Thesis (M. Nurs.)--University of Hong Kong, 2004. / Also available in print.

Thesis (M. Nurs.)--University of Hong Kong, 2004. / Also available in print.

Thesis (MA)--University of Stellenbosch, 2007. / Bibliography. Also available via the Internet.

Thesis (MCur (Interdisciplinary Health Sciences. Nursing Science))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: Workplace violence in health care is a worldwide phenomenon. In nursing, the nature of workplace violence is predominantly non-physical in nature. Literature reveals the devastating consequences for the individual nurse, both physically and / or emotionally, depending on the nature of the violence. The consequences for the organisation / institution and the profession are equally devastating, manifesting in reduced standards of patient care and increased attrition from the profession. The pervasiveness of this problem indicates that to date, remedial and protective measures have been unsuccessful. However, most of the research done on workplace violence in nursing has been conducted amongst qualified nurses. The purpose of this study was to investigate the extent of workplace violence, targeting student nurses in clinical areas. The setting was the Western Cape College of Nursing and the population was second, third and fourth-year, pre-registration students. The research objectives addressed various aspects, for example, type, prevalence, perpetrators, consequences and management of workplace violence. A quantitative research design, utilising a survey, was chosen for the study. A probability sample of n = 255 students was selected, using stratified, random sampling as the sampling method. The variables selected for stratification were gender and year of study. A self reported, anonymous questionnaire, guided by the literature review and by the research objectives, was utilised for data generation. Summary statistics were used to describe the variables, whilst distributions of variables were presented in the form of histograms and frequency tables. Where appropriate, the relationships between demographic and research variables were described, using suitable statistical analyses. The findings revealed that the perpetration of non-physical violence against student nurses is widespread, particularly that perpetrated by co-workers, more specifically registered, staff- and assistant nurses. The under reporting of workplace violence was a common finding. Student nurses suffer grave emotional consequences as a result of workplace violence. Almost half of the respondents admitted that they had considered leaving nursing due to workplace violence and that it had negatively affected their standard of patient care. The overall conclusion was that, in accordance with a worldwide trend amongst all categories of nurses, student nurses are targets of workplace violence in the clinical areas. These findings have particular implications for the management of nursing education institutions. The fact that student nurses are targeted to the extent revealed in this study indicates that existing preventive measures in the clinical areas have not been effective. The recommendations arising from this study therefore focus on equipping the vulnerable trainee with the tools to withstand workplace violence. As such, the recommendations are directed at the management of the nursing education institution, to create awareness around the problem, to empower students to confront and cope with workplace violence and to support students traumatised by workplace violence. Finally, this study suggests avenues for further research, for example, research in the same setting after implementation of the recommendations, or further research into the dynamics of workplace violence, targeting student nurses from the perspective of qualified nursing staff or patients. / AFRIKAANSE OPSOMMING: Geweld in die gesondheidsdienste werksplek is ‘n wêreldwye verskynsel. In verpleging is geweld in die werksplek oorwegend nie-fisies van aard. Die literatuur wys op die ingrypende fisiese en / of emosionele gevolge vir die individuele verpleegkundige, afhangend van die aard van die geweld. Die gevolge vir die organisasie of instelling, asook vir die verpleegberoep, is eweneens ingrypend en manifesteer in verlaagde standaarde in pasiëntsorg en ‘n toename in verpleegkundiges wat die beroep verlaat. Die algemene verskynsel van die problem dui aan dat regstellende en beskermende maatreëls tot dusver onsuksesvol was. Die meeste navorsing oor geweld in verpleging is egter tot dusver onder gekwalifiseerde verpleegkundiges gedoen. Die doel van hierdie studie was om die omvang van werksplek-geweld, met studenteverpleegkundiges as teikengroep, in die kliniese areas na te vors. Die studie is by die Wes-Kaap Kollege van Verpleging uitgevoer en die populasie was al die tweede, derde en vierde-jaar, voor-registrasie studente. Die geformuleerde navorsingsdoelwitte vir die studie het verskeie aspekte aangespreek, soos byvoorbeeld, tipe, frekwensie, die uitvoerders van geweld, gevolge en die hantering van werksplek-geweld. ‘n Kwantitatiewe navorsingsontwerp, met gebruikmaking van ’n opname, is vir die studie geselekteer. ‘n Waarskynlikheidsteekproef van n = 255 studente is deur middel van gestratifiseerde, ewekansige steekproefneming geselekteer. Geslag en jaar van studie was as die veranderlikes vir stratifikasie gekies. Die instrument vir data-insameling was ‘n self-voltooide vraelys, gebaseer op die literatuurstudie en gerig deur die navorsingsdoelwitte. Opsommende statistieke is aangewend om die veranderlikes te beskryf, terwyl die verspreidings van veranderlikes in die vorm van histogramme of frekwensie-tabelle aangebied is. Waar toepaslik, is die verhoudings tussen demografiese en navorsingsveranderlikes met behulp van toepaslike statistiese analises beskryf. Die bevindinge het onthul dat die pleeg van nie-fisiese geweld teenoor studenteverpleegkundiges algemeen voorkom, veral daardie deur mede-personeel, meer spesifiek geregistreerde, staf– en assistent verpleegundiges. Die onderrapportering van werksplek-geweld was ‘n algemene bevinding. Studenteverpleegkundiges ly aan erge emosionele gevolge, as gevolg van werksplek-geweld. Byna die helfte van die respondente het erken dat hulle oorweeg het om die beroep te verlaat en dat sodanige geweld hul standaard van pasiëntsorg negatief beinvloed het. Die oorkoepelende gevolgtrekking was dat studenteverpleegkundiges, in ooreenstemming met ‘n wêreldwye neiging onder alle kategorieë van verpleegkundiges, die teiken van werksplek-geweld in die kliniese areas is. Hierdie bevindinge hou spesifieke implikasies vir die bestuur van verpleegonderriginrigtings in. Die feit dat studenteverpleegkundiges tot die mate, soos in die studie onthul, geteiken word, het aangetoon dat bestaande voorkomende maatreëls in die kliniese areas oneffektief is. Die voorstelle vanuit hierdie studie is dus daarop gerig om die ontvanklike nuweling toe te rus om werksplek-geweld teë te staan. As sulks is die voorstelle gemik op die bestuur van die verpleegonderrig-inrigting, om bewustheid rondom die probleem te skep, om studente te bemagtig om geweld te konfronteer en te hanteer, en om studente, wat as gevolg van werksplek-geweld getraumatiseer is, te ondersteun. Laastens word moontlikhede vir verdere navorsing voorgestel, soos byvoorbeeld, navorsing in dieselfde omgewing na die implementering van die voorstelle, of verdere navorsing in die dinamika van werksplek-geweld teenoor studenteverpleegkundiges, vanuit die perspektief van gekwalifiseerde verpleegpersoneel of pasiënte.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research. / thesis (BPsychology(Hons))--University of South Australia, 2004.

Aggression occurs frequently on many psychiatric wards; its assessment and management are crucial components of inpatient care. Consequences to inpatient aggression are profound, impacting on staff and patients, ward milieu and regime, and mental health services in general. Despite considerable research, which has primarily focussed on the assessment of demographic and clinical characteristics of aggressive patients, the nature of the relationship between mental illness, inpatient treatment and aggression remains unclear. Inconsistent risk assessment practices, management strategies and treatment plans, often derived from idiosyncratic beliefs about the causes of aggression, follow. Approaches to the assessment of inpatient aggression have been categorised as structural, which emphasise form, or functional, which emphasise purpose. Studies of inpatient aggression have primarily utilized a structural approach. These studies have resulted in the identification of demographic, clinical and situational characteristics of high-risk patients and environments. Resource allocation and actuarial assessments of risk have been assisted by this research. Conversely, functional assessment approaches seek to clarify the factors responsible for the development, expression and maintenance of inpatient aggression by examining predisposing characteristics, in addition to the proximal antecedents and consequences of aggressive behaviours. While functional analysis has demonstrated efficacy in assessing and prescribing interventions for other problem behaviours, and has been regarded a legitimate assessment approach for anger management problems, psychiatric inpatient aggression has been relatively neglected by functional analysis. Against this background, four studies focussing on the assessment of predisposing characteristics, precipitants and consequences, and purposes of aggressive behaviour, were undertaken to assist in the development of a functional analysis of psychiatric inpatient aggression. All four studies were conducted within the Thomas Embling Hospital (TEH), a secure forensic psychiatric hospital in Melbourne, Australia. The first of three initial studies involved a retrospective review of Incident Forms relating to aggressive behaviours that occurred within the first year of the hospital?s operation. The second involved a comparison of prospective assessment of aggressive behaviours with retrospective review of Incident Forms. The third involved a review of Incident Forms across two forensic psychiatric hospitals, the Rosanna Forensic Psychiatric Centre, and the TEH, to allow for the study of environmental contributors to aggression. The fourth, and main study, focussed on the assessment of patients and aggressive incidents, using a framework emphasising purpose, which was assessed using a classification system designed and validated as part of this study. Demographic and clinical information in addition to social behaviour, history of aggression and substance use were collected on the 204 patients admitted to the hospital during 2002. One hundred and ten of these patients completed an additional assessment of psychotic symptoms in addition to a battery of psychological tests measuring anger expression and control, assertiveness, and impulsivity. During 2002, the year under review, there were 502 incidents of verbal aggression, physical aggression, and property damage recorded. Staff members who observed these incidents were interviewed, and files were reviewed to record the severity, type, direction and purpose of aggression. Following 71 aggressive behaviours patients also participated in the assessment of purpose. Results from this, and the three initial studies, reinforced the contribution to aggression of a number of individual characteristics, including a recent history of substance use, an entrenched history of aggression, a recent history of antisocial behaviour, and symptoms of psychosis, including thought disturbance, auditory hallucinations and conceptual disorganisation. Somewhat surprisingly, a number of other characteristics shown through previous research to have a relationship with aggression, including anger arousal and control, impulsivity, and assertiveness did not show a relationship with aggression. Further, and perhaps a consequence of the peculiar characteristics of some patients admitted to the TEH, older patients and females were more likely to be repeatedly aggressive, yet neither age nor gender differentiated aggressive from non-aggressive inpatients. In this study acts of inpatient aggression were usually precipitated by discernible events, or motivated by rational purposes. Rarely was aggression the consequence of a spontaneous manifestation of underlying psychopathology occurring in isolation from environmental precipitants. A number of proximal environmental factors, most particularly staff-patient interactions associated with treatment or maintenance of ward regime, that were considered provocative or that threatened status, were evident in incidents of aggression perpetrated against staff. The perception of provocation and the need to enhance status were common precipitants of aggression between patients. There was little evidence to suggest that aggression was used instrumentally to obtain tangible items, to reduce social isolation, or to observe the suffering of others in the absence of provocation. Results of these four studies have implications for the prediction and prevention of inpatient aggression, and for the treatment of aggressive inpatients. These are discussed, as are the limitations of this research and suggestions for further research. / thesis (BPsychology(Hons))--University of South Australia, 2004.

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: leaf 180-201.

Magister Curationis / Violence in society has reached epidemic level and has permeated the walls of the workplace. Workplace violence has also spread across all occupations, especially those dealing with the public, and has escalated over the years. In this thesis the researcher explored the experiences, perceptions and coping mechanisms used by nurses exposed to violence in the health setting. The main focus was to determine how the nurses interpret abuse, and does this interpretation determine their response to the abuse. / South Africa

"Our society has generally viewed women as less aggressive and less likely to commit acts of violence in comparison to men. Statistics show that only 13 per cent of the violent crimes in the United States have been committed by women (Steffensmeier and Allan, 1996). However, employees at psychiatric hospitals often report problems of increased violent behavior among their female inpatients. This perception of the female inpatient population is further complicated by the mixed research findings regarding gender and violence. Considering the possible other environmental causations, gender alone should not prove an accurate variable in addressing violent behavior. Variables such as age, location, time, ethnicity, institutionalization and violence to self as opposed to violence to others will likely show significant relevance. This study will attempt to demonstrate how these other biopsychosocial variables play a role in violence prediction for this group of forensically committed patients other than gender."