Perceived causes of patients aggression and violence towards nurses in psychiatry department of Muhimbili National Hospital Dar es salaam, Tanzania

Abstract

Background: Aggression and violence pose a major problem for public health and health care systems. Aggression causes harm and injuries to self, others or the environment. The incidence of aggression in health care facilities is reportedly on the increase and concerns about management of this problem are growing. Nurses are exposed to aggression and violent behavior in their day to day work Health Service Advisory Committee (HSAC) 1987. Objectives: The first objective was to assess the perceived causes of patient's aggression towards nurses in psychiatry department of Muhimbili National Hospital; the second was to explore how nurses assess and manage aggressive patients; and the last was to explore the perceptions/feelings of the patients on the management of aggression and violence. Methods: Qualitative study design was adopted. Convenient and purposeful sampling approaches were utilized to obtain the sample. Two focus group discussions were conducted, one involving patients (n=5). Nurses (n=4) participated in interview and the key informant (n= 1). All interviews were audio taped with the permission of participants and were later transcribed. Data were analyzed manually using descriptive content analysis method. Results: Aggression is a frequent and problematic aspect of psychiatric in-patient treatment. This study has revealed that perceived causes of aggression and violence among patients at psychiatric department are: environment, long hospital stay, abusive language and poor relationship among nurses. The management approach is mainly chemical restrain. Patients perceived environmental conditions and poor communication to be provocative of aggressive behavior. Nurses however, viewed the patients' mental illnesses to be the main reason for aggression, although the negative impact of the in-patient environment was recognized. From interview responses, it was evident that patients were dissatisfied with the care and management of aggression. - ----~---

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Conclusion: There are differences between the views of nurses and patients about causes of aggression and its management. 'Traditional approaches' (such as medication) seemed to be valued more by nursing staff. Training in the use of fundamental therapeutic communication skills was advocated by patients, whilst the need for greater attention to organizational deficits was advocated by nurses.

Recommendations: It is recommended that, Ministry of Health and Social Welfare should develop, implements, and monitors a national action plan for aggression and violence management. There is also a need to integrate aggression and violence prevention and management into educational policies.

The Department of Psychiatry should develop assessment form for aggression and violence and implement training in specific techniques that provide nurses with safe and effective ways of both preventing and dealing with aggression and violence such as therapeutic communication and de-escalation techniques on a regular basis.