Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study

Abstract

BackgroundPatient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses’ use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses’ experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention.MethodsThis study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis.ResultsNurses’ experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward.ConclusionsThis study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed through which nurses’ experiences and ideas concerning prevention of violent events are acknowledged.

Stress among employees in psychiatric nursing

“…Prior studies have provided evidence that a strong relationship exists between the incidence of stress and workplace experiences in psychiatric nursing. The work-related stress my affect the employees' quality of work and their everyday life (Reininghaus, et al, 2007;Dickinson & Wright, 2008;Weinberg & Creed, 2000;Čuk, 2010;Čuk & Klemen, 2010;Hanrahan, et al, 2010;Peterka Novak, et al, 2010;Hamaideh, 2011;Lombardo & Eyre, 2011;Rössler, 2012;Berring, et al, 2016;Ferri, et al, 2016;Lantta, et al, 2016). As pressure in the workplace is unavoidable due to the demands of the contemporary work environment, the employees have to develop and use healthy coping strategies to manage stress, and meet as well as enjoy professional challenges.…”

“…emocionalni in psihični pritiski sodelavcev, slabi odnosi med sodelavci, grupiranje kadra in posledično slabi odnosi v zdravstvenem in negovalnem timu, neodkritost med sodelavci, nezadovoljni posamezniki, sestanki z nadrejenimi, medpoklicno sodelovanje, ki zahteva prilagajanje za doseganje skupnega cilja. Pri medicinskih sestrah na področju psihiatrije so dejavniki stresa iz delovnega okolja med drugim tudi slabi delovni pogoji, nejasne meje poklicne odgovornosti, velika odgovornost za paciente, slaba možnost udeležbe pri organizaciji dela, slabe možnosti napredovanja, delo v turnusih, obremenitve, kot so neželene in nepredvidljive situacije (Čuk & Gnezda, 2007, p. 31), hiter tempo dela, dežurstvo, prevelik obseg dela, pomanjkanje kadra (Zeller, et al, 2009;Peterka Novak, et al, 2010;Bregar, et al, 2011;Ferri, et al, 2016;Lantta, et al, 2016), dolge vizite, veliko število sprejemov skozi dan, sprejem proti volji pacienta, neprestano hitenje, veliko število hkratnih intervencij in njihova triaža v času dežurstva, delovanje proti volji pacienta, fizično oviranje pacienta, aplikacija terapije proti volji pacienta, incidenti (npr. poskus samomora), porušen bioritem ipd.…”

“…Rezultati naše raziskave so pokazali, da je med anketiranimi člani negovalnega tima na področju psihiatrije, in sicer v kliničnem okolju in v posebnem socialnovarstvenem zavodu, stres prisoten. Tudi iz raziskav, ki so jih izvedli številni drugi avtorji (Reininghaus, et al, 2007;Dickinson & Wright, 2008;Weinberg & Creed, 2000;Čuk, 2010;Čuk & Klemen, 2010;Hanrahan, et al, 2010;Peterka Novak, et al, 2010;Hamaideh, 2011;Lombardo & Eyre, 2011;Rössler, 2012;Berring, et al, 2016;Ferri, et al, 2016;Lantta, et al, 2016), je razvidno, da se zaposleni na področju psihiatrije soočajo s stresom na delovnem mestu, ki vpliva na njihovo delovno storilnost in vsakdanje življenje. Stresu se ne moremo izogniti, zato se ga moramo naučiti obvladati, da nam bo delo kasneje v izziv in zadovoljstvo.…”

“…Consistent with the findings of other research studies, the present study indicates that the psychiatric staff have to endure also the harassment or emotional and psychological pressure by co-workers, employee grouping leading to strained interpersonal relationships within a healthcare and nursing team (inter-and intraprofessional conflicts), insincerity among employees, unsatisfied individuals, stressful meetings with superiors, and compromises in inter-professional cooperation in the pursuit of common goals. The psychiatric nurses also report poor work environment, not clearly defined responsibilities, great responsibility for patients, nonparticipation in organisation of work, poor prospects for career advancement, work shifts, and adverse and unpredictable situations (Čuk & Gnezda, 2007, p. 31), pace of work and intensity, high physical and psychological demands of workload, shortage of staff (Zeller, et al, 2009;Peterka Novak, et al, 2010;Bregar, et al, 2011;Ferri, et al, 2016;Lantta, et al, 2016). The list of stressors includes also long bedside visits, constant hurry, a large number of concurrent interventions and the triage during on-call time, acting against patients' will, non-voluntary admission, physical restraint of patients, involuntary treatment, incidents (e.g.…”

Nursing Care for Psychiatric Patients and Other Specialties Patients: Nursing Perception

“…Em estudos internacionais, observa-se preocupação em conhecer a percepção dos profissionais de Enfermagem sobre o cuidado implementado em enfermarias psiquiátricas, uma vez que trabalhar nesse serviço é associado a sintomas de Burnout e pior qualidade de vida. [10][11][12] Poucos estudos brasileiros mostraram essa mesma preocupação. 13,14 METODOLOGIA Trata-se de estudo descritivo e exploratório, de natureza qualitativa.…”