Paper: Aggression In Psychiatric Settings: Understanding Attitudes as a Key Step to Policy and Practice Change (20th International Nursing Research Congress Focusing on Evidence-Based Practice)

Thursday, 16 July 2009: 2:05 PM

Rani Hajela Srivastava, RN, MScN, PhD
Nursing Practice & Professional Services, Centre for Addiction & Mental Health, Toronto, ON, Canada
Ann Pottinger, RN, MN
Nursing Practice and Professional Services, Centre for Addiction & Mental Health, Toronto, ON, Canada
Athina Perivolaris, RN, MN
Geriatrics Mental Health, Centre for Addiction and Mental Health, Toronto, ON, Canada
Jane Paterson, BA, MSW
Nursing Practice and Professional Services, Centre for Addiction and Mental Health, Toronto, ON, Canada

Learning Objective 1: Describe the positive as well as the negative connotations and meanings of aggression

Learning Objective 2: Discuss the importance of understanding attitudes as a crucial step in policy and practice development

Purpose: The purpose of this survey was to determine staff and physician attitudes towards aggressive behavior as well as their understanding of key aspects of relevant organizational policies. The prevention/management of aggressive behavior is an essential aspect of safety within a mental health/addiction facility. Although the prevalence and determinants of aggression are well documented in the literature, little is known about nurses' attitudes toward aggression. Understanding attitudes toward aggression has important implications for the development of policies and educational programs on care related to ‘least restraint’ and ‘psychiatric emergency’. Literature indicates that attitude towards aggressive behavior guide how staff react to and manage such behaviors.

Methods: The survey utilized the 18 item Attitude Toward Aggression Scale with the addition of some policy related items developed by the researchers. The items were categorized into five subscales: offensive, communicative, destructive, protective, and intrusive. Over 270 staff , 40% of whom were nurses, completed the survey electronically.

Results: Data analysis is underway; however, the findings support previous research documenting that aggression can be viewed both positively and negatively. No significant differences were noted between attitudes of clinical and non-clinical staff on any of the five attitude subscales or between attitudes of staff working in high restraint use and low restraint use areas. Offensive subscale scores were positively correlated with destructive and intrusive subscales scores and negatively correlated with communicative subscale scores. Communicative and protective subscale scores were positively correlated and were negatively correlated with intrusive subscale scores. Regarding knowledge of key aspects of relevant organizational policies, clinical staff got a significantly proportion of questions correct than non-clinical staff, with no difference between knowledge of nurses and other clinical staff.

Conclusion:It is expected that understanding attitudes will provide guidance in developing and implementing policy and practices that promote both patient and staff safety through informed customized educational programming. Implications for policy development, education, and future research will be discussed.

See more of: Global Health in a Psychiatric Setting
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