Factors Affecting the Emergency Management and Treatment of Aggressive and Violent
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Violence by inpatients against mental health personnel, fellow patients and people uninvolved in the patient’s treatment is a common and universal problem requiring urgent attention. The current study sought to investigate factors that are important or considered important by health personnel in making crucial decisions about emergency interventions in aggressive and violent inpatients in a mental institution in Zimbabwe. In particular, the study was intended to address three major objectives namely to identify factors relevant in influencing mental health workers’wide range of interventions in response to inpatient aggressive behaviour and violent incidents; to establish the degree to which mental health workers recognise factors that influence their management and treatment of violent behaviours in emergency situations and to determine the weight of importance attached to each factor identified by mental health workers as being important in their management and treatment of aggressive and violent behaviours. By so doing, the study sought to lay foundations for the development of a checklist for mental health personnel on how to proceed in unexpected occurrence of aggressive and violent incidents in mental health wards. A quantitative descriptive research design was used in the current study. The data involved information collected from questionnaire surveys in the mental hospital’s four purposively selected wards and direct observations in Khumalo ward. The health personnel were observed as they attempt to deal with aggressive and violent incidents in emergency. They also filled in questionnaires purposively distributed in the wards at a particular time. The data collected through the questionnaire and Management and Treatment Observation Table (MTOT) were analysed descriptively using SPSS version 15.00. Qualitative data from open-ended questions were entered into SPSS as string variables, thematically analysed and post coded. Results have shown that health workers tend to rely on the use of per rising need (PRN) injection and seclusion in the management and treatment of violent and aggressive patients. As a result, number of staff present and availability of drugs became the major factors in the management and treatment efforts. Equally critical factors were found to be perceived dangerousness of aggressor, patient diagnosis, history of violence, phase of patient illness, location violent behaviour takes place, and experience, age and motivation of health worker. In the management and treatment violent patients, the health personnel in Khumalo ward need to go beyond the confines of restraining, seclusion, and rapid tranquilisation (RT). Even though the medical approach of RT effectively stabilised violent patients in the short term, knowledge and practice of behaviour medication techniques will be an invaluable tool for the health personnel. A clear guideline on the identification of behaviour requiring emergency responses and how to proceed in case of such emergency is imperative. A check list will be an invaluable tool for use by health personnel on duty in case of the occurrence of a violent incident.
Subjectmental health care