Hantering av hot och våld : Personalens syn på etik, bemötande och säkerhet i mötet med ungdomar på institutioner

The starting point of this study was that aspects of ethics as well as safety should be taken into account in meetings with patients and clients. The purpose was to increase the understanding of how staff in inpatient and institutional settings relate to the perspectives of good care and safety simultaneously in daily meetings with young clients and patients, especially in aggressive situations. The participants were staff who worked with youngsters on a daily basis at two institutions run by the National Board of Institutional Care (SiS) and a child and adolescent psychiatric clinic. The research questions were: 1) Which values can be found in the staff’s narratives about meetings with youngsters?, 2) How do staff describe the sequence of events in incidents of violence at their workplace?, and 3) How do staff describe their work with prevention and management of violence? Data collection was done through individual interviews, focus group interviews and questionnaires based on the Critical Incident Technique method. Interviews were analyzed with qualitative content analysis. Three themes of staff values emerged in the analysis: 1) From rule to relationship, an experienced movement from a rule-based to a more individualized care, 2) Ways to manage power and responsibility, thoughts about structure and pedagogics, and 3) An institution with a conscious culture, the importance of belonging to a supportive team with common basic views and an open climate. The staff described various kinds of incidents of violence and some of these incidents had serious consequences like seclusion of youngsters and staff injuries causing need for medical care. A need for more education, improved routines and organizational support was expressed. The work to prevent violence included individually detecting risks and, if necessary, communicating with other staff members when assessing these risks. Threats were reported as common but hard to cope with when directed towards a specific staff member and his or her family. The staff stressed the need, after a serious incident, to process what happened with colleagues and youngsters concerned. The colleagues were seen as the most important support, and there were some descriptions of shortcomings in the follow-up routines of violent incidents