Nurses’, patients’, and informal caregivers’ attitudes toward aggression in psychiatric hospitals: A comparative survey study

Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson’s r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents’ characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses’ scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.

Nurses' attitudes towards professional containment methods used in psychiatric wards and perceptions of aggression in Turkey

AIMS AND OBJECTIVE

The aim of this study was to determine nurses' attitudes towards professional containment methods and to explore the relationship between those attitudes and nurses' perception of aggression.

BACKGROUND

Different containment methods are used in psychiatric wards when patients behave aggressively towards others or exhibit self-harm. It is known that in addition to patient-specific and environmental influences, many factors related to the staff influence the choice of containment method. One of these factors is the perception of aggression.

DESIGN

A cross-sectional descriptive design was used and the sample consisted of 144 nurses who are employed in a psychiatric hospital in Istanbul and who volunteered to participate in the study.

METHOD

Data were collected using a questionnaire addressing the socio-demographic and professional features of nurses and using the attitudes to professional containment methods and Perception of Aggression Scale.

RESULTS

While pro re nata medication was used commonly, time-out was infrequently used in the wards. Intermittent observation, pro re nata medication and containment in the psychiatric intensive care unit were the most approved methods. The use of net beds was the least approved method. Nurses who perceive aggression as dysfunctional/undesirable are more likely to approve compulsory intramuscular medication and mechanical restraint.

CONCLUSION

These results showed that nurses' perception of aggression is an important factor influencing the choice of a professional containment method.

RELEVANCE TO CLINICAL PRACTICE

This study might lead to closer critiquing of psychiatric ward nurses' attitudes towards professional containment methods, leading to a decrease in the usage of these methods.