Aggression, violence and resilience in offender healthcare services

Hodgkinson, Sarah (2020) Aggression, violence and resilience in offender healthcare services. DForenPsy thesis, University of Nottingham.

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Service user to staff violence is well documented in healthcare service literature. However, there appears to be little consensus on the definition of this type of violence. This in turn limits ways of measuring different types of service-user aggression as experienced by staff. Nevertheless, healthcare workers in general are particularly at risk of experiencing workplace violence. Previous research would indicate that staff working in forensic-based services, although still experience aggression and violence, may have mechanisms in place that serve a protective function. Further investigation of such phenomena as resilience is warranted.

The research project followed a four stage mixed design. A systematic review explored definitions and prevalence of service user to staff violence in forensic healthcare services. The second stage comprised a critique of The Perceptions of the Prevalence of Aggression Scale (POPAS) following the systematic review highlighting conflicting conceptualisations of aggression and violence; this required exploration before subsequent project stages. The third stage investigated the negative impact of patient aggression and violence for forensic healthcare staff; resilience and perceived stress was examined in affecting this experience. Finally, a factor analysis explored the existing factor structure of the Connor-Davidson Resilience Scale (CD-RISC) with forensic healthcare staff.

The systematic review found conflicting definitions of violence were utilised across the literature. An inconsistent pattern of prevalence was found across included studies which was 15 - 91.6%. Critique of the POPAS revealed the scale has good internal consistency (Cronbach’s alpha above 0.8) across several studies. The scale appeared to have strength as a basis for the development of other scales, which could demonstrate its flexibility. Findings of the third stage of the project indicated that staff working in forensic healthcare services (N=93) experienced a moderate level of stress and were significantly negatively impacted when exposed to aggression and violence. Participants had a moderate-high level of resilience. Resilience, perceived stress and the experience of aggression and violence were significant predictors of the negative impact of aggression and violence. Such findings were in support of principles highlighted by the Resilience Portfolio Model. Following factor analysis of the CD-RISC seven factors emerged from the data; Factor 1 (adaptability, personal strength) was the strongest to emerge.

It is believed the systematic review is the first attempt to synthesise existing data and serves to provide a point of reference for further exploration. Although reliability and internal consistency of the POPAS was well-established it is recommended that further exploration is needed with respect to exploring the scale’s validity in more depth. The POPAS appeared to be a strong measure of aggression and violence in workplace contexts. In support of existing literature healthcare staff working with offenders reported experiencing a high number of aggressive and violent incidents. The sample had a high level of resilience which affected the negative impact after experiencing aggression and violence; the higher the scores of resilience and perceived stress, the lower the negative impact of experiencing aggression and violence. This was in support of theoretical principles of the Resilience Portfolio Model which guided this thesis. Comparison of current factor loadings on the CD-RISC with existing findings would indicate that resilience is complex. Findings may indicate that healthcare staff working with offenders may differ in how resilience operates with reference to experiencing aggression and violence in the workplace.

Item Type: Thesis (University of Nottingham only) (DForenPsy)
Supervisors: Chou, Shihning
Green, Kate
Yates, Jennifer
Keywords: Aggression, Violence, Resilience, Forensic, Healthcare staff
Subjects: W Medicine and related subjects (NLM Classification) > WA Public health
Faculties/Schools: UK Campuses > Faculty of Medicine and Health Sciences > School of Medicine
Item ID: 59918
Depositing User: Hodgkinson, Sarah
Date Deposited: 28 Jul 2020 08:35
Last Modified: 28 Jul 2020 08:45

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