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

Abstract

Purpose of Study: Research on psychiatric nurses’ attributions about patient aggression has so far focussed on attributions made at one point in time in response to one stimulus (vignette or real account of patient aggression). To date, no research has been conducted on how new information influences attributions made; on investigating differences in attributions in different settings; and there is inconsistent evidence regarding the impact of previous exposure to aggression. This research therefore seeks to rectify some of these gaps. This study will examine the impact of new information; the effect of incident setting; and previous exposure to aggression upon attributions made by psychiatric nurses about patient aggression. Investigation is also made into further examining the relationships between attributions, previous exposure to aggression, general health, and burnout; and how these relate to nurses’ acceptance or avoidance of their distressing experiences. Methodology: A mixed design was employed. A repeated measures design tested the effect of new information (history of aggression, diagnosis of schizophrenia, and substance misuse) upon attributions of locus, control, and stability, measured on a seven-point scale. The experimental stimulus was a vignette. Each participant was randomly assigned one vignette depicting an incident of aggression set either in a work or non-work setting (independent samples design). Five questionnaires were also completed: the General Health Questionnaire, the Acceptance and Action Questionnaire, the Maslach Burnout Inventory, the Exposure to Aggression and Violence Scale, and the Impact of Patient Aggression upon Carers Scale. Attributions were correlated with these measures. Results: A significant effect of new information about history of aggression and diagnosis of schizophrenia was found for attributions of control, but not locus or stability. Locus and stability attributions were affected by the incident setting. No effect of previous exposure to aggression was found on attributions. Several significant correlations were detected. The measure of nurses’ acceptance or avoidance of distressing experiences correlated more frequently with the other measures in comparison to attribution ratings. Conclusions: The impact of new information was not as large as expected. This may be related to methodological issues but consideration is given to other explanations. Calls for nurse training to include consideration of environmental and personal influences (including attitudes and self-awareness) are outlined.