Qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems: a hermeneutic study

Abstract

The incidence of violence within the National Health Service is rising and attention to the issue is increasing. Due to the ramifications in terms of physical, psychological and economic cost, the need to understand all the dynamics and variables involved in violence becomes evident. If nurses can provide care that reduces the frequency, intensity and negative consequences of violence, then clients, nurses and the organisation all benefit. This study attempted to discover the lived experience of nurses who experience violence perpetrated by individuals suffering from enduring mental health problems. It adopted a hermeneutic, phenomenological, method and produced an emerging theory comprised of the three key themes; Personal construct of violence, Feeling equipped and Feeling supported. Furthermore, the author suggests relationships between exposure to violent incidents and the nurse's ability to deal with the incidents therapeutically and how formal support systems for nurses influence this relationship. Strategic plans that are concerned with caring for violent individuals need to consider this reciprocity, as staff who feel well supported may well have a substantial impact on the quality of care offered to these people.

Introduction

The extent of violence within the National Health Service (NHS) is increasing, and whilst not a new problem, greater attention has been paid to the issue recently. Shah (1993) illustrates the rise in the number of international papers that focus on violence since 1980. The present author's search of publications that mention violence indicated that since 1987 there have been 1042 papers produced, with the majority of these being written during the last five years (705). Publications that focus on psychiatric inpatient violence have increased dramatically in number, perhaps indicating not only an increased interest in the subject but a growing awareness of the consequences of inpatient violence (Crichton, 1995a).

In 1987 the Health Services Advisory Committee (HSAC, 1987) found that NHS staff were three times more likely to suffer injury than industrial workers and this difference was attributed to the frequency of assault. Roach (1997) argues that since the publication of this report the situation has deteriorated not improved. The extent of violence towards nurses has major ramifications in terms of physical, psychological and economic cost and these issues should not be ignored (Whittington et al., 1996). Additionally, the White paper `Health of the Nation' (D of H, 1994) stressed the need to give attention to the specific care problems associated with individuals suffering from enduring mental illness. One such problem is violence (Crichton, 1995a). Given the apparent increase in violence and the current attention the issue receives, the need for a fuller understanding of the dynamics and variables involved in violence becomes evident.

Farrell (1997, p. 502) points out that the problem posed for nurse researchers is understanding what is meant by aggression and that few studies have asked `ordinary nurses' for their views about the nature and extent of aggression in their clinical settings. He argues that there is a need to develop an understanding of violence and aggression that is based on real incidents. He concludes

such a descriptive account of nurses' collective wisdom would be a major step forward in determining some of the parameters regarding what constitutes an aggressive act.

Consequently this paper reports on a preliminary investigation into qualified nurses' lived experience of violence perpetrated by individuals suffering from enduring mental health problems, in the hope that examination of these nurses' experiences helps enable the more complete understanding of this violence.