Mental health nurses' emotions, exporsure to patient aggression, attitudes to and use of coercive measures: Cross sectional questionnaire survey

Jalil, Rahul and Huber, J. W. and Sixsmith, J. and Dickens, G. L. (2017) Mental health nurses' emotions, exporsure to patient aggression, attitudes to and use of coercive measures: Cross sectional questionnaire survey. International Journal of Nursing Studies, 75. pp. 130-138. ISSN 0020-7489

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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 aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint.

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/non-involvement 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.

Keywords

Violence; aggression; anger; restraint; seclusion; mental health; de-escalation; emotion

Item Type:	Article
Identification Number:	10.1016/j.ijnurstu.2017.07.018
Dates:	Date Event 30 July 2017 Accepted 31 July 2017 Published Online
Subjects:	CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-01 - nursing (non-specific) CAH04 - psychology > CAH04-01 - psychology > CAH04-01-01 - psychology (non-specific)
Divisions:	Faculty of Business, Law and Social Sciences > College of Psychology
Depositing User:	Benjamin Goodwin
Date Deposited:	22 Aug 2017 08:19
Last Modified:	11 Jun 2024 13:03
URI:	https://www.open-access.bcu.ac.uk/id/eprint/4938