Junior registered psychiatric nurses' attitudes towards patient violence and violence management in Hong Kong

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Junior registered psychiatric nurses' attitudes towards patient violence and violence management in Hong Kong


Author: Lam, Chung Yan
Title: Junior registered psychiatric nurses' attitudes towards patient violence and violence management in Hong Kong
Degree: M.Sc.
Year: 2015
Subject: Violence in psychiatric hospitals
Psychiatric nurses -- China -- Hong Kong -- Attitudes.
Hong Kong Polytechnic University -- Dissertations
Department: School of Nursing
Pages: 119 leaves : illustrations ; 30 cm
Language: English
OneSearch: https://www.lib.polyu.edu.hk/bib/b2811403
URI: http://theses.lib.polyu.edu.hk/handle/200/8014
Abstract: Background: Patient violence against nurses is a worldwide problem. Nurses provide professional nursing care to patients but they are also the targets of violence due to closed contacts with patients when providing clinical care. Junior psychiatric nurses who have less clinical experience (e.g., not more than five years in this study) are at higher risk of being exposed to workplace violence because they are lack of clinical experience, knowledge and skills in handling patient violence. In Hong Kong, due to a shortage of nursing manpower and closing down of hospital schools in 2000s, junior psychiatric nurses are expected to play a leading role in making clinical decisions on the management of patient violence. However, there is lack of research on these junior psychiatric nurses' attitude towards patient violence, and their preferred strategies to handle patient violence. This research was conducted to address this issue above. The results help to understand the junior psychiatric nurses' attitudes towards patient violence and its management, and thus provide insight into their professional role development and training on patient violence. Aim: The aim of this study was to investigate junior psychiatric nurses' attitudes towards patient violence and the corresponding management in their workplace (psychiatric hospitals) in Hong Kong. Design: This was a cross-sectional and descriptive survey study using self-reported questionnaires for all junior psychiatric nurses (with not more than five years post-registration experience; full-time nurses) in Hong Kong. The Management of Aggression and Violence Attitude Scale (MAVAS) was used to evaluate junior psychiatric nurses’ attitudes towards patient aggression and violence, as well as their preferred strategies in violence management. In addition, three open-ended questions were asked about the difficulties and considerations when these junior psychiatric nurses managed the patient violence. By convenience (all available) sampling, a total of 210 junior psychiatric nurses were invited to participate in this research and those who agreed to participate received the study questionnaires via contact persons from August to December 2014. The Statistical Product and Services Solutions (SPSS) was used to analyze the quantitative data. Coding and summative analysis were used to categorize and summarize the responses for the three open-ended questions.
Results: One hundred and four junior psychiatric nurses participated in this study and the response rate was 49.5%, 54.8% (n=57) were female and most of them were aged 23-31 (88.6%) years. Only 19.2% (n=20) had a master degree level and their average time of working experience in psychiatric care was 33.8 months. They were working in a wide variety of psychiatric care settings such as admission (38.5%, n=40) and informal admission wards (18.3%, n=19). All of them had attended the first level of management of violence (MOV) training; whereas, 38.5% (n=40) participants attended level 2 and 47.1% (n=47) completed level 3 training. Nearly all participants had the experience of using physical restraint (97.1%, n=101), de-escalation (90.4%, n=94) and chemical restraint (87.5%, n=91). A majority of them (85.6%, n=89) had been verbally abused by patients, 44.2% without any experience of being physically abused and 8.7% without any experience of being physical abused and sexual harassed. About two-thirds (65.5%, n=68) had no experience of using the Hospital Authority Hong Kong reporting incident system: the Advanced Incident Reporting System (AIRS). Participants moderately agreed that internal factors (e.g., "some patients are aggressive"), external factors (e.g., "restrictive environment contribute to patient violence") and situational/interactional factors (e.g., "improving staff and patient relationship could reduce violence" and "other patient would provoke patient aggression") would contribute to patient violence. The participants attempted to adopt different approaches to manage patient violence and they relatively more agreed with the effectiveness of using medication, physical restraint and other non-physical methods, than seclusion. Many participants perceived and reported that a lack of manpower, skill and knowledge of patient violence and its management were major hinders. When they handle violent patients, they would consider patient and staff safety, de-escalation first, and patient's condition and needs (physical and mental). Conclusion: This is the first cross-sectional, descriptive research about junior psychiatric nurses' attitudes towards violent patients in Hong Kong. Nearly all the respondents had experienced of patient violence during their care, especially the most common one -verbal abuse. The research shows that junior psychiatric nurses need to enhance their competency of coping with violent incidents. Moreover, it is suggested to increase the number of the staff to provide timely nursing care and do violence assessment, so that nurses can provide early and appropriate nursing intervention to violent patient. It is also suggested to make the ward environment more comfortable to reduce the risk of external factors contributing to the patient violence.

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