Renwick Laoise, Stewart Duncan, Richardson Michelle, Lavelle Mary, James Karen, Hardy Claire, Price Owen, Bowers Len
Institute of Psychiatry, Psychology and Neuroscience, Kings College London.
School of Nursing, Midwifery Social Work, University of Manchester, Manchester, UK.
Int J Ment Health Nurs. 2016 Aug;25(4):308-18. doi: 10.1111/inm.12191. Epub 2016 Feb 19.
Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident. For this reason, we examined sequences of aggressive incidents in conjunction with other conflict and containment methods used to explore whether there were particular profiles to aggressive incidents. In the present study, 522 adult psychiatric inpatients from 84 acute wards were recruited, and there were 1422 incidents of aggression (verbal, physical against objects, and physical). Cluster analysis revealed that aggressive incident sequences could be classified into four separate groups: solo aggression, aggression-rule breaking, aggression-medication, and aggression-containment. Contrary to our expectations, we did not find physical aggression dominant in the aggression-containment cluster, and while verbal aggression occurred primarily in solo aggression, physical aggression also occurred here. This indicates that the management of aggression is variable, and although some patient factors are linked with different clusters, these do not entirely explain the variation.
攻击行为和暴力在英国心理健康信托机构中普遍存在，并且对工作人员和其他患者都会产生负面的心理和生理影响。年龄较小、男性、有物质使用史以及被诊断患有精神病的患者更有可能表现出攻击行为；然而，暴力行为并非完全由患者因素导致，还有一些复杂的情况会引发攻击行为。事实上，患者与工作人员之间的互动在住院病房的攻击行为和暴力事件中占了相当大的比例，因此在审视这些行为时，不能不考虑在攻击事件之前、期间和之后发生的其他形式的冲突及控制措施。出于这个原因，我们结合其他冲突和控制方法，对攻击事件的序列进行了研究，以探究攻击事件是否存在特定的模式。在本研究中，我们招募了来自84个急性病房的522名成年精神科住院患者，共发生了1422起攻击事件（言语攻击、针对物品的身体攻击和身体攻击）。聚类分析表明，攻击事件序列可分为四个不同的组：单独攻击、违反规则的攻击、与药物相关的攻击以及控制中的攻击。与我们的预期相反，我们发现在控制中的攻击这一组中，身体攻击并不占主导地位，虽然言语攻击主要发生在单独攻击组中，但身体攻击在该组中也有发生。这表明攻击行为的管理方式是多样的，尽管一些患者因素与不同的组相关，但这些因素并不能完全解释其中的差异。
