Trenoweth Steve
Thames Valley University/West London Mental Health NHS Trust, Southall, UK.
J Adv Nurs. 2003 May;42(3):278-87. doi: 10.1046/j.1365-2648.2003.02617.x.
Violence in British psychiatric hospitals appears to be escalating, with nursing staff the most frequent victims of assault. There is also public concern about violence on the part of individuals with mental health problems. In this climate, assessing a patient's risk of violent behaviour has become an important part of mental health care. However, little research has been published into how mental health nurses undertake such assessments in their day-to-day clinical practice.
The study focused on how mental health nurses make assessments of risk in clinical crisis situations where there is a perceived likelihood of imminent violence. The study sought to identify skills, cognitive processes or any other mechanisms which nurses draw upon to assist in such assessments.
Ten experienced mental health nurses working in a secure mental health environment were interviewed and data generated was analysed using a grounded theory approach. An in-depth literature search was also undertaken.
It was found that, in their risk assessments, nurses rely extensively on their personal knowledge of their patients (in particular, previous history of violent behaviour; biographical data; and impact of the mental health problem on violent behaviour). Nurses 'tune in' to potentially violent situations by observing a scenario as a whole, as well as specific aspects of a patient's behaviour, whilst also searching for causes of the violent behaviour. In making clinical risk assessments, nurses often make rapid, intuitive judgements in which various possibilities are considered regarding the likelihood of violent behaviour (such as the capacity and capability of a patient to be violent and the potential in the situation). It was also found that the ability to intervene successfully in potentially violent situations reduced the level of risk that nurses felt exposed to, and here nurses draw on their knowledge of a particular patient. They also perceive lower levels of risk when working in a skilled team.
The study indicates that the development of nurse-patient relationships and working in a supportive team are perceived as protective factors against risk. Implications of the research are discussed in relation to nurse-patient relationships, particularly in the context of the current nursing climate and the way in which violent behaviour may lead to an erosion of these relationships. The importance of 'working in a team' is discussed, as is the consequence of the findings for education and development. Methodological limitations of the study are also discussed.
英国精神病院的暴力行为似乎在不断升级，护理人员是最常受到攻击的受害者。公众也对有心理健康问题的人的暴力行为表示担忧。在这种情况下，评估患者暴力行为的风险已成为精神卫生保健的重要组成部分。然而，关于精神科护士在日常临床实践中如何进行此类评估的研究却很少发表。
该研究聚焦于精神科护士在临床危机情况下如何评估暴力风险，在这些情况下，人们认为暴力行为可能迫在眉睫。该研究旨在确定护士用于协助此类评估的技能、认知过程或任何其他机制。
对在安全的精神卫生环境中工作的10名经验丰富的精神科护士进行了访谈，并使用扎根理论方法对收集到的数据进行了分析。还进行了深入的文献检索。
研究发现，在进行风险评估时，护士广泛依赖他们对患者的个人了解（特别是暴力行为的既往史、传记资料以及心理健康问题对暴力行为的影响）。护士通过整体观察一个场景以及患者行为的具体方面来“感知”潜在的暴力情况，同时也在寻找暴力行为的原因。在进行临床风险评估时，护士通常会做出快速、直观的判断，其中会考虑暴力行为可能性的各种因素（例如患者实施暴力的能力和可能性以及当时的潜在情况）。研究还发现，成功干预潜在暴力情况的能力降低了护士所感受到的风险水平，在此过程中护士会利用他们对特定患者的了解。当在一个技术娴熟的团队中工作时，他们也会感觉到风险水平较低。
该研究表明，护士与患者关系的发展以及在一个支持性团队中工作被视为防范风险的保护因素。研究结果的影响在护士与患者关系方面进行了讨论，特别是在当前护理环境以及暴力行为可能导致这些关系受到侵蚀的方式的背景下。讨论了“团队合作”的重要性以及研究结果对教育和发展的影响。还讨论了该研究的方法学局限性。
