An exploration of violence, aggression, and abuse experienced by psychiatric nursing staff from patients at work

Chapter one gives some background information regarding the definitions of violence, aggression and abuse; the prevalence of these issues in psychiatric inpatient services, and sets up the aims of the thesis. Chapter two starts with a systematic review of the literature that has evaluated current training courses offered to psychiatric nursing staff, to manage or prevent violence, aggression, or abuse. This review synthesised a small body of research, and yielded tentative but positive results. It shows that some positive change is achievable with targeted training, and in some cased, violence instances can be reduced. Following this, chapter three is a mixed-methods research study which explored two aims: firstly the lived-experiences of forensic nursing staff to explore how they come to conceptualise ‘abuse’ from service-users; and secondly whether forensic psychiatric staff appraise abuse differently from the public. The research showed that the conceptualisation of abuse is complex and subjective, and is influenced by personal perceptions as well as systemic factors. In general, staff demonstrated a higher threshold for abuse as compared to a public sample. This research gives important clinical insight into the perspective of staff in this setting, and offers recommendations for future research to develop this further. Chapter four assesses the psychometric properties of the Aggression Questionnaire-12 (AQ-12; Bryant & Smith, 2001) as it is a widely used measure of aggression in psychiatric services. Although there are many measures of aggression, this tool demonstrated superior psychometric properties, and has shown to be a reliable and valid measure of aggression within forensic inpatient populations (Van Dam-Baggen & Kraaimaat, 1999; Hornsveld, Muris, Kraaimaat & Meesters, 2008). The AQ-12 is used in Chapter five, which is a single case study of an aggressive male offender who is residing in a low secure locked rehabilitation unit. The case study evaluated the effectiveness of an individual needs-led aggression-management intervention. This case study offered an insight into the service-user perspective on inpatient aggression, and there are recommendations made for future research and practice