Maagerø-Bangstad Erlend R, Sælør Knut Tore, Ness Ottar
Faculty of Health and Social Sciences, Dept. of Health and Social and Welfare Studies, Centre for Mental Health and Substance Abuse, University of South-Eastern Norway, P.O. box 7053, 3007 Drammen, Norway.
2Dept. of Education and Lifelong Learning, Norwegian University of Science and Technology, P.O. box 8900, 7491 Trondheim, Norway.
Int J Ment Health Syst. 2019 Apr 2;13:20. doi: 10.1186/s13033-019-0277-8. eCollection 2019.
Staff-directed aggression represents a considerable concern in mental health and substance abuse services, and presents a substantial challenge to the quality and continuity of service provision for people with mental health and substance abuse problems. The practitioners themselves frequently request increased competence as a way to mediate the negative effects of staff-directed violence and aggression. The aim of this study is to explore how practitioners in municipal mental health and substance abuse services conceptualize practice in prevention and management of staff-directed violence. Furthermore, we seek to explore how these conceptions change following participation in two complementary and specially developed courses advancing respectively, qualified risk assessment and situational awareness and disempowerment-sensitive and de-escalation principles for practice.
The study was conducted by using a qualitative phenomenographic research approach. The data-material comprised two-step semi-structured interviews with ten participants from various parts of community mental health and substance abuse services in the Municipality of Oslo, Norway.
The analysis resulted in the development of five qualitatively different, hierarchically ordered, yet logically interrelated conceptual categories of practice concerning prevention and management of staff-directed aggression in community mental health and substance abuse services. These are: (1) , (2) -, (3) -, (4) , and (5) . The categories vary according to the participants' attentional focus on either the responsibility of the organization, staff members' personally developed skills and techniques, team-based solutions, knowledgeable information processing in making professional judgements and reflexive, interpersonal service provision, as well as according to what meaning participants assign to practice. The authors have identified varying degrees of conceptual change following education in half of the participants.
The results of this study both show that practitioners conceptualize practice in aggressive encounters quite differently. The study also indicate that it is important to consider participant awareness of the phenomenon of interest when devising educational activities for personnel in mental health and substance abuse services.
针对工作人员的攻击行为是心理健康和药物滥用服务中一个相当令人担忧的问题，对为有心理健康和药物滥用问题的人提供服务的质量和连续性构成了重大挑战。从业者自身经常要求提高能力，以此来缓解针对工作人员的暴力和攻击行为的负面影响。本研究的目的是探讨市政心理健康和药物滥用服务中的从业者如何理解预防和管理针对工作人员的暴力行为的实践。此外，我们试图探讨在参加分别推进合格风险评估、情境意识以及对实践的无权力敏感和降级原则的两个互补且专门开发的课程后，这些观念是如何变化的。
本研究采用定性现象学研究方法。数据材料包括对挪威奥斯陆市社区心理健康和药物滥用服务各部门的十名参与者进行的两步半结构化访谈。
分析得出了五个在质量上不同、层次有序但逻辑上相互关联的概念类别，涉及社区心理健康和药物滥用服务中针对工作人员攻击行为的预防和管理实践。这些类别是：(1) ，(2) - ，(3) - ，(4) ，以及(5) 。这些类别根据参与者对组织责任、工作人员个人发展的技能和技巧、基于团队的解决方案、做出专业判断时的知识信息处理以及反思性人际服务提供的关注重点而有所不同，也根据参与者赋予实践的意义而有所不同。作者已经确定，一半的参与者在接受教育后概念发生了不同程度的变化。
本研究结果既表明从业者对攻击性行为中的实践理解差异很大。该研究还表明，在为心理健康和药物滥用服务人员设计教育活动时，考虑参与者对相关现象的认识很重要。
