AN important study into the effects of patients’ verbal aggression towards mental health nurses has shown that nurses’ judgements can be affected by receiving personal abuse.
A report published in the International Journal of Nursing Studies, research led by Abertay University in Dundee, concludes that mental health nurses exposed to verbal aggression by patients in secure units are more likely to back the use of restraint or seclusion for patients.
The study supervised by Abertay’s Professor Geoff Dickens has shown that targeted, personal, verbal aggression from patients can affect nurses’ decision-making when it comes to coercive techniques.
The project was conducted by Dr Rahul Jalil of Birmingham City University, previously of the University of Northampton, who carried out rigorous assessments with mental health nurses working in three UK secure mental health units.
The study, which was funded by Northampton and St Andrew Healthcare, revealed findings which suggest that nurses subjected to humiliating personal remarks by patients experience higher levels of distressing emotions including anger.
However, while individual nurses exposed to verbal aggression were more approving of coercive interventions, this did not translate into an increased use of restraint or seclusion.
The new information follows previous studies that have shown exposure to physical aggression and self-harm have detrimental consequences for nurses in terms of staff sickness and trauma.
The report stated: “Nurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation.
“Exposure to mild and severe physical aggression was unrelated to nurses’ emotions. Nurses’ reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes.”
The report concluded: “Verbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation.
“Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour.
“Nurse-reported anger predicted approval of coercive violence management interventions; this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents.
“Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be ‘at risk’. Future research priorities are considered.”
Dr Jalil said: “Nurses who reported being the target of derogatory remarks reported higher levels of anger than their colleagues.
“This was not true for those who had witnessed greater levels of physical aggression or self-harm.
“The same nurses who experienced humiliating remarks were more likely to endorse coercive management techniques such as restraint or seclusion.
“It seems that existing checks and balances, perhaps including team support or nurses own self-awareness, act to prevent a spiral in which behaviour is dealt with coercively which in turn might make patients more likely to insult the nursing staff.”
Dickens commented that self-awareness and management of emotional responses are areas that must be considered when training mental health nurses.
He added: “We already knew that exposure to aggression seems to be related to nurses’ approval of these less desirable interventions.
“What this study adds is that it is this particular type of insidious and seemingly less severe form of aggression that seems to play the largest role. This has real implications for education and training for staff in the prevention of violence and aggression.
“This study shows that anger seems to be a mechanism that plays a unique role.
“While it is common to hear that nurses should ‘just deal with it’, it is unreasonable to believe that nurses are immune and can do this without help or support.”
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