ABSTRACT
Difficult and challenging behaviour by inpatients is a feature of acute psychiatric ward life. Different methods are used to contain these behaviours, and there is international variation in which are approved of or used. Previous research suggests that staff attitudes to patients may affect their willingness to use, or choice of, method. The aim of this study was to explore the relationship between approval of containment measures, perception of aggression and attitude to personality disorder. A survey of student psychiatric nurses was conducted, and using three attitudinal questionnaires related to aggression and containment. An association was found between positive attitude to patients and the approval of containment methods that involved nurses being in personal contact with patients. There was evidence that students' attitudes to patients deteriorated over time. The results highlighted the importance of (and linkage between) staffs' feelings of anger and fear towards patients, and their preparedness to use containment measures.
Subject(s)
Aggression , Attitude of Health Personnel , Personality Disorders/nursing , Psychiatric Nursing/methods , Safety Management/methods , Students, Nursing/psychology , Acute Disease , Aggression/psychology , Analysis of Variance , Anger , Clinical Competence , Factor Analysis, Statistical , Fear , Female , Humans , Hypnotics and Sedatives/therapeutic use , Male , Nurse-Patient Relations , Nursing Assessment/methods , Nursing Methodology Research , Patient Isolation/methods , Personality Disorders/psychology , Psychiatric Nursing/education , Restraint, Physical/methods , Self Efficacy , Surveys and Questionnaires , Time Factors , United KingdomABSTRACT
BACKGROUND: It is well established that staff attitudes to personality disordered patients are commonly negative, characterised by pessimism and rejection. A recent study in forensic psychiatric hospitals has described the psychological and social factors underlying positive attitudes, and suggested that staff with more positive attitudes perform better and are less stressed. AIM: To assess whether it is possible to predict which staff will adjust positively to working with personality disordered people. More specifically to confirm links between attitude to personality disorder and: job performance; perception of managers; personal well-being; burnout; and interaction rates with inmates. METHODS: The opening of a new Dangerous and Severe Personality Disorder unit within a UK prison allowed a longitudinal study of prison officers to be performed, in which a number of measures, including the Attitude to Personality Disorder Questionnaire (APDQ), were collected at three fixed points (at baseline, eight and sixteen months after the opening of the unit). RESULTS: Attitude to Personality Disorder varied over the course of the study, and changes in attitude were linked to events experienced by individual officers. More positive attitude to personality disorder was associated with improved general health and job performance, decreased burnout, and favourable perception of managers. CONCLUSIONS: Attitude to Personality Disorder has important outcomes, and is responsive to the psychosocial environment. Its measurement is not useful for staff selection, because of low stability over lengthy time periods. The APDQ has been demonstrated to be valid measure of attitude to PD, and potentially useful for outcome studies, or benchmarking between units.
Subject(s)
Antisocial Personality Disorder/psychology , Attitude of Health Personnel , Dangerous Behavior , Personality Disorders/psychology , Prisoners/psychology , Prisons , Absenteeism , Adaptation, Psychological , Adult , Antisocial Personality Disorder/diagnosis , Burnout, Professional/psychology , Employee Performance Appraisal , England , Female , Humans , Inservice Training , Job Satisfaction , Longitudinal Studies , Male , Middle Aged , Patient Care Management , Personality Disorders/diagnosis , Personality Inventory , Personnel Selection , Professional-Patient Relations , Rejection, Psychology , Surveys and QuestionnairesABSTRACT
BACKGROUND: Psychiatric professionals tend to have poor attitudes towards people who suffer from personality disorder. Previous studies suggest that such attitudes are influenced by sufferer behaviours, organizational factors and the characteristics of individual professionals, but do similar considerations apply outside health services? AIM: To identify what events, experiences and factors in the course of daily work with personality-disordered people influence the attitudes and beliefs of prison staff. METHOD: Semi-structured interviews were conducted with prison officers working in a pilot "Dangerous and Severe Personality Disorder" Unit within a UK prison. Open questions were asked about any changes in their attitudes to or beliefs about personality-disordered inmates. RESULTS: Positive influences on attitude were: development of greater understanding of personality disorder and prisoners as individuals; improvement in inmate behaviours; education; the staff counselling programme; staff sharing support and skills; the challenge and purpose of the new role and having their views listened to. Negative influences were: delays in establishing the treatment programme; some inmate behaviours; fear and concern over their new roles and negative portrayal as a profession in the media. CONCLUSIONS: In order to maintain a high overall positive attitude among staff to working with people with personality disorder, units should have: consistency of direction and timely implementation of anticipated developments; clear philosophy and treatment regime; substantial investment in staff training programmes and effective programmes for the provision of clinical supervision to frontline staff.
Subject(s)
Health Knowledge, Attitudes, Practice , Hospitals, Psychiatric , Personality Disorders , Prejudice , Prisoners/psychology , Adult , Female , Follow-Up Studies , Hospitals, Psychiatric/organization & administration , Humans , Inservice Training , Male , Middle Aged , Organizational Innovation , United KingdomABSTRACT
Acute mental disorder necessitating admission to hospital is often accompanied by disturbed behaviour that threatens the health of the person concerned or that of those around them. A range of containment methods are used by psychiatric professionals to keep patients and staff safe. These strategies are strongly emotive and attract strong moral valuations, yet differ sharply between countries. This paper reports a study to investigate the relationship between attitudes to these containment methods, and exposure to psychiatric education and practice. It was hypothesized that the culture of psychiatry in the study country would socialise students' views towards the locally dominant pattern of relative evaluations. Nine cohorts of student psychiatric nurses at different stages of their training at one UK University were asked to complete ratings on 11 containment methods. Containment methods fell into five groups, with mechanical restraint and net beds attracting the most severe disapproval. Neither the relative evaluation of methods, nor the intensity of those evaluations, changed systematically with duration of training. The findings support the interpretation that the relative evaluations of psychiatric containment methods are a property of wider national cultures, rather than an isolated tradition of professional psychiatric practice.
