Haugvaldstad Marie Jørgensen, Husum Tonje Lossius
Faculty of psychology, University of Bergen, Bergen, Norway.
Centre for Medical Ethics, University of Oslo, Oslo, Norway.
Int J Law Psychiatry. 2016 Sep-Dec;49(Pt A):130-137. doi: 10.1016/j.ijlp.2016.09.001. Epub 2016 Sep 12.
Patient aggression is universally recognized as an important challenge in mental health care (MHC). Based upon a pragmatic exploration of the professional literature, we seek here to determine how negative emotional reactions of staff-including those conveyed in terms of fear, anger, and insult-may serve to exacerbate this serious impediment to safe and effective MHC. This is done using biological and evolutionary paradigms. Studies of patient aggression have tended to focus more on patient characteristics and behavior than on those of their caregivers. The authors suggest that patient aggression may be viewed as a response to "normal" interaction processes. The results of this investigation imply that the emotional reactions of staff may escalate the aggressive interaction by increasing the patient's perception of threat, and also, increase the probability of new incidents by creating a patient-staff relationship characterized by unsafety and mistrust. Mindfulness-based interventions are suggested as useful strategies to expand the staff's emotional awareness and increase emotional control.
患者攻击行为在精神卫生保健（MHC）中被公认为是一项重大挑战。基于对专业文献的务实探索，我们在此试图确定工作人员的负面情绪反应——包括那些以恐惧、愤怒和侮辱表达的情绪反应——如何可能加剧这一对安全有效的精神卫生保健的严重阻碍。这是运用生物学和进化范式来完成的。对患者攻击行为的研究往往更多地关注患者的特征和行为，而非其护理人员的特征和行为。作者们认为，患者攻击行为可被视为对“正常”互动过程的一种反应。这项调查的结果表明，工作人员的情绪反应可能会通过增强患者的威胁感知来升级攻击性互动，并且还会通过营造一种以不安全和不信任为特征的医患关系来增加新事件发生的可能性。基于正念的干预措施被认为是扩展工作人员情绪意识和增强情绪控制的有用策略。
