Violence in Mental Health - Essay Example

? Violence in Mental Health Violence in Mental Health Literature Review Even in the present era wherein there is a continuous development and improvement of the health care services, the violence being faced by health care professionals specifically the nurses is one of the main concerns in the medical field (Richter & Whittington, 2006). The objective of the study is to present the existing knowledge and the results of researches and empirical studies related to the occupational dangers encountered by health care providers in mental services and psychiatric wards in health care facilities. There are pertinent data included in the review such as the background of the topic, the causes, prevention, case studies and the solutions or management methods to the problem. Background Information on Violence of Psychiatric Patients The study is focused on presenting the different issues and factors pertinent to the violence in mental health services and facilities. To be able to achieve the said objective, there are different points that are needed to be given attention and meaning, for example the definition of the violence that can be experienced by medical providers and nursing personnel. Definition of Violence in Mental Services There are different medical conditions that can result to violence toward health care providers. Included in the said conditions are mental health, substance abuse and the combined effects of the two. In the study conducted to determine the characteristics of violence for recent entrants to acute mental health and substance abuse facility, results had shown that there is a high prevalence of violence within the sample population studied. Approximately 41% of the 171 individuals included in the study had been involved in incidents of violence within the period of 30 days. In the recorded cases of violence, The study reached a conclusion that violence is prevalent in mental health and substance abuse treatment facilities but presented the significance of the bias due to the fact that data gathering was based on self-reporting, thus, violent incidents that the patients committed were understated (Mericle & Havassy, 2008, p.392). Aside from the definition of the pertinent concepts in the topic then, the study presented the need to establish standards in the measurement of data related to violence within medical services. The main focus of the study is violence against mental health professionals. Significant number of nursing staff views the issue as an occupational hazard but the reality of the problem had been the focus of concern of authorities on the safety of the health care professionals specifically due to the effects of the violence which can range from simple physical pain to the worst which is death. Psychological effects cannot also be neglected since based on results of studies the trauma can be compared to experiencing crimes and natural calamities (Anderson & West, 2011, p.34). Risk Factors in Violence Against Medical Professionals The risk factors are also pertinent to the study specifically the patients’ tendency to commit violence and the health professionals characteristics’ that can fall victim to violent scenarios in mental facilities (Anderson & West, 2011, p.34). The patients’ tendency to commit violence had been explored by different organizations of authority. One of the main risks contributing to violence is severe mental illness of the patient in mental services. Based on the research conducted by the Epidemiologic Catchment Area (ECA) and the National Institute of Mental Health (NIMH), patients with serious mental illnesses such as schizophrenia, major depression or bipolar disorder have 2 to 3 times higher impulse to commit violent assaults as compared to other patients. But the percentage of people with such conditions is very limited that it cannot significantly alter the violent cases in mental health services. In addition to serious mental illness, the presence of multiple mental conditions can also increase the probability of committing violent actions by 2 to 4.5 times as that of other patients. Substance abuse and violence prior to admission in mental health wards can also increase the risk of violence against health care and nursing professionals (Anderson & West, 2011, p.35-36). There are also risks on the part of the health professionals. There are higher risks of experiencing violence based on prevalence of contact to the patient. This can be attributed to the higher chance of interacting with the patient that can increase the risk of assaults. Based on the said reason, nursing staffs are considered to be of highest risk in terms of experiencing violent assaults by patients (Anderson & West, 2011, p.37). Effects of Violence to the Mental Health Care Staffs The effects of violence are considered as the most important reason for the concern regarding violence in the psychiatric wards and mental service facilities. Based on the review conducted by Cornaggia, Beghi, Pavone and Barale, frequent exposure to violent attacks can lead to deteriorating effects on the general health of the nurses. In addition, the most prevalent factors that increased the probability of violence were substance abuse, hostility, paranoid thoughts, acute psychosis, young age and risk of suicide (Cornaggia, Beghi, Pavone & Barale, 2011, p. 10-17). In the study on severity of the violence in mental health care facilities, it had been noted that based on the revised Staff Observation Aggression scale (SOAS-R), the mean severity of aggressive incidents in psychiatric wards was 10.9. The rage of severity was from 10.4 to 11.5, with the scale of 0 to 22, with 22 being the highest point of severity (Foster, Bowers & Nijman, 2007, p.143). Case Studies and Empirical Data Gathered Due to the increasing concern in resolving violence in mental health facilities, different studies were conducted that focused on specific institution, locality or nation. On of the case studies focused on the violence being experienced by Irish nurses specifically the staff of the Irish Mental Health Services. Based on a questionnaire that dissected the experiences of the staff within a period of 1 month, the results showed that there is higher occurrence of verbal aggression as compared to other forms. The medical staff showed distinction between threatening and non-threatening aggression on the basis of intentions of the patients in terms of committing violence. It was concluded that there was a greater risk of experiencing indirect assaults in the institutions and it resulted to the review of policy and practice (Maguire & Ryan, 2007, p.120). In another study which was conducted by Gracci and his colleagues, the main focus are the persistently assaultive patients in Italian psychiatric units (2006). The main objective of the study was to determine the issues related to violence to be able to improve the quality of services in psychiatric care. The data had been recorded and tabulated for the past seven (7) years in the University and General Hospital S. Anna in Ferrera, Emilia Romagna Region, North-East Italy, which is considered as an important mental institution for the past few decades in the country. Through the use of the Staff Observation Aggression scale (SOAS), 65 patients multiple aggressive assaults and 95 patients were involved in a single in event of violence in the total of 160 patients included in the study. There are important conclusions based on the study. One is that aggressions were commonly committed by patients that need to stay in the facility for longer periods of time, thus, medical professional and nursing staffs were exposed to higher chances of violence. Another conclusion based on the study is the need for improved monitoring of the psychiatric inpatients to help prevent possible aggression that can endanger the nursing staffs (Grassi et al., 2006, p.698-700). A case study on the aggression of patients in the acute psychiatric facilities in Switzerland specifically the German speaking part explored the different issues pertinent to the topic such as the perception, management and the nature and frequency of the aggressive incidents. The main focus is the assessment of short-time risk of violence against psychiatric medical staffs. There were important contributions of the study which included prediction of the of in-patient violence through the use of Broset-Violence-Checklist for multi-center prospective cohort study and for instrument development and clinical application. The said tool had been considered important in the application for research and assessment of violence risks in psychiatric wards especially the enhanced version that had contributed to the completion of the study (Abderhalden, 2008, p. 138). The study was based on a previous empirical research that covered 12 psychiatric hospitals. The results of the study revealed the need for more in depth research on the guidelines in assessment of violent cases specifically due to the prevalence of such cases in mental health care facilities (Abderhalden et al., 2007). In another study undertaken by Abderhalden with colleagues in the same year was focused on a randomized controlled trial for assessment of violence in acute psychiatric wards. The main focus of the study was the determination of the effect of structural risk assessment in the decrease of prevalence. The study proved a significant decrease in the rate of violence and aggressive incidents in psychiatric in-patient care based on standardized risk assessment (Abderhalden et al., 2008, p.44). A related study had been conducted in Ireland and London which focused on the safety and security within acute psychiatric wards. Health and Safety Authorities in London and Ireland recognized the danger and the need for the establishment of guidelines, policies and procedures that can answer the need for safety and security, thus, researches had been conducted to face the concern of the local society. Through a descriptive survey research, it had been concluded that there was a no policy and procedure that can guide the health care staffs and professionals in facing situations related to safety and security. From the 124 London psychiatric wards and 43 Irish wards, it had been noted that Irish wards were comparatively more secure than that located in London (Cowman & Bowers, 2008, p. 1346-1350). It is important to consider that the study is related to the topic because it covers the safety and security within a mental service institution. The concern for the safety of nursing staffs is not limited in the Western region. Two consecutive studies focused in the violence being experienced by health care workers in psychiatric patients in Taiwan. The first study which was undertaken in 2007 was focused on the determination of the prevalence and indicators of workplace violence specifically physical attacks, verbal abuse, bullying/mobbing, sexual harassment, and racial harassment. The physical violence constitute 50.9% of the total incident reported which caused serious concern for all mental service staffs including nursing aides, nurses and clerks who spend significant amount to time with the patients (Chen et al., 2008). The follow-up research focused on the determining characteristics to be able to recognize cases of violence such as incidents of violence such as young age, female gender, lower education, shorter employment duration, and high anxiety level. In addition, study applied pre-placement education to be able to decrease the incidents of violence (Chen et al., 2009). Solutions and Management Techniques One of the most important topics in the study of the violence in mental facilities is the management methods and solution techniques that can protect and guide the nursing and clerical staffs. The National Institute for Health and Clinical Excellence (NICE) had an in depth study which resulted to the establishment of guidelines and gathering of pertinent data to be able to face and resolve violence in psychiatric facilities. Included in the solutions and management methods presented were psychosocial techniques namely de-escalation and observation techniques and other interventions such as physical interventions, seclusion and rapid tranquillization methods (2005, p. 24-30). In a study which was aimed to apply and to test an intervention, a quasi-experimental controlled research had been conducted. The main method applied was change. Different methods such as introduction of an in-patient psychiatrist which instead of working on a weekly basis was given a daily schedule were imposed. Another was the increased role of the nursing staff in the process such that instead of hiding away and decreasing exposure, overexposure was targeted to be able to make the patients more relaxed around the psychiatric service staffs. The result was a significant decrease of 34% while the control set-up even increased in the number of violent events at the end of the study (Beezhold et al., 2009, p.873). Violence can be prevented through different techniques such as systematic violence risk assessment, de-escalation, coercive interventions and staff training. Systematic violence risk assessment can help determine the main problem that can lead to violence. De-escalation was a form of preventive intervention to hinder onset of any form of violence. Application of coercive interventions although presented as alternatives for management of violent cases was considered controversial due to the failure in controlling assaults. Training for staffs exposed to psychiatric patients has been considered as the most effective form of intervention and prevention method against violence in the mental facilities and psychiatric wards (Bjorkdahl, 2010, p. 8). Conclusion Based on the gathered research results which covered different pertinent aspects of the topic such as: the background information (e.g. definition of violence in the mental facilities and psychiatric wards, risks of violence, effects of violence on the health care professionals); case studies and empirical data; and the solutions and management techniques, it can be considered that there is a valid concern for the issue of violence in the psychiatric facilities especially in terms of the safety of the health care and nursing staffs. In addition, there is already a considerable amount of data available which means that the issue had not been neglected in the past few years. It is then important to continue studies and researched that can contribute to the improvement of knowledge that can lead to improvement of guidelines and policies which can ultimately resolve the issue in the future. Analysis of a Research Methodology The decision of the research methodology to use in a particular study depends on the demands of the topic which means that different research questions can be answered through different types of relevant research methodology. There are two main types of research methodology, the qualitative and the quantitative research. The qualitative and the quantitative research methods can be differentiated from each other on the basis of data gathering paradigm. Qualitative methodology pertains to the gathering and recording of data based on the perspective and point of view of the researcher. In this method, the instrument of measurement is the researcher. Another distinct characteristic of a qualitative research methodology is being socially constructed which means that the meaning of the different factors and processes involved is based and can be understood through it’s social context. Also, qualitative methodology can be simply viewed as a research focused on exploratory and descriptive presentation of data thus it includes words, images and categories instead of numerical data. In terms of analysis of the gathered data, qualitative research is focused on inductive reasoning to be able to determine and establish patterns and themes that can explain the assimilated data (Offredy & Vickers, 2010, p.25). Quantitative research methodology is another form of research paradigm. It is aimed to achieve causal relationships between variables and interpretations based on numerical data. Statistical data gathering and analysis methods are considered as the most important tools in the said type of research methodology. It is mainly based on natural science due to the application of the scientific method in seeking solutions to problems at hand. One of the main requirements of quantitative analysis is higher number of samples to be able to increase the confidence on the results of the study. Thus, quantitative methodology is used for large scale studies (Offredy & Vickers, 2010, p.25; Pearson, 2010). Upon the determination of the individual characteristics of the two types of research methodology, the foremost objective is to determine the type of method to use in the study of the violence in mental services. It is obvious that both types have their own strengths and weaknesses but on a personal note, quantitative methodology is the main choice on the basis of different reasons. One of the main reasons for choosing quantitative method is the fact that numerical values and data can be considered both precise and accurate. Compared to qualitative method which is the description of data in a wordy and narrative manner, quantitative method of research presents exact values important in the exploration of a scientific research question. In addition, quantitative analysis can be considered of higher level of validity specifically when it is based on valid statistical analysis tool. For example, evidences gathered in relation to violence in mental services and psychiatric facilities are quantitative in nature. Another point considered as an advantage of the quantitative method is the fact that the study is dealing with evidences and information based on empirical data which can be analyzed through the use of quantitative analysis. In addition, empirical and experimental researches that contribute significantly to the knowledge base of the topic are classified as quantitative research. It can be considered then that not only are the empirical data quantitative, even the secondary researches and studies that employed statistical tools for analysis and interpretation. In the study of violence in mental services, it is then important to define a specific issue wherein the research can focus in. One example is the classification of the types of violent acts against medical professionals and staffs. Quantitative analysis can be applied to both primary and secondary data. For primary data, experimental set-ups are needed to be established but this can be considered ambitious specifically for an academic project. Another choice is a systematic review which will use secondary data gathered from primary published references such as journal articles. For the purpose of generating an overview of the different types of violent acts against medical professionals and staffs in a psychiatric facility, quantitative analysis based on a significant number of researches and studies can be undertaken. In the process, statistical guidelines are needed to be implemented which includes large sample size and the use of statistical tools for analysis. Though the result of the analysis generated using the statistical tools, a conclusion can be drawn to be able to answer the research question. References Abderhalden, C. (2008). The systematic assessment of the short-term risk for patient violence on acute psychiatric wards. Netherlands: Datawyse and University Pers Maastricht. Abderhalden, C., Needham, I., Dassen, T., Halfens, R., Fischer, J.E. and Haug, H.J. (2007). Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland. Clinical Practice and Epidemiology in Mental Health, 3 (30), 1-12. Abderhalden, C., Needham, I., Dassen, T., Halfens, R., Haug, H.J. and Fischer, J.E. (2008). Structures risk assessment and violence in acute psychiatric wards: randomised controlled trial. The British Journal of Psychiatry, 193, 44-50. Anderson, A. and West, S.G. (2011). Violence against mental health professionals: when the treater becomes the victim. Innov Clin Neurosci, 8 (3), 34-39. Beezhold, J., Williams, P., Taylor, J., Harris, A. and Kandasamy, S. (2009). A quasi-experimental controlled intervention to reduce violence on an acute psychiatric ward. European Psychiatry, 25, 873. Bjorkdahl, A. (2010). Violence prevention and management in acute psychiatric care: Aspects of nursing practice. Sweden: Karolinska Institutet Department of Clinical Neuroscience. Chen, W.C., Sun, Y.H., Lan, T.H. and Chiu, H.J. (2009). Incidence and risk factors of workplace violence on nursing staffs caring for chronic psychiatric patients in Taiwan. Int J Environ Res Public Health, 6, 2812-21. Chen, W.C., Hwu, H.G., Kung, S.M., Chiu, H.J., and Wag, J.D. (2008). Prevalence and determinants of workplace violence of health care workers in a psychiatric hospital in Taiwan. J Occup Health, 50, 288-293. Cornaggia, C.M., Beghi, M., Pavone, F. and Barale, F. (2011). Aggression in psychiatry wards: A systematic review. Psychiatry Research, 189, 10-20. Cowman, S. and Bowers, L. (2008). Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study. Journal of Clinical Nursing, 18, 1346-1353. Foster, C., Bowers, L. and Nijman, H. (2007). Aggressive behaviour on acute psychiatric wards: prevalence, severity and management. Journal of Advanced Nursing, 58 (2), 140-149. Grassi, L., Biancosino, B., Marmai, L., Kotrotsiou, V., Zanchi, P., Peron, L., Marangoni, C., Vanni, A. and Barbui (2006). Violence in psychiatric units: a 7-year Italian study of persistently assaultive patients. Soc Psychiatry Epidemiol, 41: 698-703. Maguire, J. and Ryan, D. (2007). Aggression and violence in mental health services: categorizing the experiences of Irish nurses. Journal of Psychiatric and Mental Health Nursing, 14: 120-127. Mericle, A.A. and Havassy, B.E. (2008). Characteristics of recent violence among entrants to acute mental health and substance abuse services. Soc Psychiatry Psychiatr Epidemiol, 43, 392-402. National Institute for Health and Clinical Excellence (NICE) (2005). Violence: the short-tern management of disturbed/violent behavior in in-patient psychiatric settings and emergency departments. London: Royal College of Nursing. Offredy, M. and Vickers, P. (2010). Developing a healthcare research proposal: an interactive student guide. John Wiley and Sons. Pearson, R. W. (2010). Statistical persuasion: how to collect, analyze, and present data – accurately, honestly, and persuasively. Pennsylvania: Sage. Richter, D. and Whittington, R. (2006). Violence in mental health settings: causes, consequences, management. Springer. Read More