Violence and aggression towards staff in secure settings
| Pages | 122-133 |
| Published date | 14 May 2018 |
| Date | 14 May 2018 |
| DOI | https://doi.org/10.1108/JFP-05-2017-0015 |
| Author | Annette Greenwood,Louise Braham |
| Subject Matter | Health & social care,Criminology & forensic psychology,Forensic practice,Sociology,Sociology of crime & law,Law enforcement/correctional,Public policy & environmental management,Policing,Criminal justice |
Violence and aggression towards staff in
secure settings
Annette Greenwood and Louise Braham
Abstract
Purpose –The purpose of this paper is t ou ndertake a systematic literature rev iew to appraise the current
evidence relating to the f actors associated wit h violence and aggression i n adult psychiatric hosp ital
inpatient settings.
Design/methodology/approach –A systematic search of following four databases was conducted:
Scopus, PsychINFOMedline, CIHAHL and PsychArticle. Following theapplication of the inclusion criteria, ten
papers were extracted and included in the review. A quality appraisal tool, Mixed Methods Appraisal Tool
(MMAT) version 2011 (Pluye et al., 2011), was employed for the appraisal of the qualitative and quantitative
studies. MMAT has been designed for systematic literature reviews that include qualitative, quantitative and
mixed methodsstudies. Of these, eight were of quantitative methodologyand two were of qualitative studies.
Findings –These ten papersprovide an insight intofactors associatedwith violence and aggression towards
nursingstaff. Three mainthemes were identified:the environment,attitudes/interactionof staff, and the patient’s
mental illness. The themeswere important factorsin the causes of violence but were interlinked highlighting the
complexnature of violencetowards nursing staff.The findings supportthe need for trainingfor nursing staffand
the development of ongoingsupport and for organisations to considerboth the environment and therestrictive
proceduresto help reduce violenceand aggression towards nursing staff.
Practical implications –The paper concludes by outlining the importance of considering the three main
themes for clinical practice, training and development of secure services.
Originality/value –This paper gives insight into the factors associated with patient violence and aggression
towards nursing staff in a secure setting.
Keywords Nurses, Violence, Aggression, Patients, Psychiatric, Secure setting, Secure hospital
Paper type Research paper
Introduction
Violence towards nurses
Serious assaults on nursing staff are increasing year by year with 71 per cent (43,699) of annual
incidents occurring in mental health services (NHS Protect, November 2013). These figures
suggest that as many as 25 per cent of mental health nurses in public sector hospitals are
subject to a violent incident resulting in a serious injury (Eisenstark et al., 2007). It is estimated that
137.3 million working days were lost due to sickness or injury in the UK in 2016. The number of
assaults per year is recorded by NHS Protect, however sickness absence is not listed separately
thus the real cost of absence due to assaults on staff in mental health units is not known.
Spending on secure services amounted to £1.2 billion in 2009/2010, corresponding to 18.9 per cent
of all public expenditures in adult mental health care (National Mental Health Development Unit,
2011). In the UK, the National Audit of Violence found that a third of inpatients had been threatened
or made to feel unsafe while in care (Royal College of Psychiatrists (RCP), 2000). This figure rose to
44 per cent for clinical staff (psychologists, psychiatrists and occupational therapists), while nurses
were often at the forefront of violence with 72 per cent of staff reporting a violent incident by a patient.
Understanding violence and aggression against psychiatric nursing staff and reduction of violent
assaults for both patients and staff is central to the management.
Received 17 May 2017
Revised 14 July 2017
18 July 2017
11 September 2017
14 September 2017
Accepted 15 September 2017
The authors would like to thank
Dr Stephen Melluish at the
University of Leicester for his
encouragement and support.
Annette Greenwood is a
Consultant Psychologist
Trauma Service Lead and
Louise Braham is the Clinical
Director, both at St Andrew’s
Healthcare, Northampton, UK.
PAGE122
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JOURNAL OF FORENSIC PRACTICE
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VOL. 20 NO. 2 2018, pp. 122-133, © Emerald Publishing Limited, ISSN 2050-8794 DOI 10.1108/JFP-05-2017-0015
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