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Metas de Enfermería

Metas de Enfermería

MARZO 2015 N° 2 Volumen 18

Barriers and difficulties perceived for the management of violent situations: design and validation of a questionnaire

Section: Cover story

How to quote

Pardilla Laparra A, García Pozo A. Barreras y dificultades percibidas para el manejo de situaciones violentas: diseño y validación de un cuestionario. Metas Enferm mar 2015; 18(2): 19-26.

Authors

1Ana Pardilla Laparra, 2Ana García Pozo

Position

1Enfermera. Especialista en Salud Mental. Hospital Universitario Puerta de Hierro (Madrid).2Doctora en Epidemiología y Salud Pública. Hospital General Universitario Gregorio Marañón (Madrid). Grupo de investigación de Enfermería. Instituto para la investigación sanitaria de Hospital Gregorio Marañón.

Contact address

Ana Pardilla Laparra. Pº de la Chopera, 204, 1º B. 28100 Alcobendas (Madrid).

Contact email: ana_pardilla@hotmail.com

Abstract

Objective: to assess the barriers and/or difficulties perceived by the Nursing staff in the Psychiatric Hospital Dr. Rodríguez Lafora regarding the management of violent situations, through a questionnaire previously designed and validated to this aim.  
Method: the study was conducted in two phases. During the first stage, a board of experts was held for the subsequent preparation and validation of a 22-item questionnaire about the perception of barriers and/or difficulties in the management of violent situations. For construct validation, an exploratory factor analysis was conducted. In the second stage, a transversal descriptive study was conducted, through the administration of the questionnaire to the Nursing team in the above-mentioned hospital (n= 308). A bivariate analysis (Student’s t and ANOVA) was conducted.
Results: 179 questionnaires were collected. Cronbach’s a Coefficient was 0.925. The exploratory factor analysis conducted showed five dimensions which explained the 67.01% variance. The validated questionnaire included 21 items, which obtained high scores (between 6.60 and 8.33), with the highest scores obtained in those items associated with team work and individual characteristics of the professionals.
Conclusions: after the design and validation of a questionnaire about perceived barriers and/or difficulties in the management of violent situations, the following were identified as the main difficulties in management: team work, training, regular changes of staff in the units, or the specificity of management according to each patient. It is necessary to continue the process of tool validation.

Keywords:

Violence; Mental Health; psychiatry; barriers; assaults; research; questionnaire validation

Versión en Español

Título:

Barreras y dificultades percibidas para el manejo de situaciones violentas: diseño y validación de un cuestionario

Artículo completo no disponible en este idioma / Full article is not available in this language

Bibliography

  1. Grassi L, Biancosino B, Marmai L, Kotrotsiou V, Zanchi P, Peron L et al. Violence in psychiatric units. A 7-year Italian study of persistently assaultive patients. Soc Psychiatry Psychiatr Epidemiol 2001; 41:698-703.
  2. Eker HH, Özder A, Tokaç M, Topçu I, Tabu A. Aggression and violence towards health care providers, and effects thereof. Archives of Psychiatry and Psychotherapy 2004; 4:19-29.
  3. Trenoweth S. Perceiving risk in dangerous situations: risks of violence among mental health inpatients. J Adv Nurs 2003; 42(3):278-287.
  4. Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues Ment Health Nurs 2009; 30(4):214-226.
  5. Ward L. Ready, aim fire! Mental health nurses under siege in acute inpatient facilities. Issues Ment Health Nurs 2013; 34(4):281-287.
  6. Arthur GL, Brende JO, Quiroz SE. Violence: incidence and frequency of physical and psychological assaults affecting mental health providers in Georgia. J Gen Psychol 2003; 130(1):22-45.
  7. Moreno Jiménez MA, Vico Ramírez F, Zerolo Andrey FJ, López Rodríguez A, Herrera Serenab P, Mateios Salidoc MJ. Análisis de la violencia del paciente en atención primaria. Aten Primaria 2005; 36(3):152-158.
  8. Hockenhull JC, Whittington R, Leitner M, Barr W, McGuire J, Cherry MG, et al. A systematic review of prevention and intervention strategies for populations at high risk of engaging in violent behavior. Health Technol Assess 2012; 16(3):1-152.
  9. Muralidharan S, Fenton M. Estrategias de contención para personas con enfermedades mentales graves (Revisión Cochrane traducida). En: La Biblioteca Cochrane Plus, 2008. Número 4. Oxford. [En línea] [fecha de acceso: 29 de enero de 2015]. URL disponible en: http://www.update-software.com
  10. Yao X, Li Z, Arthur D, Hu L, Cheng G. Validation of the Violence Risk Screening-10 instrument among clients discharged from a psychiatric hospital in Beijing. Int J Ment Health Nurs 2014; 23(1):79-87.
  11. Winsper C, Ganapathy R, Marwaha S, Large M, Birchwood M, Singh SP. A systematic review and meta-regression analysis of aggression during the First Episode of Psychosis. Acta Psychiatr Scand 2013; 128(6):413-421.
  12. Dean K, Walsh E, Morgan C, Demjaha A, Dazzan P, Morgan K, et al. Aggressive behaviour at first contact with services: findings from the AESOP First Episode Psychosis Study. Psychol Med 2007; 37(4):547-557.
  13. Ministerio de Sanidad y Consumo. Guía de Práctica Clínica sobre la Esquizofrenia y el Trastorno Psicótico Incipiente. Barcelona: Agència d’Avaluació de Tecnologia i Recerca Mèdiques; 2009. p. 18-90.
  14. Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: A systematic review. Psychiatry Research 2011; 189:10-20.
  15. Cervera Martínez G. Manejo de pacientes difíciles. Paciente agresivo y paciente ansioso. En: Haro Cortés G, Crespo Portero A, Menéndez Villalva C, Flórez Menéndez G. Madrid: Entheos; 2005. p. 30-110.
  16. Ng B, Kumar S, Ranclaud M, Robinson E. Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatr Serv 2001; 52(4):521-525.
  17. Virtanen M, Vahtera J, David Batty G, Tuisku K, Pentti J, Oksanen T, et al. Overcrowding in psychiatric wards and physical assaults on staff: data-linked longitudinal study. The British Journal of Psychiatry 2011; 198:149-155.
  18. Marqués Andrés S, Barrasa Santamaría L. Contención verbal: prevención primaria de la hostilidad. Metas Enferm 2011; 14(7):14-18.
  19. Prieto Báez B, Gómez Nuñez MP (eds.). Protocolo de actuación en las urgencias psiquiátricas. Ciber revista 2013; 12:1-7.
  20. Carmel H, Hunter M. Compliance with training in managing assaultive behavioral and injures from inpatient violence. Hospital and Community Psychiatry 1990; 4(5):558-560.
  21. Dean A, Duke S, George M, Scott J. Behavioral management leads to reduction in aggression in a child and adolescent psychiatric unit. Journal of the American Academy of Child and Adolescent Psychiatry 2007; 46(6):711-720.
  22. Bower L, Nijman H, Simpson A, Jones J. The relationship between leadership, teamworking, structure, burnout and attitude to patients on actue psychiatric wards. Soc Psychiatry Psychiatr Epidemiol 2011; 46:143-148.
  23. Lepping P, Steinert T, Needham I, Abderhalden C, Flammer E, Schmid P.Ward safety perceived by ward managers in Britain, Germany and Switzerland: identifying factors that improve ability to deal with violence. Journal of Psychiatric and Mental Health Nursing 2009; 16(7):629-635.
  24. Björkdahl A, Ansebo G, Palmstierna T. The influence of staff training on the violence prevention and management climate in psychiatric inpatient units. Journal of Psychiatric and Mental Health Nursing 2013; 20:396-404.
  25. Chou KR, Lu RB, Mao WC. Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan. Archives of Psychiatric Nursing 2002; 16(4):187-195.
  26. Marion J, Kathleen RD. Safety Issues on British Mental Health Wards. Journal of an American Psychiatric Nurses Association 2012; 18(2):104-111.
  27. Kontio R, Anttila M, Lantta T, Kauppi K, Joffe G, Välimäki M. Toward a safer working environment on psychiatric wards: service users’ delayed perspectives of aggression and violence-related situations and development ideas. Perspect Psychiatr Care 2014; 50(4):271-279.