University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.
BMC Health Serv Res. 2020 Apr 26;20(1):362. doi: 10.1186/s12913-020-05239-w.
Violence towards staff working in psychiatric inpatient care is a serious problem. The aim of the present study was to explore staff perspectives of serious violent incidents involving psychiatric inpatients through the following research questions: Which factors contributed to violent incidents, according to staff? How do staff describe their actions and experiences during and after violent incidents?
We collected data via a questionnaire with open-ended questions, and captured 283 incidents reported by 181 staff members from 10 inpatient psychiatric wards in four different regions. We used the Critical Incident Technique to analyse the material. Our structural analysis started by structuring extracts from the critical incidents into descriptions, which were grouped into three chronological units of analyses: before the incident, during the incident and after the incident. Thereafter, we categorised all descriptions into subcategories, categories and main areas.
Staff members often attributed aggression and violence to internal patient factors rather than situational/relational or organisational factors. The descriptions of violent acts included verbal threats, serious assault and death threats. In addition to coercive measures and removal of patients from the ward, staff often dealt with these incidents using other active measures rather than passive defence or de-escalation. The main effects of violent incidents on staff were psychological and emotional. After violent incidents, staff had to continue caring for patients, and colleagues provided support. Support from managers was reported more rarely and staff expressed some dissatisfaction with the management.
As a primary prevention effort, it is important to raise awareness that external factors (organisational, situational and relational) are important causes of violence and may be easier to modify than internal patient factors. A secondary prevention approach could be to improve staff competence in the use of de-escalation techniques. An important tertiary prevention measure would be for management to follow up with staff regularly after violent incidents and to increase psychological support in such situations.
针对精神科住院患者工作人员的暴力行为是一个严重的问题。本研究旨在通过以下研究问题探讨工作人员对涉及精神科住院患者的严重暴力事件的看法：根据工作人员的说法，哪些因素促成了暴力事件？工作人员如何描述他们在暴力事件期间和之后的行动和经历？
我们通过一份带有开放式问题的问卷收集数据，从四个不同地区的 10 个住院精神病病房的 181 名工作人员报告了 283 起事件。我们使用关键事件技术来分析这些材料。我们的结构分析从将关键事件中的摘录结构化为描述开始，这些描述分为三个时间顺序的分析单元：事件发生前、事件发生期间和事件发生后。此后，我们将所有描述分为子类别、类别和主要领域。
工作人员通常将攻击和暴力归因于内部患者因素，而不是情境/关系或组织因素。暴力行为的描述包括言语威胁、严重攻击和死亡威胁。除了强制性措施和将患者从病房中移走外，工作人员通常还使用其他主动措施来处理这些事件，而不是被动防御或降级。暴力事件对工作人员的主要影响是心理和情绪方面的。在暴力事件发生后，工作人员必须继续照顾患者，同事提供支持。管理层的支持报告较少，工作人员对管理层表示有些不满。
作为初级预防措施，重要的是要提高认识，即外部因素（组织、情境和关系）是暴力的重要原因，并且可能比内部患者因素更容易改变。二级预防方法可以是提高工作人员在使用降级技术方面的能力。重要的三级预防措施是管理部门在暴力事件发生后定期与工作人员联系，并在这种情况下增加心理支持。
