MENTAL HEALTH NURSES’ EMOTIONS, EXPOSURE TO PATIENT AGGRESSION, ATTITUDES TO AND USE OF COERCIVE MEASURES: CROSS SECTIONAL QUESTIONNAIRE SURVEY

Jalil, R and Huber, J W and Sixsmith, J and Dickens, G L MENTAL HEALTH NURSES’ EMOTIONS, EXPOSURE TO PATIENT AGGRESSION, ATTITUDES TO AND USE OF COERCIVE MEASURES: CROSS SECTIONAL QUESTIONNAIRE SURVEY. International Journal of Nursing Studies. ISSN 00207489

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Abstract

Abstract
Background: Mental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents; coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses’ exposure to
aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence.

Objectives: To identify relationships between mental health nurses’ exposure to patient

Design: Cross-sectional, correlational, observational study.

Settings: Low and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England.

Participants: N=68 Mental health nurses who were designated keyworkers for patients enrolled into a related study

Methods: Participants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses.

Results: Nurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression
was unrelated to nurses’ emotions. Nurses’ reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and
in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/noninvolvement
in coercive measures.

Conclusions: Verbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger
did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be ‘at risk’. Future research priorities are considered.

Item Type: Article
Uncontrolled Keywords: Violence; aggression; anger;restraint;seclusion;mental health;de-escalation; emotion
Subjects: B700 Nursing
C800 Psychology
Divisions: Faculty of Business, Law and Social Sciences > School of Social Sciences > Dept. Psychology
Related URLs:
Depositing User: Prof Keith A. Osman
Date Deposited: 03 Aug 2017 15:57
Last Modified: 03 Aug 2017 15:57
URI: http://www.open-access.bcu.ac.uk/id/eprint/4941

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