The process of psychological recovery of unqualified nursing staff after serious violent assault in a secure setting

This thesis is comprised of four parts: A literature review, a research study, a reflective critique of the research process and a service evaluation. A systematic literature review was undertaken to appraise the current evidence relating to the factors associated with violence and aggression in adult psychiatric hospital inpatient settings. A systematic search of four databases; Scopus; PsychINFO Medline; CIHAHL and PsychArticle was conducted. Following the application of the inclusion criteria, ten papers were extracted and included in the review. Of these, eight were of quantitative methodology and two were qualitative studies. These ten papers provide an insight into the possible factors associated with violence and aggression towards nursing staff. Three main themes were identified: the environment, attitudes/interaction of staff, the patient’s mental illness. The themes were important factors in the causes of violence but were interlinked highlighting the complex nature of violence towards nursing staff. The findings support the need for training for nursing staff and the development of on-going support and for organisations to consider both the environment and the restrictive procedures to help reduce violence and aggression towards nursing staff. A research study was conducted to explore the psychological recovery of nursing staff in a secure mental health hospital setting in the UK who had experienced a violent assault in the previous fortnight. Study participants were five unqualified nursing staff/HealthCare Assistants (HCAs) who were interviewed on two occasions, immediately following the assault and at six months. All participants accessed the in-house Trauma Response service for help in coping with the effects of the assault which had been reported as level 3-5 on a Serious Untoward Incident matrix. Data were collected via in depth interviews and transcribed verbatim. Interpretative Phenomenological Analysis (IPA) was adopted which identified three overarching themes: Putting on a front, Organisational relationships and Recovery and moving-on. Recommendations include the development of team-based working to help de-stigmatise the impact of a serious violent assault and improving managerial response to violent assault and support on the hospitals wards. More specifically, the study recommends the acknowledgement within the organisational culture of the psychological impact of serious assaults on staff well-being. The implications of the findings are discussed in relation to the wider provision of trauma support for staff. A reflective critique records the personal experiences of the author during the research and thesis process. It includes a description of the challenges and learning through the process of engaging in the academic and research process for this thesis. Service evaluation recommendations describe the development of a trauma response service for nursing staff working in a secure mental health hospital.