Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, Vic., Australia.
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
J Psychiatr Ment Health Nurs. 2021 Oct;28(5):924-939. doi: 10.1111/jpm.12758. Epub 2021 Apr 24.
WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.
在精神病住院病房中，攻击和暴力行为是长期存在的问题。从医护人员和患者的角度已经确定了预防暴力的因素。迄今为止，针对暴力和攻击性行为住院的事件，研究和综述并未进行充分的解释。本文的创新点在于，它提供了患者和医护人员观点的比较，并发现这些观点存在差异，并且受到住院文化因素的影响。两者都同意的一个促成因素是医护人员人际交往技巧在加剧或缓解攻击和暴力方面的作用。住院文化被发现对导致暴力和攻击的大多数促成因素产生了不同的看法。对实践的影响：虽然医护人员的人际交往技巧被认为是他们与患者的互动是否导致攻击和暴力的主要影响因素，但这受到住院环境文化的影响。以患者为中心的互动技巧需要关注患者对尊重和积极参与的需求，而不是引起不尊重或胁迫的感觉。以患者为中心的沟通技巧，体现对患者在住院环境中的体验的理解，需要成为精神科护士的核心技能。摘要：背景高比率的攻击和暴力是精神科住院环境中的一个长期存在的问题。比较医护人员和患者对这些原因的看法可能会提供新的见解。目的本综述旨在比较患者和医护人员对住院环境中攻击和暴力原因的看法。方法对 Ovid（Medline、Embase、PsycINFO）数据库进行文献综合回顾，并进行手动搜索。结果符合纳入标准的文章有 30 篇。在发生攻击或暴力事件之前，患者将这些互动描述为不尊重和胁迫，而医护人员则将其视为患者的精神状态或个性的指示。两组人员都确定了以患者为中心的沟通技巧的重要性。讨论本综述确定了患者和医护人员对暴力和攻击原因的看法存在差异。在医护人员和患者之间存在一种相互作用的动态关系，这种关系受到住院环境文化的影响。对实践的影响：了解住院文化如何在塑造患者和医护人员之间的动态关系中发挥作用，并培养承认这一点的沟通技巧，可能有助于减少住院环境中的暴力和攻击。
