Understanding Patient Aggression: An Experimental Study of Psychiatric Nurses’ Attributions For Patient Aggression and Their Relationship To Staff Well-Being

摘要

Purpose of Study: Research on psychiatric nurses’ attributions about patientudaggression has so far focussed on attributions made at one point in time in response toudone stimulus (vignette or real account of patient aggression). To date, no research hasudbeen conducted on how new information influences attributions made; on investigatinguddifferences in attributions in different settings; and there is inconsistent evidenceudregarding the impact of previous exposure to aggression. This research therefore seeksudto rectify some of these gaps. This study will examine the impact of new information;udthe effect of incident setting; and previous exposure to aggression upon attributionsudmade by psychiatric nurses about patient aggression. Investigation is also made intoudfurther examining the relationships between attributions, previous exposure toudaggression, general health, and burnout; and how these relate to nurses’ acceptance orudavoidance of their distressing experiences.udMethodology: A mixed design was employed. A repeated measures design tested theudeffect of new information (history of aggression, diagnosis of schizophrenia, andudsubstance misuse) upon attributions of locus, control, and stability, measured on audseven-point scale. The experimental stimulus was a vignette. Each participant wasudrandomly assigned one vignette depicting an incident of aggression set either in a workudor non-work setting (independent samples design). Five questionnaires were alsoudcompleted: the General Health Questionnaire, the Acceptance and ActionudQuestionnaire, the Maslach Burnout Inventory, the Exposure to Aggression andudViolence Scale, and the Impact of Patient Aggression upon Carers Scale. Attributionsudwere correlated with these measures.udResults: A significant effect of new information about history of aggression anduddiagnosis of schizophrenia was found for attributions of control, but not locus orudstability. Locus and stability attributions were affected by the incident setting. Noudeffect of previous exposure to aggression was found on attributions. Several significantudcorrelations were detected. The measure of nurses’ acceptance or avoidance ofuddistressing experiences correlated more frequently with the other measures inudcomparison to attribution ratings.udConclusions: The impact of new information was not as large as expected. This mayudbe related to methodological issues but consideration is given to other explanations.udCalls for nurse training to include consideration of environmental and personaludinfluences (including attitudes and self-awareness) are outlined.