Four in five nurses on mental wards face violence
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《英国医生杂志》
A detailed audit of 265 facilities for psychiatry and learning disability in England and Wales has uncovered "startlingly high" levels of violence towards staff and among patients.
It says that alcohol and drug abuse are the main triggers for this violence, although other factors are staff shortages, failures in basic safety techniques, poor training, and boredom and inactivity on many wards.
The study, produced by the Royal College of Psychiatrists for the NHS inspection body the Healthcare Commission, shows that nurses suffer the most violence, with nearly four out of five saying they experienced violent or threatening behaviour during their time on the ward. One staff member said it had become "part of the job."
Patients and other staff encountered less violence; but even so more than a third of patients and 18% of visitors reported experiencing violent behaviour of some sort. Nearly half of patients and a third of visitors had witnessed violent incidents.
The incidence of violence was high in both psychiatric and learning disability services. The highest levels were reported by nurses in short stay units for learning disability (86% of nurses) and the lowest in forensic units (73%).
The main trigger for violent behaviour, according to patients and visitors, was substance misuse, including alcohol, drugs, and withdrawal problems. But they also blamed attitudes of staff and staffing levels, overcrowding, medication problems, and frustration and boredom. Some pointed to a shortage of areas for smoking and irritation caused by others' smoking behaviour.
Most mental health staff agreed that drugs and alcohol caused trouble. One even said that dealing was common in the ward or hospital grounds. "There is a culture of using drugs and alcohol among the young men. It is almost accepted by staff, and little is or can be done to stop it," the staff member said.
The authors raise particular concern about mental health services for elderly people, where the incidence of violence is high but standards of care are markedly lower. Most of the problems relate to staffing, and they paint "a picture of a particularly unsupported and vulnerable group of patients."
Mamade Chattun, 43 (left), was beaten to death by psychiatric patient Jason Cann (right) at Tooting's Springfield Hospital in June 2003. A new report shows that staff face "startlingly high" levels of violence
Credit: TOPFOTO.CO.UK
Credit: PHOTO NEWS SERVICE/TOPFOTO.CO.UK
Professor Paul Lelliott, director of the royal college's research unit, which produced the report, said inpatient psychiatric care needed to be recognised as a separate specialty and that ward managers should be given back the authority to manage their wards. "We need to put modern matrons back in charge of psychiatric wards," he said.
He also called for national guidelines on minimum nursing levels and on managing drugs and alcohol. "I think there is a decade of work ahead for us to get the wards in this country up to the level the best wards have achieved," he said.
The Healthcare Commission's chief executive, Anna Walker, said the "startlingly high" figures indicated that although community services were important, more attention needed to be given to inpatient services. She pledged to refine the way the commission assesses the performance of mental health units. "We've got to ensure best practice becomes standard practice."(Andrew Cole)
It says that alcohol and drug abuse are the main triggers for this violence, although other factors are staff shortages, failures in basic safety techniques, poor training, and boredom and inactivity on many wards.
The study, produced by the Royal College of Psychiatrists for the NHS inspection body the Healthcare Commission, shows that nurses suffer the most violence, with nearly four out of five saying they experienced violent or threatening behaviour during their time on the ward. One staff member said it had become "part of the job."
Patients and other staff encountered less violence; but even so more than a third of patients and 18% of visitors reported experiencing violent behaviour of some sort. Nearly half of patients and a third of visitors had witnessed violent incidents.
The incidence of violence was high in both psychiatric and learning disability services. The highest levels were reported by nurses in short stay units for learning disability (86% of nurses) and the lowest in forensic units (73%).
The main trigger for violent behaviour, according to patients and visitors, was substance misuse, including alcohol, drugs, and withdrawal problems. But they also blamed attitudes of staff and staffing levels, overcrowding, medication problems, and frustration and boredom. Some pointed to a shortage of areas for smoking and irritation caused by others' smoking behaviour.
Most mental health staff agreed that drugs and alcohol caused trouble. One even said that dealing was common in the ward or hospital grounds. "There is a culture of using drugs and alcohol among the young men. It is almost accepted by staff, and little is or can be done to stop it," the staff member said.
The authors raise particular concern about mental health services for elderly people, where the incidence of violence is high but standards of care are markedly lower. Most of the problems relate to staffing, and they paint "a picture of a particularly unsupported and vulnerable group of patients."
Mamade Chattun, 43 (left), was beaten to death by psychiatric patient Jason Cann (right) at Tooting's Springfield Hospital in June 2003. A new report shows that staff face "startlingly high" levels of violence
Credit: TOPFOTO.CO.UK
Credit: PHOTO NEWS SERVICE/TOPFOTO.CO.UK
Professor Paul Lelliott, director of the royal college's research unit, which produced the report, said inpatient psychiatric care needed to be recognised as a separate specialty and that ward managers should be given back the authority to manage their wards. "We need to put modern matrons back in charge of psychiatric wards," he said.
He also called for national guidelines on minimum nursing levels and on managing drugs and alcohol. "I think there is a decade of work ahead for us to get the wards in this country up to the level the best wards have achieved," he said.
The Healthcare Commission's chief executive, Anna Walker, said the "startlingly high" figures indicated that although community services were important, more attention needed to be given to inpatient services. She pledged to refine the way the commission assesses the performance of mental health units. "We've got to ensure best practice becomes standard practice."(Andrew Cole)