Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting

Abstract

Inpatient mental health clinicians need to feel safe in the workplace. They also require confidence in their ability to work with aggressive patients, allowing the provision of therapeutic care while protecting themselves and other patients from psychological and physical harm. The authors initiated this study with the predetermined belief that a comprehensive and integrated organizational approach to inpatient aggression was required to support clinicians and that this approach increased confidence and staff perceptions of personal safety. To assess perceptions of personal safety and confidence, clinicians in a forensic psychiatric hospital were surveyed using an adapted version of the Confidence in Coping With Patient Aggression Instrument. In this study clinicians reported the hospital as safe. They reported confidence in their work with aggressive patients. The factors that most impacted on clinicians' confidence to manage aggression were colleagues' knowledge, experience and skill, management of aggression training, use of prevention and intervention strategies, teamwork and the staff profile. These results are considered with reference to an expanding literature on inpatient aggression. It is concluded that organizational resources, policies and frameworks support clinician perceptions of safety and confidence to manage inpatient aggression. However, how these are valued by clinicians and translated into practice at unit level needs ongoing attention.

24-Karat or fool’s gold? Consequences of real team and co-acting group membership in healthcare organizations

“…Moreover, the relative isolation of co-acting group members (compared to those with real team membership who share a common goal with their teammates) means that they can more easily be subject to abuse by patients, their relatives and other members of the public (Hayes & Bonnet, 2010). Indeed, Martin and Daffern (2006) found that a team approach was fundamental to manage patient aggression and maintain perceptions of personal safety amongst mental health clinicians. Further, poor team communication, an unsafe team approach, and a lack of team support were all factors that reduced staff confidence in managing aggressive patients.…”

Detached Concern of Forensic Mental Health Nurses in Therapeutic Relationships With Patients

“…In the research literature, increasing attention is devoted to staff management of and attitudes toward inpatient aggression (Björkdahl, Olsson, & Palmstierna, 2006;Bowers et al, 2006;Duxbury, 2005;Martin & Daffern, 2006;Meehan, McIntosh, & Bergen, 2006;Needham et al, 2005). Improvement of the interaction between staff and patients, for example, by collaborating on relapse prevention plans, may lead to a reduction of rates of inpatient violence (Duxbury & Whittington, 2005;Fluttert et al, 2008;Kettles, 2004;Meehan et al, 2006).…”

“…T HE OCCURRENCE OF severe aggressive incidents on acute psychiatric wards is a serious problem and can have a great impact on staff; they can trigger feelings of shock, fear, or anger and are often followed by rumination, guilt, or anxiety (Bowers, Brennan, Flood, Lipang, and Olapado, 2006;Camerino, Estryn-Behar, Conway, Heijden van der, & Hasselhorn, 2007;Jonker, Goosens, Steenhuis, & Oud, 2008;Martin & Daffern, 2006;Mason, King, & Dulson, 2009;Needham, Alberhalden, Halfens, Fischer, & Dassen, 2005). Patients also suffer from the consequences of their aggressive behavior; it is likely that these kinds of behaviors cause conflicts with staff, possibly resulting in coercive measures (Meehan et al, 2006;Paterson & Duxbury, 2007).…”

“…Bowers et al (2006) argued that conflicts with patients in acute psychiatric wards can be reduced by improving staff skills in regulating their own reactions to patients and by creating a predictable and safe ward atmosphere. Nurses may also become more confident in managing patients' aggression when they learn to apply risk management interventions and preventive strategies (Martin & Daffern, 2006;. The need for safe and supportive working conditions is vital in forensic care, and nursing care would profit from implementation of evidencebased risk management strategies (Bjørkly, 2004;Morrison et al, 2002).…”

Providing neurologic care in criminal systems and state mental hospitals

“…9 The issues of sex, experience, and perceptions are more fully reviewed elsewhere. 10 While some patients may be at increased risk for violence, the awareness of this possibility is typically proportionally heightened in these facilities.…”