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A qualitative study into the attitudes of patients and staff towards violence and aggression in a high security hospital.

This paper provides a brief overview of research conducted within a high security hospital to ascertain staff and patient views on how aggression and violence are managed and their subsequent impact on all parties. Both the National Institute for Mental Health in England (NIMHE, 2004) and the National Institute of Clinical Excellence (NICE, 2005) have emphasized the need to take account of contextual factors when considering the cause and management of aggression. While patient variables (internal) are important within psychiatry, the environment or setting (including culture), relational issues (including gender) and staff attitude are equally important (Jansen et al. 2006). Duxbury & Whittington (2005) found that poor communication contributed to the development of patient aggression, whereby restrictions and environmental factors are fundamental to relational issues. There is currently very little research conducted in high secure services (HSS) that focuses on the management of violence and aggression (MVA) in this context. Uppal & McMurran (2009) report on the frequency and nature of incidents of violence, selfharm and security and Ireland (2006) consider bullying within this context. However, these studies do not focus specifically on the attitudes of staff and patients to violence and aggression. McKeown & Stowell-Smith (2006) speak about the construction of ‘difference’ between staff and patients, who exist in conditions of high security; they suggest that we separate ourselves from those with psychopathic personalities to cope with the work, but acknowledge that this creates its own difficulties within the establishment of the therapeutic relationship. More recently, Canadian authors Jacob et al. (2009) stated that ‘Forensic psychiatric nurses work with individuals who may evoke feelings of empathy as well as feelings of disgust, repulsion, and fear.’ (p. 153). They attribute these emotions to the fear of caring for individuals who are viewed as ‘monsters’ (Jacob et al. 2009). This view resonates with that of McKeown & Stowell-Smith (2006), who suggest that in the face of abjection, staff create a context that constructs a sense of difference and ‘otherness’ between themselves and the patients. They suggest that developing greater understanding, and thus a better attitude towards the client group, would benefit forensic mental health nurses. This in turn, would enable them to engage in a reflective process regarding their professional practice, and, as a result, improve the provision of nursing care. Such commentary is valuable, but is based upon observation and experience rather than research.