Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units

Abstract

BackgroundIn psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings.MethodsA convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings.ResultsEighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued.ConclusionsAggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour.

Prevalence of aggressive behaviours among inpatients with psychiatric disorders: A case study analysis from Jordan

“…The prevalence rates of aggression within mental health inpatient settings remains one of the most challenging aspects of working with this population (Griffith et al, 2013). Previous research suggests that aggressive behavior is linked to certain demographic variables, such as age, sex, marital status, diagnosis, psychopathology, and type of admission (Chukwujekwu & Stanley, 2011;McCann et al, 2014). The role that age plays in predicting aggression among psychiatric consumers has been previously investigated, with results suggesting that younger age is associated with more aggressive behaviors (Flannery et al, 2011).…”

“…The role that age plays in predicting aggression among psychiatric consumers has been previously investigated, with results suggesting that younger age is associated with more aggressive behaviors (Flannery et al, 2011). McCann et al (2014) reported that female sex, admission status, and a diagnosis of substance abuse were also predictors of both verbal and physical aggression.…”

“…McCann et al . () reported that female sex, admission status, and a diagnosis of substance abuse were also predictors of both verbal and physical aggression.…”

Reliability and validity of the Management of Aggression and Violence Attitude Scale (MAVAS-BR) for use in Brazil

“…The studies that have evaluated the attitudes of nurses towards the problem are scarce, although this problem has been extensively studied in other countries [10][11][12] .…”

“…In this respect, there is evidence that their attitudes towards this problem can affect the manner in which they manage these types of behavior, such that positive attitudes may contribute to the development of interpersonal approaches, whereas negative attitudes may contribute to the use of coercive measures 10 and may consequently increase the unnecessary use of physical and chemical restraint 13 . On the other hand, the identification and characterization of the attitudes of health workers towards the management of aggressive behaviors may serve as a strategy to cope with this situation 9 , to promote more humanized care 9 , and to help develop protective measures for their own emotional health 4 .…”