Strategies that mental health nurses can utilise to reduce aggression in acute mental health settings through cultural change

Transcription

1 3 rd NUS-NUH International Nursing Conference & 20 th Joint Singapore-Malaysia Nursing Conference 2015 Strategies that mental health nurses can utilise to reduce aggression in acute mental health settings through cultural change Eric Lim, RN, MNurSt, PhD candidate Curtin University Faculty of Health Sciences School of Nursing, Midwifery & Paramedicine

2 Background and Introduction Aggression is a major problem in the acute mental health settings Described as any attempted or actualised verbal or physical behaviour directed by a person with the goal of threatening or injuring self, others or property

3 Background and Introduction Aggression can be verbal (swear and sexually threatening remarks) and physical (hitting, kicking, scratching, spitting, throwing objects, pinching, grabbing clothes, pulling hair, choking or strangling) Aggression can occur due to individual related factors, environmental factors and interpersonal conflicts, as well as provoked by fear of being harm or having unmet needs and demands

4 Background and Introduction Nurses who are exposed to consumer aggression report high level of stress and burnout Some serious effects from this exposure include permanent disability, economic impacts, lost productivity and reduce quality of life The impact of aggression on the workforce can lead to severe nursing shortage and staffing problems and increase health care cost with the use of causal staff

5 Background and Introduction Nurses depend on a range of factors to determine the appropriate strategy to prevent an aggressive incident in the wards Attitudes, beliefs, knowledge, skills, number of staffs and staff genders Other factors include feeling of apprehension working in a potentially aggressive environment and expectations to prevent aggression

6 Background and Introduction Nurses who agree with the internal model of causation may therefore use more controlling means rather than interpersonal means to prevent aggression less optimistic in potentially aggressive individuals strengths and coping strategies to improve their predicament may have the tendency to deploy containment measures prematurely

7 Background and Introduction These responses is damaging to the consumer-staff relationship and can lead to more negative interactions that ultimately hinder consumer recovery process People may find nurses stigmatising and discriminating and with the enforcement of restrictive environments and become aggressive.

8 Background and Introduction A paradigm shift in the acute mental health settings to recovery-oriented practices may be the solution to reduce aggression Consumers who experience recovery-oriented care may be more satisfied with staff treatment and care hence improve consumer-staff relationship and reduce aggression

9 Aim of this Review To understand how mental health nurses can facilitate recovery-oriented practices to reduce aggression in the acute mental health settings.

10 Method The Joanna Briggs Institute reviewers manual 2014 guided this systematic search and review An initial search was conducted in March 2015 via CINAHL and MEDLINE using the PiCo keywords A logic grid of commonest keywords for the second step PICO tool Population Phenomenon of Interest Context Keywords Mental health nurses Culture, practices, consumer-centred, recoveryoriented, recovery-focused, recovery Mental health (primary) Aggression, violence, assault (Secondary)

11 Method In the second step Ten electronic databases using the terms recovery or aggression with the terms consumer participation, consumer consultation, or user involvement, and mental health or mental illness, and psychiatric nursing or mental health nursing Databases used: EMBASE (Ovid), EBSCOhost CINAHL PLUS with full text, MEDLINE, PubMed, PsycINFO, PsycArticles, ProQuest nursing and allied health source, ProQuest Dissertations and Theses Global, Scopus, Science Direct

12 Method The inclusion criteria were: 1) related to mental health nursing, 2) Adult aged 18 to 70 3) Related to nursing culture 4) Related to consumer aggression 5) Quantitative and qualitative studies written in English from the year 2005 to 2015

13 Method Studies excluded from the review were: 1) Not research paper and 2) Did not contain information that contributed to addressing the review questions Methodological quality of papers were assessed using JBI s critical appraisal tools

14 Results The search found no research on strategies that MHNs can utilize to facilitate cultural change to reduce aggression acute mental health settings A broader look at the publications identified thirty-two research papers and one thesis to be included

15 Results Six strategies that nurses can utilise to facilitate recoveryoriented care in acute mental health settings to reduce aggression were identified in this review and they are: 1. Create a positive consumer perception of acute mental health services 2. Provide a truly safe environment for consumers 3. Establish interdependent partnership with consumers 4. Use recovery languages 5. Show enthusiasm to involve consumers 6. Optimise consumers strength and potentials

16 Brief discussion of the strategies 1. Create a positive consumer perception of acute mental health services: Recovery is a subjective social process influence by the interactions between consumers, health professional and the environment so that one find meaning and personal growth in life Consumers who perceive staff as supportive in their recovery journey may increase their level of cooperation in treatment and care and may reduce interpersonal conflicts leading to aggression

17 Brief discussion of the strategies 2. Provide a truly safe environment for consumers: Consumers need a place that they can escape from the stigma and discrimination faced in the society that isolated them with limited choices so that they can gradually regain stability and rebuild their lives This kind of environment can provide consumers with more choices to collaborate, discuss and negotiate treatment options hence may reduce negative feelings which may result in aggression

18 Brief discussion of the strategies 3. Establish interdependent partnership with consumers: Nurses need to understand the important the depending on people s lived experiences and expertise in their own mental illness to collaborate and achieve person-centred care Consumers who provide more inputs in service planning and delivery may experience more satisfaction with their needs met hence increase their acceptance of nurses involvement in their care

19 Brief discussion of the strategies 4. Use recovery language: Recovery language are dialogues that can help people develop a mindset that value themselves, retain some control of life, be hopeful and find meaning in life despite having a debilitating mental illness Positive and constructive staff interactions may reduce stigma and discrimination and may help consumers become more hopeful and meaningful in their life

20 Brief discussion of the strategies 5. Show enthusiasm to involve consumers: Consumers want to be regarded as experts and not merely patients and be involved in their own care. However they may be passive or active depending on their health symptoms, motivations, and interests Nurses who show enthusiasm in involving consumers may offer consumer more choices and self-determination hence reduce the tension of power imbalance in consumerstaff relationship that may lead to aggression

21 Brief discussion of the strategies 6. Optimise consumers strengths and potentials: Consumers have resources, strengths and potential to live a fulfilling life and to deal with their own problems and emotions despite having a severe mental illness Nurses who optimise consumers strengths and potentials may help consumers reframe their strength to derive their own coping strategies and to assume responsibilities to manage their own mental health issues and emotions

22 Conclusion Aggression is a major problem in the acute mental health settings and can result in nurses experiencing psychological issues and impact health care costs Aggression can resulted from many factors and also negative consumer-staff relationship in these settings Nurses who are apprehensive working in potentially aggressive environments yet expected to prevent an incident may use more containment measures that may further damage the relationship leading to aggression

23 Conclusion Consumers who experience recovery-oriented care may: change their perceptions of the inpatient settings gain more satisfactions with nursing care when their needs and demands are taken into considerations more willing to take responsibilities and be involve in managing their mental health issues and emotions These may result in a reduction of aggressive incidents in acute mental health settings

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