The Safety of Nurses in a Ward Setting when Restraining Aggressive Patients
The Research Problem
In psychiatry, professionals are also at risk of aggression and violence which involves the risks of being verbal assault and physically assaulted. These negative conducts of patients may include different forms of violence. Nurses are the professions that are more prone to this aggression because they are an immediate relationship with the patients in a psychiatric ward. The nurses also have a closer relationship with the patients, and therefore cases of violence are inevitable (Draper, 2015) .In this study, violence and aggression have been considered as a range of conduct or behaviour which can result to hurt, injury or harming another individual. Violence and aggression include both physical and verbal expression or physical harm which is experienced by one person from another. The definition of these terms also involves a combination of an immoral or inappropriate behaviour, hurt, damage, intentions to dominate other people, anger, behaviour that are protective and even non-verbal gestures.
Most of the injuries that are sustained by nurses that serve in the mental health units have turned to a global challenge. There is a worldwide concern for the security of the nurses. The major objective of nurses is to increase the health of patients, the safety of the people that nurse these patients and also the occupational health, which need to be protected and promoted (Baillie, 2015). Most cases of nurses being assaulted by their patient end up in emotional response which includes anxiousness, anger, helplessness, increased irritability and loss of control. Some cases of these form of assault have resulted to physical injuries to the nurses. The physical injuries may take a relatively short period to heal, but the major problem is experienced in the emotional assault which takes long time to heal and which affects the service delivery of the nurse (Botti & Endacott, 2008). This study is developed to identify different ways which can be effected to reduce the injuries and assault that the nurses experience when restraining aggressive patients. This is with the aim of promoting mental and physical health for the nurses while on duty.
The Aims of the Study
The main aim of this research proposal is to describe the injuries and patterns that can be sustained by the nurses when restraining patients that are aggressive. The study aims to outline the factors in the process of restraining, which can be modified to increase the safety of nurses in their service delivery while restraining patients. The study also has specific objectives which include:
To outline the injuries and patterns which nurses can sustain during the procedure of restraining aggressive patients.
To examine the perceptions of nurses which is associated with the injuries that they can sustain while restraining patients.
To examine the perception of nurses on the ways that can be implemented to improve their safety in the procedure of restraining patients.
To increase the awareness of the nurses concerning the issues of aggression and violence in the psychiatric ward and
To increase the confidence of the nurses in the process of handling aggressive patients in a psychiatric ward.
Hypothesis and Review of the Study
This study will investigate two hypothesis;
Hypothesis 1: The exposure of nurses to aggressive conditions in a psychiatric ward is the main challenge in their service delivery.
Hypothesis 2: The exposure of nurses to aggressive patients during the process of restraining is related to the negative attitude of the nurses.
Justification of the Study
The exposure of nurses in aggressive conditions during the process of restraining patients may have more negative effects to the emotional health of the nurse than their physical health. This is what facilitates this study to investigate the mitigating factors that can be implemented to improve the safety of the nurses in their process of service delivery. Although extensive research has been done in relation to this study, there is scanty information that has been presented concerning the factors that can be implemented to improve the safety of nurses while restraining patients that are aggressive. The study is also expected to extend the knowledge of frontiers to the future researchers which may be interested in carrying their research in this topic.
Restrain and Aggression in a Psychiatric Ward
The most manual technique in the management of aggression is the restraining the patient. This technique has existed in a mainstream of psychiatry for a bout fifteen years although there is scarse research that has been conducted with regards to the safety and effectiveness of the procedure. There are four components that are used in the use of physical restrain which are the restriction of the movement of limbs through the use of some form of holding the subject (Bloomfield et al., 2010). The immobilization of the subject is also done through the use of body strength and body weight. The subject can be kept in an off-balance by position and the fourth one involves the use of reasonable force. These methods are mostly used in many psychiatric wards to in the control of patients.
In order to describe the patterns of the injuries sustained by the in the ward, the restrain process can be categorized into three stages. These stages include the initiation of restrain, where the nurse goes towards the patient being restrained. The second stage involves holding, where the nurse makes efforts to maintain the patient in a state that is immobilized by the use of special hold which is referred to as a lock. The third stage is the exist, where the nurse loosen themselves from the holds of their patients and move away from them.
Patterns of Injuries of Nurse During Restrain
Injuries for the medical staff, especially the nurses is a common experience in many psychiatric wards. However, the prevalence of these cases varies from one institution to another depending with factors such as the training and experience of the nurses and the available facilities in the wards (Coopey et al., 2006). It is estimated that about sixteen percent of the cases results to the abrasions with either the staff or the patients themselves. In this case, nurses are the ones that are likely to sustain injuries during the process of containment.
In the most cases of aggression and injuries, there are common factors which are involved in causing injuries to the nurses. Some of the staff may not be adequately trained to handle cases of aggression and restraining the patients (Botti & Endacott, 2008). The cases are as a result of poor techniques of restraining the patients which results to the injuries of the nurses and even patients themselves.
Means of Mitigating Injuries Nurse During Restrain
Some of the means which can be provided to help mitigate the incidences of injuries to nurses during the process of restrain includes the provision of adequate training to the nurses. They can be provided with seminars on the prevention of violence against and in the management of violence in the process of restraining the patients. The nursing profession can introduce policies to endorse non- tolerance to occupational violence and aggression to all the members. The policy can help in the prevention of injuries to the nurses since it does not allow any form of violence to the professions in this field (Endacott, 2007).
This study will make the use of two methods of data collection. The first phase will involve the analysis of incidents reports where violence has been experienced in the process of restrain. The second phase will involve a questionnaire to collect information on perception of nurses to the process of restrain and aggression.
The data and patterns of injuries that nurses have experienced over a specified period of time will be retrieved through the process of incident reports. This information will be retrieved from the hospital reports and data base (Baillie, 2015). The items of data which will be expected to be collected will involve the time of injury, the type of injury, gender of the victim, the cause of the injury, the stage of the restraining process when the incident was reported. In this method of data collection, the reports incidents will be re-identified to ensure the privacy and anonymity of the patients and nurses.
A set of a questionnaire will be administered to collect the data concerning the perceptions of nurses with their sustained injuries, ways of improving their safety during the restraining process and the most common types of injuries to the nurses. The questionnaires and consent forms will be distributed to the nurses to fill at their most preferred time. In this method of data collection, the anonymity and privacy of the respondents will also be observed.
Setting the sample size
The study will be conducted in a psychiatric ward. The two eligible criteria that will be used for participation in this study will be: being a nurse in the psychiatric ward and being eligible to restrain patients that are aggressive. All the nurses who work in this ward will be provided with a detailed plan of the study since they are eligible to participate in the study. The population of the study is relatively small because sampling a larger population would result to sampling errors and also prone to selection bias (Endacott & Botti, 2007). The potential respondents are expected to be both male and female of the age between twenty and sixty- five. After the identification of the respondents, a series of meeting will be conducted between them and the researcher to offer them with adequate training. The information and questionnaires will be administered during the meetings.
Reliability and Validity of the Study
The method of incident reports is recognized globally and a valid and reliable means of data collection. This method has been used for many years in medical research to produce injury surveillance data (Gerrish et al., 2015). The information obtained from this method of data collection includes the injuries to nurses and patients in most medical institutions. A pilot study will be carried out to a group of ten students in the school in ordered to establish the validity and reliability of the questionnaires that will be administered.
The data collected will be analyzed by the use of the statistical package Stata. The description statistics will also be used in analysis of the data. The Fishers exact examination will be used to assess the relationship between the variables (Bloomfield et al. 2010). In this study, a significance level of p < 0.05 will also be used to ascertain the reliability of the data collected. In the analysis of the questionnaire, a content analysis technique will be used to determine the qualitative response.