This review examines the research on ecologic factors that may contribute to or lessen the likelihood of inpatient unit violence. Understanding these factors can provide psychiatric inpatient unit staff with valuable therapeutic relational and cultural strategies to decrease violence. International and US studies from OVID Med- line, CINAHL, and PsycInfo that evaluated aggression and violence on psychiatric inpatient units between 1983 and 2008 were included in this review. The review revealed that violence results from the complex interactions among the patient, staff, and culture of the speci?
Inpatient psychiatric staff can decrease the poten- tial for violence by using therapeutic relationship strategies such as using good communication skills, advocating for clients, being available, having strong clinicalassessment skills, providing patient education, and collaborating with patients in treatment planning.
Cultural improvements include providing meaningful patient ac- tivities and appropriate levels of stimulation and unit staf? ng. Inpatient psychiatric unit aggression has a negative effect on patients, staff, and the milieu. Both patients and staff can be de- moralized, traumatized, angry, and helpless after the occurrence of a violent event, and physical and emotional harm can result from violence (Menckel & Viitasara, 2002). Health care profes- sionals, especially inpatient psychiatric nurses, are among those at highest risk of being engaged in a violent encounter at work (Arnetz, Arnetz, & Soderman, 1998; Foster, Bowers, & Nijman, 2007; Menckel & Viitasara, 2002; Quintal, 2002). This review examined studies of aggression or violence on psychiatric in- patient units between 1983 and 2008.
Forensic units, prisons, outpatient community settings, and medical units were excluded from this literature review because of the special nature of these units and patient populations. DEFINITION OF AGGRESSION Mental disorder predisposes behavioral problems, often in the form of poorly controlled impulses. The therapeutic work of Address correspondence to Vanya Hamrin, Yale University, School of Nursing, 100 Church Street South, P. O. Box 9740, New Haven, CT 06536. E-mail: vanya. [email protected] edu inpatient psychiatric nursing requires helping patients control their behavior through modeling, guidance, limit-setting, verbal interaction, and reduction of psychiatric symptoms in a ther- apeutically structured milieu. Violence and related antecedent
Behaviors, such as verbal and physical intimidation, present one of nursing’s most challenging situations. Aggression was broadly de? ned in this literature review as “hostile, injurious or destructive behavior” (Merriam-Webster, 2008). Speci? c ex- amples of aggression de? ned in several of the studies reviewed were threatening or intimidating behavior, verbal assault, assault on property, self-injury, and physical assault directed at others such as, hitting with hand or st, kicking, scratching, spitting, sexually threatening, throwing objects, pinching, biting, hitting with object, grabbing clothes, pulling hair, choking or strangling
(Chou, Lu, & Mao, 2002; Duxbury, 2002; Foster et al. , 2007; Grassi et al. , 2006; Morrison, 1998; Owen, Tarantello, Jones, & Tennant, 1998; Secker et al. , 2004; Sukhodlsky, Cardona, & Martin, 2005). SOCIETAL VIOLENCE Violence on inpatient units is in? uenced by the larger US culture, which has among the developed world’s highest rates of violent behavior, including homicide which is higher in 15- to 24-year-olds than in any other country (Peden, McGee, & Sharma, 2002). Personhood as individually possessed and ultimately isolated from all other persons is a paradigmatic assumption of Western culture (Foucault, 1986, 1997; Taylor, 1989).
Features of this cultural assumption particularly appar- ent in relationships include self-responsible independence in having and meeting needs; emphasizing on personal unique- ness (Taylor, 1989) and an attitude of absolute individual value (Foucault, 1986). The US’s Declaration of Independence and US culture in general represent some of the most extreme ex- pressions of Western individualism. Stout (2005) asserts that the high rate of sociopathy in the United States as compared to other countries results from holding individualism as a central value. 214 Prev Page Next Page View as single page Search Topics in this document
Aggression, Hospital, Mental disorder, Mental health, Psychiatric hospital, Psychiatry, Psychology, Violence Related Documents Psych …? Breaking Bad Habits or Starting Good Ones: Behavior Modification using Operant Conditioning Deadline: beginning of class on Wednesday, October 23rd Is there a habit that you would like to break? For example, maybe you think that you drink too much coffee, bite your nails too much, or put things off too often. Or maybe there is a word or phrase that you would like to use less frequently (e. g. , “like”, “uhhh” “literally”). Alternatively, is there a behavior that you would like to…