Introduction:
According to NICE guidelines, between 2013 -2014, there were 68,683 assaults reported against NHS staff in England. Violence against staff members has become a growing concern in health care institutions worldwide .The reduction of work place violence is a major issue affecting health care staff in recent years. All forms of aggression form a potential occupational hazard to health care staff. Experience of violence can lead to severe physical, psychological and financial consequences for all concerned- the employees, the patient and the organisation.
This review of literature will examine several studies which discuss the psychological or emotional impact of the violence on staff in inpatient mental health settings. On completion of this study, the reviewer hopes to gain understanding of how violence from patients affects the staff psychologically and highlight implications for professional practice. The background to the topic and the rationale for the chosen topic of review will be discussed in the opening section.
The next chapter will focus on the methodology which includes the systematic approaches used in selecting, critiquing and analysing the selected literature. The selected literature will be critically appraised for their strengths and weaknesses. This will be followed by the identification of emerging themes and the discussion of findings. This review will also highlight implications for practice.
Rationale:
The focus question of the literature review is: What are the psychological impacts of patient violence on staff working in mental health. The aim of this literature review is to explore and examine the psychological impacts of patient violence on staff working in mental health.
The World Health Organisation defines violence as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal development, or deprivation.” It is defined as any physical, emotional or sexual behaviour that harms individuals physically and or emotionally. (Anderson & West, 2011)
Violence and aggression refer to a range of behaviours or actions that can result in harm, hurt or injury to another person, regardless of whether the violence or aggression is physically or verbally expressed, physical harm is sustained or the intention is clear. (NICE Guidelines NG 10, May 2015)
Work place violence against health care professionals takes various forms such as physical assault, sexual assault/harassment and verbal aggression. Verbal abuse is the most common form of aggression clinical staff experience (Baby et al).
Physical violence includes, but is not limited to: Using physical force which results in pain, discomfort or injury; Hitting, pinching, hair-pulling, arm-twisting, strangling,
stabbing, punching, pushing, slapping, beating, shoving, kicking, choking, biting, or any other rough treatment; Assault with a weapon or other object or threats with a weapon or object. Verbal aggression has been described as a behaviour which involves attacking the self – concept of others to inflict psychological pain (Infante & Wigley, 1986).
Erdos and Hughes in their study found that staff who spend more time with patients are at greater risk of experiencing assault. Nursing staff who are on the front line are at more risk of aggression from patients than any other clinical staff.
Though violence and aggression against healthcare workers is widespread among different areas such as accident and emergency, and geriatrics, violence and aggression against staff members is more pronounced in mental health services. Nurses working in mental health frequently experience verbal and physical violence from patients (Shiao et al, 2010). Research indicates that 75% to 100% of nurses who work in inpatient mental health services, experience violence by patients at least once in their career. (McGuire& Ryan, 2007) Several studies have focussed on the reasons for the aggression in mental health units and found that it could be a product of different variables such as patient factors, staff factors, environmental factors and the interaction between staff and patients. The management of aggression is still an existing issue, even though considerable effort has been put in by health care organisations and the government to improve the safety of health care employees.
Aggression and violence from inpatients has an extensive physical and psychological impact on staff members.(Needham, 2006). Physical outcomes of exposure to patient aggression may include injuries and disabilities. The aggressive incidents have a negative impact on the psychological well-being of the staff .On an organisational level it might lead to negative consequences such as increased absenteeism, difficulties with staff retention and work place injury claims.
Though there is extensive research on this issue of patient aggression against staff and the management of it in health care settings, the problem still persists. The topic is important because research shows that a large number of health care staff are frequently exposed to aggression and this produces a range of professional and psychological sequele .(Needham, Abderhalden, Halfens, Fischer et al 2005).
The reviewer’s current job setting in an acute mental health unit, where violence from patients towards staff is not a rare occurrence, inspired the reviewer to look into this topic. Though the staff members who experienced these assaults were supported by the team, the psychological effect it had on them seems to be overlooked at times. The focus question was developed through further reading on the subject and discussion with the team members.Understanding the psychological impact of patient aggression on staff will assist in enhancing recognition of these and facilitate developing supportive strategies to address this issue.
The terms violence and aggression are used interchangeably in this study. Violence in this study is broadly represented as comprehensively including physical assault, threatening behaviour and verbal aggression. Horizontal violence experienced by health care workers from colleagues or managers is not taken into consideration for this study.