Patient and nurse accounts of violent incidents in a Medium Secure Unit

Abstract

Most studies examining violence in a forensic setting have adopted a statistical approach to associate relevant predictors and the likelihood of violence. Views of patients and nurses have been a relatively neglected research area. This study explored patients' and nurses' accounts of violent incidents, considering similarities and differences in their narratives. Permission was obtained from the local National Health Service Research Ethics Board and the Research Ethics Committee of University of East London. Anonymized transcripts were produced from semi-structured interviews conducted in a Medium Secure Unit with four nurses and four patients, who consented to talk at length with the first author about violent events they had witnessed on the Unit. Grounded theory analysis of the data generated a core category, 'control', and five constituent themes: the construction of identity of the perpetrator of violence; nurses' dual role of caring and controlling; aspects of parentalism involved in control; following set policies and procedures; and segregation from mainstream society. Because of widespread social interest and media coverage in the topic, discursive examination was made of aspects of social context arising within the data. This study was small scale and exploratory, and further confirmatory research is needed. Nevertheless, clear contrasts between the nurse and patient accounts indicated tentative suggestions for training (including user involvement) and intervention in managing violent behaviour.

A tale of two cultures: examining patient-centered care in a forensic mental health hospital

“…seclusion, restraint) rather than engaging and collaborating with patients. This finding is consistent with other research focused on the professional tensions that exist while balancing care and custody in forensic hospitals (Hinsby & Baker, 2004; Mason, 2002; Meehan, McIntosh, & Bergen, 2006). For example, findings of a qualitative study by Hinsby and Baker (2004) suggested that forensic mental health providers tend to give greater weight to maintaining safety and security, as opposed to being caring, as they carry out their clinical duties.…”

Comparing the outcomes of the application of C&R (general service) and SCIP in the management of disturbed behaviour in mental health care

“…Communication and engagement between staff and patients have been highlighted as influencing factors in the management of disturbed behaviour (Duxbury & Whittington, 2005;Hinsby & Baker, 2004;Mistral et al, 2002;Whittington & Richter, 2005). The style of communication in engaging the patient is a major influencing factor which cannot be underestimated.…”

Men and Masculinities in Forensic Psychiatric Care: An Interview Study Concerning Male Nurses' Experiences of Working with Male Caregivers and Male Patients

“…Previous research in this field focuses on different aspects of forensic psychiatric care such as threat, violence, destructive behaviour, protection, aggression, attitudes, practice, and relationships. Men's identity and physical appearance are overlooked despite being important factors in a nursing environment (Daffern, Mayer, & Martin, 2004;Hinsby & Baker, 2004;Rask, 2002;Urheim & Vandenbos, 2006). Threats and violence in forensic psychiatric care are common among male patients.…”

“…Aggressive behaviour and violent situations are caused by a small number of patients and often are related to existing rules at the unit. These aggressive behaviors are targeted at caregivers and not the patients (Daffern, Mayer & Martin, 2004;Hinsby & Baker, 2004;Urheim & Vandenbos, 2006).…”