The violence prevention climate of mental health wards: a cross-sectional study of staff and patient views

Abstract

Purpose: Ward climate can shape the behaviour of both staff and patients. A subset of the ward climate is the violence prevention climate, the unique characteristics that are perceived by the people within the environment as contributing towards the prevention of violence. The aim of this study was to explore differences between and within staff and patient groups in terms of their perceptions of the violence prevention climate. Methods:A cross-sectional survey was conducted with staff (n=326) and patients (n=95) in mental health care pathways within one charitable trust. All participants completed the VPC-14 to measure perceptions of the violence prevention climate, a validated 14-item two-factor scale (staff actions and patient actions). Staff demographic information was collected on the VPC-14 front sheet; patient demographic, clinical and violence data was collected from electronic case records. Bivariate analyses were conducted to compare within-and between-group variables. Significant staff and patient variables were entered into multiple hierarchical regression analyses to assess their relationship with VPC-14 factors.Results: Staff had a more positive view than patients of staff actions and patients had a more positive view of patient actions than did staff; staff-or patient-group membership was the best predictor of staff action scores. Individual staff characteristics accounted for a small amount of the variance in staff and patient action scores; individual patient characteristics explained more variance, but this was still below 20%.Conclusions: Staff perceive their violence prevention-related contributions more positively than patients and vice versa. This has implications for staff; they may need to better articulate their role in violence prevention to patients, as well as recognise the role that patients play. However, within staff and patient groups, individual variables only make up a small amount of variance of perceptions of the violence prevention climate. This suggests that the violence prevention climate is a valid construct i.e. that despite differences in individual variables, individuals within the patient group have similar perceptions of the VPC, as do those within the staff group.

Examining the utility of the Violence Prevention Climate scale: In a metropolitan Australian general hospital

“…In relation to ‘Patient Actions’, it seems that, as a group, this sample of non‐mental health trained staff does not identify a consistent view related to the potential for patients themselves to contribute to the violence prevention climate (Hallett & Dickens, 2017). This is in contrast to studies of the Violence Prevention Climate scale in mental health settings where there is some evidence that staff and patients samples both have more positive views of their own contribution than they do of that of the other (Hallett & Dickens, 2020). Therefore, failure to detect a coherent view of patients’ actions among the staff‐only sample reported here should not be taken as evidence that further investigation is unwarranted.…”

“…Scores on the staff actions factor in previously published research in an Australian general mental health inpatient setting ( N = 200 M = 37.1[5.4]) (Dickens et al, 2020) and a United Kingdom forensic mental health setting ( N = 281 M =36.9 [4.3]) (Hallett & Dickens, 2020) were greater than those reported in the current study (34.4[5.6]). Calculation of effect size between mental health and generalist settings (difference in mean scores divided by pooled standard deviation; Cohen (1988) suggests a moderate effect size ( d = 0.51) indicating that mental health staff report stronger agreement that they perform actions which are perceived to be associated with a more positive violence prevention climate (Lakens, 2013).…”

Restrictive interventions: understanding and reducing their use in mental health settings

“…There is some evidence that social climate is associated with patient aggression, particularly patients' feelings of safety, cohesion between patients, the 'atmosphere' of the environment and how open the environment is (Robinson et al 2016). It may be unsurprising to learn that staff and patients often have differing views about the atmosphere; the things that staff do to improve the atmosphere tend to be viewed more highly by staff than by patients (Hallett and Dickens 2021). The 15 Steps is one method of assessing the first impressions of a ward (NHS England 2017).…”

Psychiatric inpatients' view of the therapeutic environment: A Turkish interview study

“…In terms of healing, it is important that patients feel that nurses and other personnel are empathic and interested in them, and to feel that health workers are focused on improving the patients' well-being. 8 Properly designed and managed therapeutic environments in psychiatric clinics shorten the length of patients' hospital stays, reduce the incidence of violence in the clinic, 9,10 and increase the number of social activities available, 11 patient-personnel interaction 12,13 and patient satisfaction. 14 They also positively change the behaviors of patients and personnel.…”

“…Properly designed and managed therapeutic environments in psychiatric clinics shorten the length of patients' hospital stays, reduce the incidence of violence in the clinic, 9,10 and increase the number of social activities available, 11 patient–personnel interaction 12,13 and patient satisfaction 14 . They also positively change the behaviors of patients and personnel 15 …”