Aggressive behaviour on acute psychiatric wards: prevalence, severity and management

Abstract

It is estimated that in a 12 month period at the hospital in this study a nurse would have a one in 10 chance per year of receiving any kind of injury as a result of patient aggression. Despite the predominance of verbal over physical aggression, the fear generated from working in such an environment and a difficulty in understanding the causes of patient aggression may motivate staff to manage aggressive incidents with physical methods such as seclusion and restraint on a frequent basis.

Restraining good practice: Reviewing evidence of the effects of restraint from the perspective of service users and mental health professionals in the United Kingdom (UK)

“…The results of the search indicated that in the last 14 years relevant studies equated to seven published papers. Of the seven studies identified; four were qualitative studies (Bonner et al 2002;Fish & Culshaw, 2005;Jones & Kroese, 2006;Perkins et al 2012), one study used mixed methods (Duxbury et al 2002), one study made use of a survey comprising of quantitative and qualitative questions (Lees et al 2003) and one was a quantitative study (Foster et al 2007). See Table 1 below for an overview of the studies.…”

“…Five of the studies (Duxbury 2002;Lees et al 2003;Fish & Culshaw, 2005;Foster et al 2007;Perkins et al 2012) gave voice specifically to mental health professionals regarding the use of restraint, while three (Bonner et al 2002;Duxbury 2002;Jones & Kroese, 2006 ) offered a voice to the service user.…”

“…Three studies (Duxbury, 2002;Fish & Culshaw, 2005;Foster et al, 2007) were carried out in one region, North-West England, making generalisations to other regions difficult, as they may have different policies, procedures and training, as well as different organisational cultures.…”

“…In four of the seven studies (Duxbury 2002;Fish & Culshaw, 2005;Foster et al 2007;Perkins et al 2012) incidents of violence and aggression were cited as the main trigger for using restraint. It was reported that the majority of incidents had been preceded by the service user either physically assaulting or attempting to assault someone, or had been threatening physical violence (Duxbury 2002;Perkins et al 2012 et al (2007) found no significant differences in service user and staff targeted incidents.…”

“…Service users felt that approaches on the part of the staff were controlling in nature, believing that poor communication and environmental factors often precede episodes of aggression (Bonner et al 2002;Duxbury, 2002;Fish & Culshaw, 2005;Jones & Kroese, 2006). The notion of using restraint as a way of controlling behaviour was evident in five of the studies (Lees et al 2003;Fish & Culshaw, 2005;Jones & Kroese, 2006;Foster et al 2007;Perkins et al 2012). …”