Psychiatric nurses' experiences with inpatient aggression

Using a survey instrument, the experiences of psychiatric nurses with inpatient aggression were investigated in East London, U.K. On this “Perceptions of Prevalence Of Aggression Scale” (POPAS), annual experiences with 15 types of disruptive and aggressive behavior were rated anonymously. Staff members were also asked to disclose the number of days missed from work due to inpatient violence. On the basis of these POPAS forms, internal consistency of the instrument, mean reported aggression frequencies, and days missed from work due to violence were calculated. Internal consistency of the POPAS appeared to be reasonable. Verbal abuse and threats were experienced by most of the psychiatric nurses during a one‐year period (i.e., by about 80–90 percent of nurses). Sexual harassment or intimidation was also experienced relatively often on an annual basis (68 percent), particularly by female and young staff members. A minority of staff members (i.e., 16 percent) had experienced severe physical violence. Although not prevalent, this type of behavior was most strongly connected with reporting sick. In particular, staff members working with involuntarily admitted patients experienced much (severe) violence during their work. Although the validity of estimates of aggression prevalence with the POPAS instrument needs to be investigated further, such a survey may be helpful in gaining insight rather quickly into the level of day‐to‐day contact with aggressive behavior. Also, since information on verbal, physical, and sexual violence, and on days missed from work, can be provided anonymously, this rather delicate, but essential management information, may be accessed relatively easily with the POPAS. Aggr. Behav. 00:000–000, 2005. © 2005 Wiley‐Liss, Inc.     

Dating Violence Victimization,Dispositional Aggression,and Nonsuicidal Self‐Injury among Psychiatrically Hospitalized Male and Female Adolescents

The objective of the current study was to characterize the association between dating violence victimization and dispositional aggression in predicting nonsuicidal self‐injury (NSSI) among psychiatrically hospitalized male and female adolescents. One hundred fifty‐five adolescents (ages 13–17) and their parents completed the Schedule for Affective Disorders and Schizophrenia for School‐Age Children clinical interview to assess NSSI and child abuse; adolescents completed self‐report measures of aggression and dating violence victimization (verbal, physical, and sexual). Dating violence victimization and NSSI were found to be highly prevalent among both males and females in this psychiatric inpatient sample. Two moderational models were supported, wherein dating violence was associated with NSSI in the context of elevated trait anger in males and indirect aggression in females. Findings suggest that helping victims of dating violence acquire skills to address certain forms of dispositional aggression may attenuate NSSI.     

Situational determinants of inpatient self-harm

Auto-aggressive individuals have a higher likelihood of engaging in interpersonal violence, and vice versa. It is unclear, however, whether ward circumstances are involved in determining whether aggression-prone patients will engage in auto-aggressive or outwardly directed aggressive behavior. The current study focuses on the situational antecedents of self-harming behavior and outwardly directed aggression of psychiatric inpatients. Inwardly and outwardly aggressive behavior were monitored on a locked 20-bed psychiatric admissions ward for 3.5 years with the Staff Observation Aggression Scale-Revised (SOAS-R). A map of the ward was attached to each SOAS-R form, enabling staff members to specify locations of aggressive incidents. Time of onset, location, and provoking factors of auto-aggressive incidents were compared to those connected to aggression against others or objects. Of a total of 774 aggressive incidents, 154 (20%) concerned auto-aggressive behavior. Auto-aggression was significantly more prevalent during the evening (i.e., 50% compared to 32%), and reached its highest level between 8 and 9 P.M. (17% compared to 7%). The majority of self-harming acts (66%) were performed on patients' bedrooms. Outwardly directed aggression was particularly common in the day-rooms (24%), the staff office (19%), the hallways of the ward (14%), and the dining rooms (10%). Provoking factors of auto-aggressive behavior are less often of an interactional nature compared to outwardly directed aggression. The results suggest that a lack of stimulation and interaction with others increases the risk of self-injurious behavior. Practical and testable measures to prevent self-harm are proposed.     

Psychiatric nurses' attitudes towards inpatient aggression: preliminary report of the development of attitude towards aggression scale (ATAS)

Professional skills to adequately manage patient aggression are a prerequisite for nurses working in psychiatric hospitals. These ‘technical’ skills, however, are necessary but not sufficient for effective nurse intervention. The attitude of nurses' towards client aggression also contributes to their response to a patient's behaviour. In order to study the domains (types) of attitudes towards aggression, a sample was taken of nurses working in the fields of general psychiatry (n=288), psychiatry for children and adolescents (n=242) and psychogeriatrics (n=88). A cross‐sectional survey design was adopted for the study. The Attitudes Towards Aggression Scale (ATAS) consisting of 32 items is presented, representing three types of attitudes towards aggression: aggression as a ‘harming’ reaction, a ‘normal’ reaction and a ‘functional’ reaction. The strongest predictors of the type of attitude respondents had towards the aggressive behaviour of their clients were (1) field, (2) setting they worked in, (3) gender and (4) type of shifts they predominantly had. Although the measure of domains of nurses' attitudes towards aggression needs further psychometric testing, it can be a useful tool in clinical practice for the assessment of staff attitudes towards aggression. This can support the decision‐making about the management of aggressive behaviour on a ward. Aggr. Behav. 00:1–10, 2005. © 2005 Wiley‐Liss, Inc.     

Sectioned offenders presenting with enduring mental illness: a study exploring behaviors indicative of bullying

Logit and logistic regression analyses were employed to explore the nature, extent and predictors of behaviors indicative of "being bullied" and of "bullying others" in a sample of 125 adult male offender-patients sectioned for enduring mental illness and detained within a high-secure psychiatric hospital. The study addresses the lack of research into this specialized population to date, with a subsidiary aim of comparing the results directly with a previous study conducted with a population of adult male personality-disordered offender-patients (n = 53). Participants were required to complete a self-report behavioral checklist (Direct and Indirect Patient behavior Checklist-Hospital version Revised). The prediction that indirect (subtle) aggression would be reported more frequently than direct aggression was supported in relation to perpetration estimates, with evidence such aggression was also more prevalent among personality-disordered than mentally ill offender-patients. As predicted verbal aggression was the most commonly reported direct behavior. Although it was predicted that those perpetrating aggression would present with increased experience with secure settings this was only supported with regard to bully-victims. Contrary to the prediction made, those victimized did not present with less experience of secure settings. Consistent with the hypothesis, bully/victims were predicted by increased negative behavior toward staff and hospital rules. The results are discussed in relation to the environment in which the aggression is taking place with the implications for practice and future research outlined.     

The Prevalence and Co-Occurrence of the Forms of Violence Against Women

ABSTRACT

To examine the relative risk of the multiple forms of violence against women as well as the incidence and co-occurrence rates of self-reported childhood sexual assault (CSA), childhood physical assault (CPA), intimate partner violence (IPV), and witnessing family violence. The sample included 1,069 female undergraduates who completed measures of childhood trauma exposure (CPA, CSA, and exposure to family violence) and IPV victimization. Fifty-four percent of women in the sample experienced one or more forms of violence. Nearly 30% of participants reported IPV, 23% reported witnessing violence as a child, 13% reported experiencing CPA, and 11% reported experiencing CSA. Regarding co-occurrence, 31% experienced only one form of violence, 16% reported two forms, 6% reported three forms, and just over 1% of the sample reported experiencing all four forms of violence. For all forms of violence, the relative risk of experiencing another form of violence was significant at p < .0001, with witnessing violence and CPA being associated with the highest risks. This study highlights the importance of more carefully describing the violence experiences of participants used in violence research and accounting for poly-victimization in explanatory models of these forms of aggression and abuse.     

Psychological Dating Violence Perpetration and Victimization: Trajectories From Middle to High School

Despite evidence documenting the negative consequences, psychological dating violence occurs frequently in adolescent dating relationships. No information exists on the trajectories that adolescents follow and their association to nonphysical peer violence. The sample comprised 624 randomly selected 6th graders. In yearly surveys from 6th through 12th grade, 550 of the 624 students reported dating at least twice during the 3 months prior to completing the survey. These students responded to questions about frequency of engagement in psychological dating violence perpetration and victimization. We used Proc TRAJ to identify developmental trajectories of behavior over time and generalized estimating equation models to examine the associations of the trajectories and peer aggression. Adolescents followed three distinct developmental trajectories related to psychological dating violence victimization and perpetration: low, increasing, and high. Based on the joint probabilities of victimization and perpetration, we identified four predominant groups: low victimization/low perpetration (LVLP; 36%), increasing victimization/increasing perpetration (40%), high victimization/high perpetration (HVHP; 15%), and increasing victimization/low perpetration (IVLP; 7%). The LVLP had significantly more boys and White students; the HVHP group had an even gender distribution and more African‐American students. For all groups, peer aggression decreased from Grade 6 to 12; students in the HVHP group reported the highest peer aggression, and students in the LVLP reported the lowest peer aggression. Findings suggest a strong, reciprocal relationship in the developmental trajectories of adolescents who experience and perpetrate psychological dating violence. Those highly engaged in these behaviors were also more likely to be violent toward peers. Aggr. Behav. 38:510‐520, 2012. © 2012 Wiley Periodicals, Inc.     

Violence in the community—a study of violence and aggression in homelessness and mental health day services

This study examined violence and aggression in five agencies providing day services in homelessness or mental health. Incident reporting was used to test the hypotheses that aggression is associated with alcohol problems, drug use, mental disorder, homelessness, history of violence, age and sex. Agency policies and patterns to aggressive incidents were explored. Three agencies provided a sufficient number of incidents for analysis (involving 30 ‘aggressors’). A history of violence was associated with aggression in all three agencies; alcohol problems, drug use and younger age were associated with aggression in at least one agency; no association was found for mental disorder, homelessness or sex. A degree of pattern to incidents could be discerned, with drink or drugs often involved, and exercises of authority or intervention in client altercations being particularly likely to precede aggression towards staff. A variety of incidents were reported, from verbal arguments to threats with a knife and serious physical assault. © 1997 John Wiley & Sons, Ltd.     

The dynamic appraisal of situational aggression: an instrument to assess risk for imminent aggression in psychiatric inpatients

Considerable research has attempted to delineate the demographic and clinical characteristics of high-risk psychiatric patients and identify salient modifiable aspects of aggression prone environments. Recently, there has also been increased interest in the development and testing of structured schemes for the assessment of risk for aggression within inpatient psychiatric settings. Although some of these methods show acceptable predictive validity, their ability to inform day-to-day treatment and management decisions is limited. The current research was designed to identify existing and novel risk factors that would assist staff to identify and manage the risk for aggression in psychiatric inpatient populations. Results showed that assessments supported by structured risk measures were more accurate than unaided clinical judgements based only on nurses' clinical experience and knowledge of the patient alone. Seven test items emerged that were maximally effective at identifying acute psychiatric patients at risk for engaging in inpatient violence within 24 hours; these items have been combined in the development of the Dynamic Appraisal of Situational Aggression. Empirical analyses and clinical experience support the efficacy of the instrument in assisting clinical staff in the identification and management of inpatient aggression.     

Staff-administered functional analysis and treatment of aggression by an elder with dementia

In the current study, nursing home staff were taught to administer functional analyses to determine the variables maintaining aggression by an elder with dementia. The results indicated that aggression was evoked during bathroom routines and that escape maintained aggression. Staff then reduced aggression to near-zero levels with noncontingent escape. Implications for the assessment and treatment of problem behaviors in nursing home settings are discussed.     

Physical aggression toward teachers: Antecedents,behaviors, and consequences

School violence is a significant public health concern that occurs in many forms. Physical aggression can cause serious bodily injury and long-term negative effects, and both teachers and students experience significant rates of physical aggression. There are few studies examining teachers’ experiences of physical aggression. Studies that go beyond prevalence are limited, and we know little about the triggers and consequences that surround these incidents. This qualitative investigation used an antecedent-behavior-consequence (A-B-C) framework to understand how incidents of physical aggression directed toward teachers unfold. The sample included 193 elementary and secondary teachers who completed an anonymous, online survey and described events leading up to and following their experiences with physical aggression. Using conventional content analysis, we identified common antecedents, such as breaking up fights, discipline, and directives, and common consequences, such as student removal, school staff involvement, positive outcomes, and inaction. Further analyses revealed seven common A-B-C patterns among physical aggression incidents that are highlighted and discussed. Utility of the A-B-C framework for teacher-directed violence is described, along with implications for research, practice, and policy. Exploring the context surrounding incidents of physical aggression directed against teachers provides useful information for violence prevention and interventions.     

Patterns of Women’s Aggression Against Partners and Others: Broadening Our Understanding of Violence

Research on women's aggression typically focuses on relational aggression. However, the study of violence must include multiple forms of violence such as aggression against partners and non‐partner others, while also considering victimization experiences by partners and non‐partners. The focus of this study is the multiple experiences of violence (perpetration and victimization) of women who are incarcerated. Incarcerated women are likely to experience higher rates of both than women in community settings, but most will be released in a brief period of time. Using a random sample (N = 580) we conducted cluster analyses to identify five patterns of women's aggression. Clusters varied depending on the target/s of aggression (i.e., partner and/or others), and type of aggression (i.e., physical and/or intimidation). Multinomial logistic regression was performed to determine the relationship between women's membership in a perpetration cluster and their victimization. Victimization history was related to an increased risk of perpetrating aggression, and varied depending on the target and type of aggression. Our findings provide support that research and interventions addressing women's use of aggression must also address their victimization history. Furthermore, results indicate that for some women, aggression towards partners and others is related. Future research should investigate multiple forms of aggression.     

Prevalence, antecedent causes and consequences of domestic violence in Myanmar

The present study explored women's experiences of domestic violence in Myanmar. In particular, the study examined the relation between antecedents and outcomes of their experiences as well as influences of attribution styles, response styles and different types of violence on their experiences. Using the Myanmar version of the Revised Conflict Tactic Scale, survey data from a representative sample of 286 women in Myanmar were conducted. Results indicated that 27% of women experienced physical assault and 69% of women experienced psychological aggression in a 1-year period. The factors associated with increased risks of violence included witnessing parental violence, husbands' unemployment, husbands' frequent alcohol use, and women's feminism attitudes. Severe physical assault was a strong predictor of negative outcomes and formal intervention. Formal intervention was related to fewer negative outcomes.     

Relationship aggression,violence and self‐regulation in Australian newlywed couples

Research in the United States shows that relationship violence occurs in a substantial minority of newlywed couples, and is associated with a range of risk factors such as family‐of‐origin violence. Few of the associated risk factors, however, are potentially modifiable through early intervention to prevent violence. In the current study self‐reported aggression and violence were assessed in 379 Australian newlywed couples. Consistent with US‐based research, >20% of newlywed Australian couples reported at least one incident of relationship violence in the past year. A range of correlates of relationship violence and aggression was assessed, including the construct of relationship self‐regulation, which is the extent that partners report being able to enhance their relationship with their partner. Low relationship self‐regulation was correlated with relationship aggression and violence. It was concluded that the aggression and violence are common problems in Australian newlywed couples, and that enhancing relationship self‐regulation might help reduce the prevalence of aggression.     

Neighborhood violent crime and adolescent relationship aggression

Research has shown that neighborhoods play a role in the etiology of violence. However, few adolescent relationship aggression (ARA) studies have objective measures of violent neighborhoods. Drawing on a nationally representative sample of youth, this study examines the association between ARA and local levels of violent crime (measured using geocoded Uniform Crime Report data from each of the youths’ residential neighborhoods). Study analyses are based on survey data from 723 youth (ages 10–18) in current or recent dating relationships (351 males and 372 females) in the Survey on Teen Relationships and Intimate Violence (STRiV), a national representative household panel survey exploring interpersonal violence and related aggression among adolescents. About 19% of the sample reported ARA victimization in their most recent dating relationship (ARA perpetration was 17%). Neighborhood violent crime in the study (males living in 86.9 and females 99.8) was slightly lower than the national average of 100. With a broad national sample, 40% non-Whites, hypotheses guided by theories of neighborhood influence were tested. The study did not find an association between neighborhood violent crime and ARA victimization and perpetration, controlling for key demographic factors. The results, for a broad range of high- and low-crime neighborhoods, suggest that neighborhood violence does not seem to affect individual rates of ARA. The results suggest the ARA victimization and perpetration are perhaps ubiquitous and found both in low and high violent crime neighborhoods, suggesting that addressing local violent crime rates alone does not seem to be a path to also reducing ARA.     

Gender,sexual harassment,workplace violence,and risk assessment:: Convergence around psychiatric staff's perceptions of personal safety

This paper reviews literature in sexual harassment, workplace violence, and risk assessment as it relates to staff in psychiatric and forensic work environments. These three areas of research overlap in their applicability to psychiatric staff in that each addresses the understanding and management of types of violence to which many staff, particularly women, are likely to be exposed while working. Employee well-being, encompassing mental and physical health, job satisfaction, and morale, has been shown to be closely tied to organizational productivity and cost. In addition, gender has been shown to be an important factor in perceptions and decision-making, and prior work has suggested that female staff often have qualitatively different experiences in traditional male workplaces such as inpatient and forensic settings. Despite these findings, research to date on psychiatric staff has typically focused only on number of assaults by patients. It has not addressed how staff's gender may impact their perceptions of personal safety and judgments of risk from patients, nor have any empirical studies been performed in naturalistic settings to investigate this issue. Given the high correlation between organizational productivity and employee well-being, it is mutually beneficial to both employers and staff to examine current understanding of how certain staff variables such as gender may influence their feelings of safety and judgments of risk from patients.     

Characteristics of residential retarded clients as predictors of staff expectations and frustrations

The purpose of this study was to examine the relationship of four client characteristics—functioning level, aggressive behavior, self-injurious behavior, and attractiveness—with staff expectations of and frustration with clients. Forty staff members who worked with severely and profoundly retarded individuals served as participants. Staff members rated each client with whom they worked on the extent to which the client could behave better and learn faster as well as the level of frustration experienced in working with the client. A client's functioning level was related to staff perceptions such that the higher the functioning level, the more the client was seen as having the potential to behave better or learn faster than (s)he was presently demonstrating. Staff frustration was related to client aggression indicating that as aggression increased so did staff frustration in working with that client. Implications of the results are discussed.     

Reductions of intimate partner violence resulting from supplementing children with omega‐3 fatty acids: A randomized,double‐blind,placebo‐controlled,stratified, parallel‐group trial

Omega‐3 supplementation has been found to reduce externalizing behavior in children. Reciprocal models of parent‐child behavior suggest that improving child behavior could lead to improvements in parent behavior, however no study has examined whether omega‐3 supplementation in children could reduce intimate partner violence or child maltreatment by their adult caregivers. In this randomized, double‐blind, placebo‐controlled, stratified, parallel group trial, a community sample of children were randomized to receive either a fruit drink containing 1 gm of omega‐3 fats (Smartfish Recharge; Omega‐3 group, n = 100) or the same fruit drink without omega‐3's (Placebo group, n = 100). Child participants, adult caregivers, and research staff were blinded to group assignment. Adult caregivers reported inter‐partner and child‐directed physical assault and psychological aggression at baseline, 6 months (end of treatment) and 12 months (6 months post‐treatment) using the Conflicts Tactics Scale. Caregivers of children in the omega‐3 group reported long‐term reductions in psychological aggression in a group × time interaction. Improvements in adult psychological aggression were correlated with improvements in child externalizing behavior scores. No differences were reported for child maltreatment. This study is the first to show that omega‐3 supplementation in children can reduce inter‐partner psychological aggression among adult caregivers not receiving supplements. Findings suggest that improving child behavior through omega‐3 supplementation could have long‐term benefits to the family system as a whole.