School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China.
Community Psychiatric Services, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong (SAR), China.
PLoS One. 2022 Sep 29;17(9):e0274536. doi: 10.1371/journal.pone.0274536. eCollection 2022.
Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson's r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents' characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses' scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.
对攻击行为的态度是精神病学中一个有争议的现象。本研究从护士、患者和非正式照顾者的角度考察和比较了精神病院中对患者攻击行为的态度，并确定了与这些态度相关的因素。共有 2424 名参与者完成了一份关于攻击行为态度的自我报告工具（12 项感知攻击量表；POAS-S）。我们分析了来自护士（n=782）、患者（n=886）和非正式照顾者（n=765）的数据。使用 Pearson's r 相关分析来检验变量之间的关联。使用方差分析/多变量方差分析和事后 Sheffe 检验分析组间得分的差异。使用多元逻辑回归模型和逻辑回归分析来检验受访者特征对其攻击行为态度的影响。根据 POAS-S 总分，护士对攻击行为的看法明显更消极、容忍度更低（平均值[标准差]47.1[7.5]，p<0.001），而患者（平均值[标准差]44.4[8.2]）和非正式照顾者（平均值[标准差]45.0[6.9]）。同样的趋势也存在于功能障碍和功能亚量表中（平均值[标准差]分别为 25.3[4.1]和 15.0[3.6]）；当将护士的分数与患者（平均值[标准差]分别为 23.7[5.3]和 14.0[4.1]）和非正式照顾者（平均值[标准差]分别为 24.4[4.2]和 13.9[3.5]）的分数进行比较时，组间差异具有统计学意义（p<0.001）。该研究为不同治疗环境中的攻击行为提供了新的认识，在这些环境中，对患者行为的态度引发了伦理和实际困境。这些结果表明，护理人员需要更有针对性的在职培训、针对患者的攻击行为管理康复计划以及针对非正式照顾者的同伴支持计划，重点关注患者的攻击行为。
