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Mental health nurses exposed to verbal aggression by patients in secure units are more likely to back the use of restraint or seclusion interventions, a new study has shown.
Research supervised by Abertay University’s Professor Geoff Dickens has shown that targeted, personal, verbal aggression from patients can affect nurses’ decision-making when it comes to coercive techniques.
Published today in the prestigious International Journal of Nursing Studies, the project was conducted by Dr Rahul Jalil of Birmingham City University, previously of the University of Northampton, who carried out rigorous assessments with mental health nurses working in three UK secure mental health units.
The study, which was funded by Northampton and St Andrew Healthcare, revealed that, while individual nurses exposed to verbal aggression were more approving of coercive interventions, this did not translate into an increased use of restraint or seclusion.
However the findings suggest that nurses subjected to humiliating personal remarks by patients experience higher levels of distressing emotions including anger.
The new information follows previous studies that have shown exposure to physical aggression and self-harm have detrimental consequences for nurses in terms of staff sickness and trauma.
Dr Jalil said: "Nurses who reported being the target of derogatory remarks reported higher levels of anger than their colleagues.
“This was not true for those who had witnessed greater levels of physical aggression or self-harm.
“The same nurses who experienced humiliating remarks were more likely to endorse coercive management techniques such as restraint or seclusion.
"It seems that existing checks and balances, perhaps including team support or nurses own self-awareness, act to prevent a spiral in which behaviour is dealt with coercively which in turn might make patients more likely to insult the nursing staff.”
The research was one part of Dr Jalil's PhD studies which also involved looking at the role of anger in patient aggression and in the nurse-patient therapeutic relationship.
Professor Dickens is part of Abertay's Division of Mental Health Nursing which offers a BSc Hons degree in the subject.
He said self-awareness and management of emotional responses are areas that must be considered when training mental health nurses.
He added: "We already knew that exposure to aggression seems to be related to nurses' approval of these less desirable interventions.
“What this study adds is that it is this particular type of insidious and seemingly less severe form of aggression that seems to play the largest role.
“This has real implications for education and training for staff in the prevention of violence and aggression.
“Training provision largely focuses on managing physical aggression through techniques such as de-escalation.
"While this is great, more attention should be paid to how nurses regulate their own responses to this behaviour.
“This study shows that anger seems to be a mechanism that plays a unique role.
“While it is common to hear that nurses should 'just deal with it', it is unreasonable to believe that nurses are immune and can do this without help or support."
To read the study in full visit http://www.sciencedirect.com/science/article/pii/S0020748917301700