Violent Behaviour in a Mental Healthcare System - Essay Example

Critical Analysis of a Research Study on the Causes and Management of Violent Behaviour in a Mental Healthcare System. Introduction This document is a critical view of the methods used to research the causes and affects of patient aggression in a mental healthcare facility. Research critique has been a valuable tool to support researchers and to help enhance available methods for conducting research studies (Beck, 1990). According to Polit and Beck (2004), the main elements contained in a qualitative research study include research design, sample choice, data collection and analysis. The object of this paper is to evaluate how well this research study was conducted in examining its main axioms by using Critical Appraisal Skills Programme (CASP) as the methodology to estimate the validity and thoroughness of the research study. CASP contains some of the elements mentioned by Polit and Beck as necessary to the estimation of qualitative research study. The research work under evaluation has been motivated by an apparent increase in aggressive behaviour of patients in mental healthcare facilities. The study attempts to identify the reasons, as well as some of the possible ways to address the issue for less violence and aggression in that environment. Methodology The study was conducted by Duxbury et al. from the Mental health Department at the University of Central Lancashire. The sampling data pool consisted of over eighty patients and around the same number of staff members. Although, it is unclear in the study as of the choices of the sample size and makeup, the overall methodology used in the proceeding of the research study is well detailed. The quantitative and qualitative aspects of the research are highlighted in a way that allows to make valid considerations of the data collected during the experiments to reach some plausible conclusions as to the affects of patient staff aggression in a mental health facility. Since the research is mostly qualitative in nature; there is good emphasis on the process used to present relevant issues, on the methods to address these issues, and on the means employed to justify their importance in making the mental health care environment a better working environment both from a patient and staff perspectives. The qualitative research conducted was based on the a survey administered to the sample as well as some one-on-one surveying to complement the survey results. The surveying approach which is a common procedural method in qualitative research study was targeted around the Management of Aggression and Violence Attitude Scale (MAVAS) surveying style. The MAVAS study which was developed by Duxbury himself was also used in a 2005 research study concerning aggressive patient behavior (Jansen 2005), which attests of its credibility in the field of mental healthcare. The interviews conducted in the process were used as a tool for validating some of the patterns that came up from the surveying. CASP Analysis In order to critique the methods used to conduct this research, we are basing our arguments on the CASP method. The CASP method looks at the many different aspects of a qualitative research and investigates the methodology to assess how thorough the conducted research was in consideration of several factors that are justified in their metric system as key to any quantitative based research endeavour. The following segment of the document reports on the details of the analysis of the research on the aggression level in patient and staff interactions in the mental health care environment. The research study by Duxbury et al. (2004) evaluates the various possible causes of aggressive and violent behaviour in the mental healthcare facility based on internal, external, and environmental aspects that may affect or trigger such behaviour. The objective of such research is to find ways and methods that can be implemented as inferred from the study to reduce the occurrence of such behaviour which is eventually risky for the patient and for the staff despite the precautions in place at most facilities to insure minimal injury as a repercussion of comparable behaviour. The methodology and research designs seemed appropriate for the type of qualitative research being conducted. The use of surveying and interviewing of the sample being tested appears as a reasonable research method to utilize in an attempt to highlight some key response patterns in the data sample chosen, and further investigate such pattern through and a careful interviewing process. A major drawback in the presented research study is the sample of patient and staff chosen to participate in the study. In effect the study remains evasive on the reasons for the small size of the sample, as well as to the justification to have it come from three separate mental healthcare wards. We would expect a more in detail discussion of how the sample was determined by the researchers and their justifications as to the relevance of the sample size and composition in revealing aspects of the patterns that could prove to be meaningful to a larger population in a general mental healthcare facility. The study reports on the hypothetical causes of the aggressive behaviour in the mental healthcare environment based on the internal, external, and situational models as outlined by Nijman (Duxbury 2004). The study does not attempt to derive alternative sources or causes for aggression, but rather investigates known models mentioned above. According to the research, the internal model is based around the assumption that the aggressive and violent behaviour of the patients is mainly due to their illness, and therefore draws a direct link between the patient disorder and the violence that may result as a consequence of such disorder. Certain types of disorders such as schizophrenia and alcohol related disorders seem to present heightened characteristics leading to violent behaviour in mental healthcare patients. The external model, however, suggests that violent behaviour occurs due to environmental factors such as lack of privacy and space, or overall design of the units where patients live. The situational or interactional model is perceived as model relating to inadequate social interactions between patient and healthcare staff that eventually leads to aggressive behaviour on the patient side (Duxbury 2004). The previously presented models make up the hypothesis evaluated in the research study by Duxbury et al. in order to arrive at corresponding methods to address and manage aggressive or violent behaviour in the healthcare facility. To arrive at the suggested management solutions, the study points out in detail the MAVAS surveying procedure as well as the main components of the survey and how it was evaluated both quantitatively and qualitatively. The MAVAS study used consisted of a number of statements relating to violence. The survey participants were to answer as agreeing or disagreeing with the given statements. In fact, most of the statements used were in direct correlation to the aggressive behaviour of patients in the facility and how it may occur. The data pool and demographics are briefly outlined, and a thorough interpretation of the metric system used to evaluate the responses of the data sample is provided. The survey was then followed by an interview process based on a reduced sample. The chosen participants in the interview process were given 45-minute interviews that were audio-taped for recordkeeping and data analysis purposes. The researchers involved in the study do not emphasize on how the interview process was conducted, if it was conducted at a main location in each facility or at various locations. The details of the post survey portion of the data collection remain a bit general also. There is no examination of potential bias in the study between the researcher and the participants of the study whether staff or patient. However, the partnership relation which is considered an important aspect of CASP to evaluate qualitative research study, did not appear as a critical element in this study. In such medical endeavours, ethical issues are often raised by the study and should thus be considered by the researchers during their procedures. In the present study, the researchers made a small reference to ethical issues as being estimated in the evaluation of the research focus. There is little emphasis however on the detailed examination of ethical issues, although the study makes the reference of a violation of human rights concerning some precautionary measures used with patients displaying violent behaviour. The data obtained from the study was rigorously obtained through the survey and interview processes, and the methods used to obtain it are very well explained by the researchers. In analysing the data collected however, the study shows a greater emphasis on the explanation of the MAVAS questionnaire than on the details of the interview process. Obviously the interview process being a conversational based task, it also requires less of a system to measure and evaluate. In addition, it is mostly a method to outline the significant patterns that were revealed form the MAVAS surveying phase. Overall, the data analysis part could have been emphasized more in the study in order to fully present the relevance of the sample, the relevance of the responses brought in with respect to the possible causes and management solutions to address aggressive behaviour in the healthcare facility. Other methods could have been employed such as the Perception of Aggression Scale used in similar studies conducted by Jansen et al. in 1997 and by Abderhalden et al. in 2002, could have provided complimentary data analysis for the study. Several perspectives tested in this manner would provide an adequate data pool for triangulation. The study outlines the findings based on the hypothesis of the models introduced at the beginning of the report. In fact, the results showed that the causes for aggression and violence were related to internal, external, and situational factors. The internal factors corresponded to the various mental illnesses, the external aspect related to the general environment of patients, and the interactional factor related to the poor communication and/or poor interaction between staff and patient. The study fails to report which aspect prevailed as the main cause for violent behaviour. It does make reference to the fact that the internal aspect was usually dominating as a cause from the staff's perspective. In responding to the various causes the study reports on the procedures used by staff including seclusion, administration of medication to patient, de-escalation (Duxbury 2004). The methods used to manage and control violent behaviour of patients are mentioned in the research, but the study omits to investigate the actual efficiency of such methods in reducing violence in the mental healthcare facility. The findings seem to lack any original outcome as they only go to support the hypothesis presented by previous work. However, the MAVAS surveying system which was devised by the researchers is a distinguishable aspect of the presented study. It would have proved interesting for the study to attempt to evaluate which out of the internal, external or interactional aspects was more prevalent as a cause for aggressive behaviour based on the sample tested. The perspective could have led to some results that would have related to the importance of the research in a better manner that displayed by the study. Conclusion This research study is an important issue to address in the healthcare facility. The findings that come from it are meaningful in several aspects to the medical community. The real value of this research study lies in the gathering of significant data and results that have the potential to positively affect the violent and aggressive behaviour of patients in a mental healthcare facility system. As a suggestion for future work, the affects of occupational therapy and staff procedural methods for better communication and interaction between staff and patient could be estimated to reduce patient aggressive behaviour in a healthcare facility. References Beck, C. T. (1990). The Research Critique: General criteria for evaluating a research report. JOGNN, 19(1), 18-22. Duxbury, J., Whittington, R., (2004). Causes and management of patient aggression and violence: staff and patient perspectives. Issues and Innovations in Nursing Practice. Jansen, G.J., Middel B., Dassen Th.W.N. (2005), An International Comparative Study on the Reliability and Validity of the Attitudes towards Aggression Scale. Ch 5, International Journal of Nursing Studies 42, 467-477. Jansen, G.J., Middel B., Dassen Th.W.N. (2005), Staff Attitudes towards Aggression in Health Care: a Review of the Literature. Ch 2, International Journal of Nursing Studies 12, 3-13. Polit, D. F., & Beck, C. T. (2004). Nursing Research: Principles and Methods (Seventh ed.). Philadephia: Lippincott Williams & Wilkins. Read More