Prevalence and predictors of early traumatic stress reactions in assaulted psychiatric nurses

Workplace violence and risk factors for PTSD among psychiatric nurses: Systematic review and directions for future research and practice

WHAT IS KNOWN ON THE SUBJECT?: Trauma among psychiatric nurses and other healthcare workers is related to workplace violence, but other risk factors may also contribute, including those occurring before, during or after workplace violence. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: Most previously identified PTSD risk factors were not tested or supported in research with psychiatric nurses, although there is promising evidence for risk factors including severe or injurious assault, cumulative exposure, burnout, and other worker characteristics. We identify directions for research needed to improve knowledge, including collecting data before nurses experience workplace violence, defining workplace risk factors consistently and conducting and reporting qualitative analysis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Provide training in risk assessment and violence prevention to psychiatric nurses. Offer mental health support to those exposed to violence, especially with cumulative exposure. ABSTRACT: Introduction Psychiatric nurses are at risk of workplace violence and post-traumatic stress disorder (PTSD). There is limited understanding of pre-trauma and post-trauma risk factors. Aim Our aim was to review factors associated with workplace PTSD in psychiatric nurses. Method We searched quantitative and qualitative studies from 1980 to 2019 in 23 databases plus abstracts for studies on psychiatric hospital nursing staff, potentially traumatic workplace events, workplace factors and PTSD. Following duplicate abstract (n = 10,064) and full-text (n = 199) screening, data were extracted in duplicate from 19 studies. Using best-fit framework synthesis, we identified workplace violence, pre-trauma and post-trauma risk factors. Results Six variables yielded evidence in at least two empirical studies scoring at least 6/8 on a quality measure, or one such study plus more than one other study ("promising": severe/injurious assault, cumulative exposure, burnout, poor mental health, low compassion satisfaction, neuroticism). Four were supported by at least one better quality study or at least two others ("suggestive": gender, poor training, any physical aggression exposure, compassion fatigue). Discussion Pre-trauma measures, consistent definitions of workplace exposures and thorough reporting of quantitative results are needed to improve research. Implications for Practice Violence prevention and mental health care for exposed nurses appear the most promising targets for PTSD prevention. Therefore, it is particularly important to understand workplace violence and mental health among nurses working in psychiatric hospitals.

The influence of coping and cognitive appraisal in predicting Posttraumatic Stress Disorder: A prospective study on workplace violence in psychiatric staff in Denmark

BACKGROUND: Since psychiatric staff experience a high occurrence of workplace violence and subsequent Posttraumatic Stress Disorder (PTSD), it is important to assess the behavioral and cognitive risk factors of PTSD in this population. OBJECTIVE: The current study assesses the incidence of PTSD 12 months after the occurrence of WV. Furthermore, it examines possible prospective associations between coping strategies and cognitive appraisals, respectively, and PTSD. METHODS: This prospective cohort study was conducted with staff from 18 psychiatric wards in Denmark (n = 183) who had reported an incidence of workplace violence. Most subjects were women (83.3%). RESULTS: The incidence of PTSD was 9.8%. The main analysis showed a significant relationship between negative cognitive appraisals about the self and PTSD (OR = 2.87, p < .05), and a coping strategy of self-blame and PTSD (OR = 2.21, p < .05). CONCLUSIONS: Certain dysfunctional coping strategies and negative cognitive appraisals seems to predict posttraumatic stress in an occupational context. Information about these processes could be important for preventive strategies in the workplace.

The Effect of Abuse and Mistreatment on Healthcare Providers (TEAM): A Survey Assessing the Prevalence of Aggression From Patients and Their Families and Its Impact

OBJECTIVE

Aggression from patients and families on health care providers (HCP) is common yet understudied. We measured its prevalence and impact on HCPs in inpatient and outpatient settings.

METHODS

Four thousand six hundred seven HCPs employed by a community teaching hospital received an anonymous survey with results analyzed.

RESULTS

Of 1609 HCPs (35%) completing the survey, 88% of inpatient staff reported experiencing different types of aggression compared to 82% in outpatient setting. Almost half did not report it to their supervisor. Younger staff were more likely to report abuse. Negative impacts on productivity and patient care were reported. A third of all responders' indicated negative effects on mental health.

CONCLUSIONS

Despite negative impacts on staff wellbeing and productivity, patient/family aggression toward HCPs is highly prevalent and underreported. Our healthcare system needs measures to address staff security and wellness.

Effects of Indirect Experience of Client Violence on Social Workers' Posttraumatic Stress Disorder

OBJECTIVE

This study aims to empirically determine if indirect exposure to client violence has significant negative effects on social workers' posttraumatic stress disorder (PTSD) the same way direct victimization does.

METHODS

Using a sample of 1,359 social workers drawn from the data collected by the Seoul Association of Social Workers, this study employs descriptive statistics to examine the prevalence of indirect experiences with client violence, and utilizes a series of hierarchical regression analyses to demonstrate the potential impact of indirect exposure to client violence on PTSD. To assess the severity of PTSD symptoms in participants, the Korean version of the Impact of Events Scale-Revised (IES-R-K) was employed.

RESULTS

A descriptive analysis shows that 12.4% of the sample indirectly experienced client violence by witnessing it or hearing about a violent incident, whereas 6.0% were directly victimized. Hierarchical regression analyses indicate that direct experience (B=4.548, p<0.05) and indirect experience (B=7.297, p<0.001) of client violence have a significant association with the scores on IES-R-K. An investigation of the interaction terms between experiences of client violence and violence-prevention training illustrates that such training significantly moderates the influence on the scores on IES-R-K from indirect exposure to client violence (B=-8.639, p<0.01).

CONCLUSION

Social workers who are indirectly exposed to client violence experience PTSD symptoms comparable to their colleagues who were directly victimized. Further, violence-prevention training has greater ameliorative effects with regard to indirect experience of client violence than for direct victimization.

Risk assessment of workplace violence towards health workers in a Chinese hospital: a cross-sectional study

OBJECTIVE

This study aimed to assess the risk factors associated with workplace violence towards health workers (HWs) in a Chinese hospital.

METHODS

We conducted a cross-sectional survey in a Chinese secondary hospital in 2019 using an international survey questionnaire, and collected valid data from 1028 HW respondents via mobile phone. Alongside analysing the potential association between exposure to violence and respondents' characteristics, we compared the workplace violence between this survey and a baseline survey in the same hospital using the same questionnaire in 2018, and investigated the existing measures.

RESULTS

A total of 5.45% of respondents had encountered physical violence while 41.63% had experienced psychological violence. Women (OR=3.45, 95% CI 1.87 to 6.38), those working in outpatient and emergency departments (OR=7.96, 95% CI 2.27 to 27.95), and those with extremely high concern about workplace violence (OR=7.94, 95% CI 1.04 to 60.85) were significantly more likely to suffer physical violence. Working in the outpatient and emergency department (OR=2.03, 95% CI 1.23 to 3.34), having direct physical contact/interaction with patients (OR=2.98, 95% CI 1.62 to 5.49), and extremely high worry about workplace violence (OR=6.47 95% CI 3.38 to 12.40) significantly increased the risk of psychological violence. When the results of the baseline survey were compared with those in this survey, it was shown that physical violence declined significantly from 8.79% in 2018 to 5.45% in 2019, while psychological violence declined significantly from 47.14% in 2018 to 41.63% in 2019. The most recognised measures were security measures (81.03%) while the least recognised measures were check-in procedures for staff (11.19%).

CONCLUSION

Workplace violence towards HWs is a global problem with country-specific features. In our study, workplace violence in the hospital is of great concern. While demonstrating the effectiveness of measures in some degree, there is significant room for improvement. To achieve the vision of 'zero violence' in the health sector, aligned comprehensive measures should be systematically adopted.

Work-related post-traumatic stress disorder: report of five cases

Post-traumatic stress disorder (PTSD) may arise after events involving a risk to physical integrity or to life, one's own or that of others. It is characterized by intrusive symptoms, avoidance behaviors, and hyper-excitability. Outside certain categories (e.g., military and police), the syndrome is rarely described in the occupational setting. We report here five unusual cases of work-related PTSD, diagnosed with an interdisciplinary protocol (occupational health visit, psychiatric interview, psychological counselling and testing): (1) a 51-yr-old woman who had undergone three armed robbery attempts while working in a peripheral post office; (2) a 53-yr-old maintenance workman who had suffered serious burns on the job; (3) a 33-yr-old beauty center receptionist after sexual harassment and stalking by her male employer; (4) a 57-yr-old male psychiatrist assaulted by a psychotic outpatient; (5) a 40-yr-old woman, sales manager in a shoe store, after physical aggression by a thief. All patients required psychiatric help and pharmacological treatment, with difficulty of varying degrees in resuming work. We conclude that PTSD can develop even in professional categories generally considered to be at low risk. In such cases, a correct interdisciplinary diagnostic approach is fundamental for addressing therapy and for medico-legal actions.

Occupational Violence and PTSD-Symptoms: A Prospective Study on the Indirect Effects of Violence Through Time Pressure and Nontraumatic Strains in the Occupational Context

OBJECTIVE

The aim of this study was to assess whether frequency of occupational violence (OV) affects posttraumatic stress disorder (PTSD) symptoms through nontraumatic strains in the occupational context.

METHODS

Twelve-month prospective survey data on 1763 Social educators were used. Path-analysis measured direct and indirect pathways of frequency of OV on PTSD through change in time pressure, change in burnout, change in sense of safety at work, and change in coping with regret in patient work.

RESULTS

Forty-two pct. of the variance in PTSD symptoms was predicted; F (20, 1541) = 36.8, P < 0.001, R = 0.42. Frequency of OV indirectly affected level of PTSD through all the mediators; estimated indirect effects = 0.14, 95% confidence interval 0.07 to 0.22.

CONCLUSION

PTSD resulting from OV is not only a result of the violent acts themselves but is also caused by nontraumatic strains. It is essential to include the broader context of work environment factors in prevention of work-related PTSD.

Does acute stress disorder predict posttraumatic stress disorder following workplace violence? A prospective study of psychiatric staff

OBJECTIVES

Psychiatric staff is at risk of workplace violence (WV) and subsequent posttraumatic symptomatology. The current study assesses the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in psychiatric staff following WV. This also examines the prospective association between ASD and PTSD.

METHODS

This is a prospective cohort study of staff from 18 psychiatric wards in Denmark (n = 250), that reported an incident of workplace violence.

RESULTS

The prevalence of ASD was 10.8%, while 8% had PTSD 3 months post-assault. Generalized linear mixed models showed a significant predictive power of ASD on PTSD (OR 8.45, p < 0.001) in the fully adjusted model.

CONCLUSIONS

ASD seems to be a predictor of future PTSD in an occupational context and should be considered a possible instrument in enactment of preventive strategies.

Experiencing and Witnessing Patient Violence - an Occupational Risk for Outpatient Therapists?

Violence against therapists by their clients are a common occurrence across clinical settings and may have a lasting impact on the clinician's professional and personal functioning. In spite of this, no study to date has looked at the frequency of trauma-induced symptoms in psychotherapists. Using a sample of N = 917 psychotherapists across Germany, Austria, and Switzerland, we analyzed the frequency and sequelae of patient attacks suffered or witnessed by therapists. More than half (51.3%) of the sample reported having been the victim or witness of patient attacks or threats of violence in their career. Among the affected therapists, 27.7% reported posttraumatic symptoms lasting longer than four weeks and 2.7% presented symptoms amounting to a full-PTSD diagnosis. Thus, while the frequency of attacks and trauma-induced symptoms were considerable, estimated PTSD rates were rather low. The findings suggest that practitioners should be conscious of client violence being an occupational risk and that it is advisable to have protective measures in place.

Employees exposed to work-related threats and violence in human services sectors: Are any employees members particularly exposed to violence and threats and what role do supervisors play?

BACKGROUND

The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others.

OBJECTIVE

This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors.

METHODS

Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses.

RESULTS

We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant.

CONCLUSION

The results stress that effective prevention requires involvement of both employees and supervisors.

Design of a tailored and integrated violence prevention program in psychiatric wards and prisons

BACKGROUND

Violence and threats of violence against personnel at psychiatric wards as well as in the prison service is a major work environment problem. To date results from interventions to prevent violence and threats in these sectors have been inconclusive or of small effect. One of the reasons may be that violence and threats of violence occur as a consequence of a complex interaction between employee-level and management-level factors.

OBJECTIVE

To design a tailored and theory-based intervention program directed at violence prevention in psychiatric wards and prisons that integrates the employee-level and management-level, and development of an evaluation design building on the Context, Process, and Outcome Evaluation Model.

METHODS

The study follows a stepped-wedged design with 16 work units entering the intervention in four groups with differing start dates from September 2017 to January 2019. The context and process evaluation includes: calculating the implementation degree; mapping of contextual factors; interviews with unit-leaders and employees before and after the intervention. The outcome evaluation includes performing multi-level statistical analysis on data from a three-monthly questionnaire to employees at the participating workplaces.

RESULTS

The first results will be available in 2020.

CONCLUSIONS

The comprehensive evaluation of the intervention will give insight into the processes and effects of the intervention.

Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity

Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual's stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5 % had experienced physical assault in the previous 12 months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences.

Experiencing violence in a psychiatric setting: Generalized hypervigilance and the influence of caring in the fear experienced

BACKGROUND

Exposure to violence in the mental health sector both affects employees and has implications for the quality of care provided.

OBJECTIVE

This phenomenological study aims to describe and understand the ways in which acts of aggression from a patient might affect workers in a psychiatric institute, their relationships with the patients and the services offered.

METHODS

Two semi-structured interviews were conducted with each of the 15 participants from various professions within a psychiatric hospital.

RESULTS

Our analysis reveals four themes: hypervigilance, caring, specific fear toward the aggressor and generalized fear of all patients. A state of hypervigilance is found among all participants. An emphasis on caring is present among the majority and unfolds as a continuum, ranging from being highly caring to showing little or no caring. A feeling of fear is expressed and is influenced by the participant's place on the caring continuum. Caring workers developed a specific fear of their aggressor, whereas those showing little or no caring developed a generalized fear of all patients. Following a violent event, caring participants maintained this outlook, whereas those demonstrating little to no caring were more inclined to disinvest from all patients.

CONCLUSIONS

Hypervigilance and fear caused by experiences of violence impact the quality of care provided. Considerable interest should thus be paid to caring, which can influence fear and its effects.

Validation de la version française canadienne du Perception of Prevalence of Aggression Scale auprès d’un échantillon d’intervenants en protection de la jeunesse1

Objectif. L’objectif de cette étude est d’évaluer la validité de construit de la version française de l’échellePerception Of Prevalence of Aggression Scale (POPAS), un questionnaire auto-rapporté mesurant l’exposition à la violence au travail commise par la clientèle du milieu de la santé et des services sociaux.Méthode. Un échantillon de 310 intervenants en protection de la jeunesse est utilisé afin de confirmer la structure interne à quatre facteurs de l’instrument. À défaut de confirmer cette structure, un modèle d’équation structurelle exploratoire est utilisé. Les facteurs retenus sont soumis aux tests d’alpha de Cronbach qui permettent d’évaluer leur cohérence interne. Ils sont corrélés avec la version française duPosttraumatic Stress Disorder Checklist Scale(PCLS) et du nombre de jours d’absence du travail causé par la violence afin d’évaluer la validité convergente. Il sont également corrélées avec leFelt Accountability(FA) afin d’évaluer la validité divergente. Des analyses de comparaison en fonction du lieu de travail permettent d’explorer la validité de critère.Résultats. L’analyse factorielle confirmatoire ne confirme pas la structure à quatre facteurs du POPAS. L’équation structurelle exploratoire valide une structure à trois facteurs : « violence verbale », « violence physique » et « violence envers soi-même ». Les deux premiers possèdent une bonne cohérence interne. Les corrélations positives entre ces deux facteurs et le PCLS, ainsi qu’entre ces deux facteurs et le nombre de jours d’absence appuient la validité convergente du POPAS. Toutefois, l’absence de corrélation significative entre le dernier facteur et le PCLS, et entre ce facteur et le nombre de jour d’absence n’appuient pas cette convergence. L’absence de corrélation des facteurs avec le FA appuie la validité divergente du POPAS. Les différences observées selon les environnements de travail attestent aussi de la validité de critère.Discussion. La validité de construit de la version française canadienne du POPAS suggère que l’outil permet d’évaluer la fréquence subjective de différentes formes de violence au travail vécues par les intervenants en protection de la jeunesse. Il offre ainsi une alternative aux données officielles (c.-à-d. déclaration d’incidents à l’employeur) qui reflètent peu la réalité de ces travailleurs compte tenu de la sous-déclaration des incidents de violence dans ce milieu.

Towards a model for understanding the development of post-traumatic stress and general distress in mental health nurses

In their daily work, mental health nurses (MHN) are often exposed to stressful events, including patient-perpetrated aggression and violence. Personal safety and health concerns, as well as concern for the physical and psychological well-being of patients, dominate; these concerns have a profound impact on nurses. This cross-sectional study explored and compared the psychological well-being of 196 hospital-based MHN (97 forensic and 99 mainstream registered psychiatric nurses or psychiatric state enrolled nurses). The aim was to examine exposure to inpatient aggression and work stress, and identify factors contributing to the development of post-traumatic stress reactions and general distress. Multiple regression analyses indicated that working in a mainstream setting is associated with increased work stress; however, mainstream and forensic nurses experienced similar psychological well-being. As a group, 14-17% of mainstream and forensic nurses met the diagnostic criteria for post-traumatic stress disorder, and 36% scored above the threshold for psychiatric caseness. A tentative model of post-traumatic stress and general distress in nurses was developed, illustrating the impact of aggression and stress on well-being. The present study affirms that mental health nursing is a challenging and stressful occupation. Implications for organizations, managers, and individual nurses are discussed.

Causes and management of aggression and violence in a forensic mental health service: perspectives of nurses and patients

Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.

Work-related post-traumatic stress disorder

BACKGROUND

Work-related post-traumatic stress disorder (PTSD) is an important condition encountered by many occupational health practitioners.

AIMS

To carry out an in-depth review of the research on occupational groups that are at particular risk of developing work-related PTSD.

METHODS

A literature search was conducted in the databases OVID MEDLINE, OVID Embase, Ovid PsycINFO, ISI Web of Science and CSA Health and Safety Science Abstracts.

RESULTS

Professionals such as police officers, firefighters and ambulance personnel often experience incidents that satisfy the stressor criterion for the PTSD diagnosis. Other professional groups such as health care professionals, train drivers, divers, journalists, sailors and employees in bank, post offices or in stores may also be subjected to work-related traumatic events. Work-related PTSD usually diminishes with time.

CONCLUSIONS

Mental health problems prior to the traumatic event and weak social support increase the risk of PTSD. Prevention of work-related PTSD includes a sound organizational and psychosocial work environment, systematic training of employees, social support from colleagues and managers and a proper follow-up of employees after a critical event.

Bullying within the forestry organizations of Turkey

Today, many studies are conducted in order to determine bullying behaviors and to resolve conflicts with the purpose of increasing and maintaining organizational success in developed countries. According to these studies, bullying cases are more common in public institutions when compared to other sectors. In public institutions, bullying generally occurs when successful workers are discouraged and/or harassed by their managers, thus leaving them feeling distressed and dissatisfied with their jobs. The present study examines whether forest engineers working in the seven geographical regions of Turkey are exposed to bullying behaviors, the level of any bullying, and whether there are any regional differences (N = 835). Through statistical analysis, a significant relationship was determined between bullying and demographic characteristics. The results of the present study were evaluated along with the results of other studies, and some suggestions were made in order to prevent bullying behaviors in forestry organizations.

An evaluation of nurses' interpersonal styles and their experiences of violence

Nursing is a demanding and stressful occupation. Nursing staff is required and expected to develop an interpersonal style that conveys concern for mentally ill patients. This study is aimed at investigating whether staff attitudes and behaviours are related to assaults on nurses in psychiatric settings. One hundred, sixty-two nurses working in psychiatric hospitals participated in this descriptive and analytical study. The data were gathered with an Interview Form and The Interpersonal Style Inventory. The statistical analysis shows that nurses who are less social and less tolerant are more exposed to physical assaults from patients, however nurses who are more help-seeking are more exposed to verbal assaults and have a concern of being assaulted. The findings of this research suggest that nurses' interpersonal styles may contribute to aggressive behaviours of patients/relatives.

The effects of direct versus witnessed threat on emergency department healthcare workers: implications for PTSD criterion A

We compared post-traumatic stress disorder (PTSD) symptom severity and symptom cluster profiles in hospital emergency department (ED) medical staff (N=100) who experienced an emotionally distressing work event that presented either a direct threat to themselves or a witnessed threat to patients. The two groups displayed similar levels of PTSD symptoms, however, they differed on symptom profiles and work consequences. The direct threat group experienced significantly greater fear during the event, more ongoing arousal symptoms, and more job dissatisfaction than the witnessed threat group. The witnessed threat group was more likely to appraise their PTSD symptoms as reflecting personal weakness. Overall, the results point to the need for further research to identify distinctive features of responses to different types of traumatic stressors.

Incidence and recurrent work-related violence towards healthcare workers and subsequent health effects. A one-year follow-up study

AIMS

The aim of the present study was to analyse the incidence of violence and threats of violence during the first year at work after graduating as a healthcare worker, the risk of re-exposure and health effects among respondents previously exposed to violence or threats.

METHODS

We analysed baseline data from 5,696 healthcare students and conducted prospective multinomial regression analyses following 2,847 respondents during their first year of employment.

RESULTS

At baseline we found that nearly a third of the respondents had been exposed to violence or threats of violence, 8.7% during trainee periods. At follow-up, we found that 24.6% of the healthcare workers had been exposed to violence and 33.4% to threats during the first year at work after graduation. Exposure to violence or threats during trainee periods was a strong predictor of violence (Odds ratio (OR)=3.3) and threats (OR=4.2) at follow-up. The results showed that violence or threats in previous jobs or at other places had a significant impact on the health of the victims at follow-up independent of gender, age, sense of coherence, self-efficacy and health at baseline. Exposure during trainee periods had a small but not quite significant (p=0.06) impact on the health of the victims at follow-up.

CONCLUSIONS

The study shows a high risk of violence and threats of violence among healthcare workers during training and the first year at work after graduation, indicating a need for violence prevention planning involving both college and workplaces.

Post-traumatic stress disorder following patient assaults among staff members of mental health hospitals: a prospective longitudinal study

BACKGROUND

Violence by patients against staff members in mental health institutions has become an important challenge. Violent attacks may not only cause bodily injuries but can also have posttraumatic consequences with high rates of stress for mental health staff. This study prospectively assessed posttraumatic stress disorder (PTSD) in employees who were severely assaulted by patients in nine German state mental health institutions.

METHODS

During the study period of six months 46 assaulted staff members were reported. Each staff member was interviewed three times after the violent incident, using the Impact of Event Scale-Revised (IES-R), a widely used PTSD research tool, as well as the Posttraumatic Stress Disorder Checklist--Civilian (PCL-C).

RESULTS

In the baseline assessment following an assault by a patient, eight subjects (17%) met the criteria for PTSD. After two and six months, three and four subjects respectively still met diagnosis criteria.

CONCLUSION

A small minority of assaulted employees suffer from PTSD for several months after a patient assault.

A study of psychiatric nurses' beliefs and attitudes about work safety and assaults in Turkey

In Turkey, the cultural structure effects the gender roles in the society, and women are subject to violence in an intense manner both inside the family and in their workplaces. In nursing, which is still defined as a woman's job in our country, it is possible to encounter many aggressive and threatening behaviours. Knowing no geographical borders, aggression leads to dissatisfaction and alienation with the profession for the nurses working at the psychiatric institutions in Turkey, thus aggression is a significant health risk in physical, psychological and social dimensions. The research was carried out with 162 randomly selected nurses working in the psychiatric institutions in Istanbul using the Attitudes Toward Patient Physical Assault Questionnaire. It has been determined that nurses' rate of exposure to verbal/physical assault by the patients and their relatives is high and that they experience an intense uncertainty and conflict, especially in legal issues, and that the duration of working in the psychiatry clinics effects attitudes toward the assaults. It is concluded that the nurses working at the psychiatry clinics in Turkey are under risk in regards to safety and they need protection and support, both in emotional and in legal terms.

Is sense of coherence a mediator or moderator of relationships between violence at work and stress reactions?

The relationships between exposure to violence at work, sense of coherence, and stress reactions were analysed in a large sample of the Danish workforce. The results showed that employees subjected to violence have a weaker sense of coherence than the rest of the respondents. Sense of coherence acted as a mediator and not as a moderator of relationships between exposure to violence and psychological, psychosomatic and cognitive stress reactions. The stability of the sense of coherence construct is discussed. With respect to the relation between sense of coherence and violence, preventative measures at the individual and organizational level are suggested.

Coercive manoeuvres in a psychiatric intensive care unit

Coercive manoeuvres in a psychiatric intensive care unit The practice of physical restraint techniques in the management of disturbed behaviour is a significant part of the role of mental health nurses, particularly in Psychiatric Intensive Care Units (PICUs). Debate about what constitutes good practice is intense, and the subject of recently issued guidelines by National Institute for Mental Health in England. However, the contribution of other forms of conflict management techniques has tended to be ignored. The purpose of this study was to identify, describe and categorize coercive manoeuvres used by nurses, and to examine the circumstances and appropriateness of their use. Non-participant observation of verbal and non-verbal interaction between patients and nurses during conflict situations was undertaken on one PICU. The critical incidents observed were identified, categorized and systematically recorded. Nurses used a variety of low level physical and interactional manoeuvres in order to manage patients' disturbed and resistive behaviour. These manoeuvres were seldom recorded, discussed or reviewed, although they were frequently used to manage critical conflict situations. These manoeuvres have neither been previously described nor evaluated. They may, in some cases, be useful substitutes for actual restraint, alternatively they may, in some cases, be judged undesirable. It is not known how widespread these practices are in acute psychiatry.

Characteristics of staff victims of psychiatric patient assaults: updated review of findings, 1995-2001

This paper examines the peer-reviewed, databased journal articles on the characteristics of staff victims of psychiatric patient assaults from 1995 to 2001. These studies partially confirm earlier findings in that patient assaults on staff victims continue across all disciplines. Unlike findings in earlier reviews, this review found that psychiatric residents and older, more experienced nurses were at highest risk for violence. Since there is little empirical data on staff victims of assaults by Alzheimer's and other dementia patients, this paper will explore the implications of the present findings for long-term care settings.

A systematic review of stress and stress management interventions for mental health nurses

BACKGROUND

Health care professionals in the United Kingdom (UK) appear to have higher absence and sickness rates than staff in other sectors, and stress may be a reason for nurses leaving their jobs. These problems need to be addressed, particularly in the mental health field, if current service provision is to be maintained.

AIM

The aim was to identify stressors, moderators and stress outcomes (i.e. measures included those related to stress, burnout and job satisfaction) for mental health nurses, as these have clear implications for stress management strategies.

METHOD

A systematic review of research published in English between 1966 and 2000 and undertaken in the UK that specifically identified participants as mental health nurses was carried out to determine the effectiveness of stress management interventions for those working in mental health nursing. Studies from non-UK countries were examined as potential models of good practice. The study was limited to primary research papers that specifically involved mental health nurses, where the health outcomes measured were stressors, moderators and stress outcomes and where sufficient data was provided.

RESULTS

The initial search identified 176 papers, of these 70 met the inclusion criteria. Seven studies have been reported since the completion of the review and have been included in this article. Sixty-nine focused on the stressors, moderators and stress outcomes and eight papers identified stress management techniques. Relaxation techniques, training in behavioural techniques, stress management workshops and training in therapeutic skills were effective stress management techniques for mental health nurses. Methodological flaws however, were detracted from the rigour of many of the studies.

CONCLUSIONS

The review demonstrated that a great deal is known about the sources of stress at work, about how to measure it and about the impact on a range of outcome indicators. What was found to be lacking was a translation of these results into practice, into research that assessed the impact of interventions that attempt to moderate, minimize or eliminate some of these stressors.