Nurses' perceptions regarding the causes and management of aggression and violence : a quantitative study.

Abstract

The aim of this study is to identify nurses' perceptions regarding the causes and management of patients' aggression and violence within an acute psychiatric setting. The objectives are to determine nurses' perceptions regarding contributory causes of aggression and violence and on ways of managing these behaviours in patients within an acute psychiatric ward setting. Furthermore, these perceptions were analysed by gender, age and years of nursing experience in a psychiatric setting. For this study a cross-sectional inferential design was utilized. Quantitative data was gathered by means of 'The Management of Aggression and Violence Attitude Scale'- an instrument which has proven reliability and validity (Duxbury, 2003). The nurses working in an acute psychiatric setting (N=68) were invited to participate in this study. Fifty six nurses returned the completed tool to the present author, giving a response rate of 82.4%. The data collected was analyzed with the use of the Statistical Package for the Social Sciences (SPSS)-version 18 and univariate statistical analyses -independent t-tests and one way ANOVA's were computed. Overall the findings in this study generally agreed with other studies carried out abroad. The results show that local nurses mainly perceive that characteristics relating to the actual illness (internal causes), the restrictive environment patients are in and poor therapeutic relationship between staff and patients as the main causes that may contribute to patient' aggression and violence. Perceptions that the patient's physical environment may influence his/her behaviour, is influenced by the nurses' age. Additionally, the nurses participating in this study agree that patient' aggressive and violent behaviour can be handled more effectively in the wards. They also agree that medication is a valuable approach to control such incidents. Maltese nurses also view seclusion as one of the most effective approaches in violent situations whilst they agree that the patients are physically restrained for their own safety. Negotiation between staff and patients and de-escalation techniques were perceived as the best approach to prevent aggressive and violent incidents. Following these findings, the present author made a number of recommendations such as in the area of clinical practice with the need for more human resources to enable staff to devote more quality time to the patient, enhancing the therapeutic relationship; in education the need for specialized staff training in diverse means of management strategies such as de-escalation techniques especially with the older nurses and those with a greater number of years of psychiatric nursing experience and in research by carrying out a longitudinal study to determine how nurses perceptions may vary over time within a mental health setting.