, Hottinen A, Kontio R, Sailas E. Psychiatric staff on the wards does not share attitudes on aggression. Int J Ment Health Syst 2014; 8:14. [PMID: 24778708 PMCID: PMC4002577 DOI: 10.1186/1752-4458-8-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent’s gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.
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Affiliation(s)
- Tero Laiho
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Nina Lindberg
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Faculty of Medicine, Forensic Psychiatry, University of Helsinki, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Hanna Putkonen
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Vanha Vaasa Hospital, Vaasa, Finland
| | - Anja Hottinen
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Raija Kontio
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
| | - Eila Sailas
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
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Soares MH, de Vargas D. [The translation and cultural adaptation of the Management of Aggression and Violence Attitude Scale - MAVAS - for nurses in Brazil]. Rev Esc Enferm USP 2013; 47:899-906. [PMID: 24310688 DOI: 10.1590/s0080-623420130000400018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 02/13/2013] [Indexed: 11/22/2022] Open
Abstract
This study translated and culturally adapted the Management of Aggression and Violence Attitude Scale - MAVAS - for use in Brazil (BR). The methodology followed the international guidelines for the cultural adaptation of psychometric scales: conceptual equivalence, semantic equivalence, items equivalence, and operational equivalence. A group of judges performed a content validity analysis that resulted in a 23-item scale divided into four factors with satisfactory content validity coefficients (CVCs) for the following parameters: clarity of language (CL; 0.88), practical relevance (PR; 0.91), and theoretical relevance (TR; 0.92). The data were collected in Londrina, state of Paraná, BR in 2011. The MAVAS was translated and culturally adapted for use in BR, and the MAVAS-BR exhibited satisfactory content validity. Future studies concerning the MAVAS-BR are suggested, including the evaluation of psychometric qualities, such as its construct validity and reliability.
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Affiliation(s)
- Marcos Hirata Soares
- Department of Nursing, Centro de Ciências da Saúde, Universidade Estadual de Londrina, LondrinaPR, Brasil,
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Knotter MH, Wissink IB, Moonen XMH, Stams GJJM, Jansen GJ. Staff's attitudes and reactions towards aggressive behaviour of clients with intellectual disabilities: a multi-level study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:1397-1407. [PMID: 23474992 DOI: 10.1016/j.ridd.2013.01.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 01/30/2013] [Accepted: 01/30/2013] [Indexed: 06/01/2023]
Abstract
Data were collected from 121 staff members (20 direct support staff teams) on background characteristics of the individual staff members and their teams (gender, age, years of work experience, position and education), the frequency and form of aggression of clients with an intellectual disability (verbal or physical), staff members' attitudes towards aggression, and the types of behavioural interventions they executed (providing personal space and behavioural boundary-setting, restricting freedom and the use of coercive measures). Additionally, client group characteristics (age of clients, type of care and client's level of intellectual disability) were assessed. Multilevel analyses (individual and contextual level) were performed to examine the relations between all studied variables and the behavioural interventions. The results showed that for providing personal space and behavioural boundary-setting as well as for restricting freedom, the proportion of variance explained by the context (staff team and client group characteristics) was three times larger than the proportion of variance explained by individual staff member characteristics. For using coercive measures, the context even accounted for 66% of the variance, whereas only 8% was explained by individual staff member characteristics. A negative attitude towards aggression of the direct support team as a whole proved to be an especially strong predictor of using coercive measures. To diminish the use of coercive measures, interventions should therefore be directed towards influencing the attitude of direct support teams instead of individual staff members.
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Affiliation(s)
- Maartje H Knotter
- De Twentse ZorgCentra, Den Alerdinck 2, 7608 CM Almelo, The Netherlands.
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Bilgin H, Tulek Z, Ozcan N. Psychometric properties of the Turkish version of the perception of aggression scale. J Psychiatr Ment Health Nurs 2011; 18:878-83. [PMID: 22074024 DOI: 10.1111/j.1365-2850.2011.01742.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate the psychometric properties of the Turkish version of the Perception of Aggression Scale. Cross-sectional data were collected by the completion of questionnaires by 350 nursing students from two nursing schools in Istanbul, Turkey. The psychometric properties of the Turkish version of the scale were analysed by using factor analysis (principal component analysis), assessment of internal consistency and reliability, and Spearman's rank correlation coefficients. The two-factor structure was confirmed by principal component analysis: the first factor treated aggression as functional and the second as dysfunctional. The correlation between the means of the items and dimensions was moderate (r for factor 1: 0.47-0.73; r for factor 2: 0.29-0.70). The coefficient of internal consistency of the scale was 0.85 for factor 1 and 0.81 for factor 2. Thus, Turkish version of Perception of Aggression Scale is a valid and reliable tool. It is essential to understand perceptions of aggressive behaviour in order to establish effective management strategies to tackle untoward events in clinical settings.
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Affiliation(s)
- H Bilgin
- Florence Nightingale School of Nursing, Istanbul, Turkey.
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Hahn S, Müller M, Needham I, Dassen T, Kok G, Halfens RJG. Measuring patient and visitor violence in general hospitals: feasibility of the SOVES-G-R, internal consistency and construct validity of the POAS-S and the POIS. J Clin Nurs 2011. [DOI: 10.1111/j.1365-2702.2011.03768.x 10.1111/j.1365-2702.2011.03768.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hahn S, Müller M, Needham I, Dassen T, Kok G, Halfens RJG. Measuring patient and visitor violence in general hospitals: feasibility of the SOVES-G-R, internal consistency and construct validity of the POAS-S and the POIS. J Clin Nurs 2011; 20:2519-30. [DOI: 10.1111/j.1365-2702.2011.03768.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulsford D, Duxbury JA, Hadi M. A survey of staff attitudes and responses to people with dementia who are aggressive in residential care settings. J Psychiatr Ment Health Nurs 2011; 18:97-104. [PMID: 21299721 DOI: 10.1111/j.1365-2850.2010.01646.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aggression is reportedly common among older people with dementia in residential care. The attitudes of staff in care homes and strategies they use are under researched. Theoretical models that may be used to both understand and respond to such behaviour exist. They are the standard and person-centred paradigms. The aim of this study was to explore the views of nursing staff about aggressive behaviour in people with dementia and strategies used in practice. A survey of the attitudes of staff in six dementia care units using the Management of Aggression in People with Dementia Attitude Questionnaire was conducted including an audit of aggressive incidents using the Staff Observation Aggression Scale-Revised over a 3-month period. Staff expressed views reflective of a person-centred as opposed to standard paradigm. They viewed aggressive behaviour by people with dementia as deriving from the environment, situation or interactions with others. Participants strongly supported interpersonal means of responding to aggression, the moderate use of medication, and were largely opposed to physical restraint. Aggressive incidents were managed using less intrusive strategies such as distraction and de-escalation. Responses to aggressive behaviour, while pragmatic, were largely underpinned by a person-centred ethic as reflected in the attitudes expressed by staff.
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Affiliation(s)
- D Pulsford
- School of Nursing & Caring Sciences, University of Central Lancashire, Preston, Lancashire, UK
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Nakahira M, Moyle W, Creedy D, Hitomi H. Attitudes toward dementia-related aggression among staff in Japanese aged care settings. J Clin Nurs 2008; 18:807-16. [DOI: 10.1111/j.1365-2702.2008.02479.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kottner J, Dassen T. An interrater reliability study of the Braden scale in two nursing homes. Int J Nurs Stud 2008; 45:1501-11. [DOI: 10.1016/j.ijnurstu.2008.02.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 02/04/2008] [Accepted: 02/20/2008] [Indexed: 10/22/2022]
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Jonker EJ, Goossens PJJ, Steenhuis IHM, Oud NE. Patient aggression in clinical psychiatry: perceptions of mental health nurses. J Psychiatr Ment Health Nurs 2008; 15:492-9. [PMID: 18638210 DOI: 10.1111/j.1365-2850.2008.01261.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Mental health nurses are faced with an increasing number of aggressive incidents during their daily practice. The coercive intervention of seclusion is often used to manage patient aggression in the Netherlands. However, GGZ Nederland, the Dutch association of service providers for mental health and addition care, has initiated a project to decrease the number of seclusions in clinical psychiatry. A first step in this project is to gain insight into the current situation: the perceived prevalence of patient aggression, the attitudes of mental health nurses towards patient aggression and those socio-demographic and psychosocial factors that contribute to the use of coercive interventions. A survey was undertaken among 113 nurses from six closed and semi-closed wards. In this survey, two questionnaires were used: (1) the Attitude Toward Aggression Scale; and (2) the Perceptions of the Prevalence of Aggression Scale. Variables derived from the Theory of Planned Behaviour were also measured. Nurses reported being regularly confronted with aggression in general and mostly with non-threatening verbal aggression. They perceived patient aggression as being destructive or offensive and not serving a protective or communicative function. The nurses generally perceived themselves as having control over patient behaviour (i.e. considerable self-efficacy) and reported considerable social support from colleagues. Although the nurses in this study were frequently confronted with aggression, they did not experience the aggression as a major problem.
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Affiliation(s)
- E J Jonker
- Innovation and Research, Adhesie Mental Health Care, Deventer, the Netherlands
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Nau J, Dassen T, Halfens R, Needham I. Nursing students' experiences in managing patient aggression. NURSE EDUCATION TODAY 2007; 27:933-46. [PMID: 17368872 DOI: 10.1016/j.nedt.2007.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 01/02/2007] [Accepted: 01/17/2007] [Indexed: 05/14/2023]
Abstract
BACKGROUND Nursing students are at high risk to become a victim of patient aggression. There is little evidence that training programmes developed for post-registered nurses or nurses in psychiatric or forensic settings can meet the needs of nursing students. To gain more insight into student nurses' educational outcomes in Germany the view of the target group was explored. METHODS Twelve nursing students participated in semi-structured interviews. Data were evaluated by qualitative content analysis. RESULTS Managing patient aggression is a general challenge for nursing students and is not confined to psychiatric settings. Specific problems of beginners became evident. Additionally, general issues were addressed on control of causes of aggression, interpretation aggressive situations, dealing with the aggressive patient, coping with stress, and organizational issues. CONCLUSION Nursing students need preparation and training in handling patient aggression. They should acquire knowledge about aggression, awareness of contributing problems, self-confidence in dealing with aggressive patients, assertiveness and empathy in communication and the ability to cope in an appropriate manner. In addition the safety policy of hospital placements should be examined for appropriateness to support nursing students.
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Affiliation(s)
- Johannes Nau
- Evangelisches Bildungszentrum für Pflegeberufe Stuttgart, Protestant Centre of Nursing Education Stuttgart gGmbH, Stöckachstrasse 48, 70190 Stuttgart, Germany.
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Jansen GJ, Middel B, Dassen TWN, Reijneveld MSA. Cross-cultural differences in psychiatric nurses' attitudes to inpatient aggression. Arch Psychiatr Nurs 2006; 20:82-93. [PMID: 16549245 DOI: 10.1016/j.apnu.2005.08.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2005] [Revised: 08/05/2005] [Accepted: 08/20/2005] [Indexed: 11/18/2022]
Abstract
Little is currently known about the attitudes of psychiatric nurses toward patient aggression, particularly from an international perspective. Attitudes toward patient aggression of psychiatric nurses from five European countries were investigated using a recently developed and tested attitude scale. Data were collected from a convenience sample of 1,769 student nurses and psychiatric nurses. Regression analysis was performed to identify personal and occupational characteristics of the respondents able to predict their attitude toward aggression. Analysis of variance was used to identify significant differences in attitudes between and among countries. Attitude was predicted by sex, contractual status (full vs. part time), and the type of ward on which subjects worked. With one exception (communicative attitude), attitudes differed across countries. More research on attitude formation is needed to determine which factors account for these differences.
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Affiliation(s)
- Gerard J Jansen
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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