2.5 Demands and Challenges Associated with Caring for Institutionalised Mentally Ill Patients
2.5.3 Safety and Security Problems
To increase efficiency at work, mental health facilities need safe working environments (Alhassan & Poku, 2018). A study by Alhassan and Poku (2018) shows that 87% of nurses are aware of workplace health risks at their places of work and that working in a
30 psychiatric facility is more dangerous than working in other hospital environments.
Nurses working in the psychiatric field have a twenty-fold higher risk of experiencing physical violence than those working in public hospitals, according to Magnavita and Heponiemi (2012). In comparison to nurses working in medical-surgical units, mental nurses deal with patient aggression more frequently, with 0.55 violent cases per bed per month on average in acute mental institutions (Pekurinen et al., 2017).
A study conducted by Manyedi and Dikobe (2016) reveals that PNs felt unsafe when caring alone for psychiatric patients with chronic mental illness. They require help from other nurses because they feel uncomfortable and uneasy. The reason for this is that psychiatric patients are physically aggressive, unpredictable, and not cooperative (Zarea et al., 2012). Additionally, many nurses emphasized their concern about their patients' bodily harm, suicide, and homicide. Moreover, nurses also reported being fearful regarding the possibility of being physically assaulted by the patients.
According to Mani and Abutaleb (2017), it is considered hard to care for violent patients in inpatient psychiatric hospitals. This is due to the fact that the in-patient section, where nurses are prone to conflict or irrational aggression, had a number of patients with various mental conditions. Violence and unexpected hostile behavior also signal an unsafe atmosphere to nurses and other patients. Such an environment is perceived to be full of stress for mental health nurses, which made them passive to the degree that they consider their mental patients to be harmful, immature, dangerous, and pessimistic (Mani & Abutaleb, 2017). Cho and Lee (2018) discovered that physical and verbal and aggression such as intimidation, was constantly faced by nurses in psychiatric wards.
Internationally, psychiatric facilities are known to be experiencing a certain level of violence and aggression (Bimenyimana et al., 2009). Health care clincians working in mental health institutions face high level of violence and aggression from patients (Bimenyimana et al., 2009). Aggression is a common feature in psychiatric in-patient awads in Africa. Nurses in in-patient units in Nigeria are frequently subjected to aggression (James et al., 2011). Aggression is defined as a behavior intended to increase harm to someone else who is trying to avoid that harm. It can manifest itself in
31 a variety of ways, ranging from relatively minor acts, such as verbal abuse, to unprovoked mild to severe acts, such as physical attacks (Al-Omari et al., 2019).
Patient aggression on staff remains a concern and poses regular complications to in- patient psychiatric hospitals and staff. Both verbal and physical aggression mayPatient aggression on workers continues to be a source of concern for in-patient mental wards and staff. Verbally or physically aggression can cause bodily or emotional harm to employees. This harm can manifest as physical injury, distress, or strained interpersonal interactions (Ezeobele et al., 2019). result in physical or emotional harm to the staff. This harm may occur in the form of physical injury, hurt feelings, or damaged social relationships (Ezeobele et al., 2019).
Psychiatric patients' aggression is considered to be a significant problem both locally and globally. 86% of nurses who were affected by violent and aggressive patient behavior reported experiencing aggression toward them (Bekelepi et al., 2015; Al-Omari et al., 2019). Healthcare professionals, especially nurses, are frequently subjected to violent behavior in acute care psychiatric settings, including verbal assault (46.0% to 78.6%), threats (43.0% to 78.6%), and sexual harassment (9.5 per cent to 37.2 per cent). As a result of this aggressive behavior, staff nurses may suffer from physical injuries, psychological harm, depressed mood, post-traumatic stress disorder (PTSD), anxiety, sleep disturbances, and burnout, which also has a negative impact on staff work productivity (Lantta et al., 2020).
At the same time, a number of other factors may play a role in patient aggression. Some factors are related to the staff, such as their youth, lack of educational qualification, and lack of work experience, as well as the nurses' gender and whether the work is full-time or shift-based. Aggression is the display of violence, which can be directed at oneself, others, or objects, and it is a common act in psychiatric wards (James et al., 2011).
However, globally MHCUs are known always to have been associated with some form of aggression (Gule, 2013). Aggression towards psychiatric nurses influences them mentally and emotionally. Furthermore, nurses consider aggression to be hostile, dangerous, and burdensome. These nurses reported being subjected to abusive language, demeaning aggression, aggressive dividing behavior, threatened physical
32 aggression, destructive aggressive behavior, and, on rare occasions, physical violence (James et al., 2011).
Female psychiatric nurses in South African facilities for mental health were subjected to sexual abuse and a hazardous working conditions during weekend shifts, according to a study by Maluleke and van Wyk (2017).Depending on the environment and geographic location, different forms of violence against nurses are committed. However, they also comprise threats, sexual assault, verbal and physical abuse, and bullying (Boyle &
Wallia, 2016). In addition, two-thirds of nurses have experienced psychological violence, and close to a quarter have experienced sexual harassment. It has been discovered that about a third of nurses worldwide experience physical abuse and bullying, and about a third have reported suffering an injury as a direct result of violence (Spector et al., 2014). After any violent episodes, nurses require managerial guidance and assistance on an individual and emotional level (Baby et al., 2014; Christie, 2015, as cited in Zhang et al., 2021). The performance of professional nurses' duties is impacted by a lack of security. Participants expressed concern about being attacked by MHCUs who are allowed to roam the ward at will. Participants went on to say that the courts had referred some of the MHCUs to their facility for observation. Marshall et al. (2017) emphasized this and discovered that professional nurses in New Zealand are vulnerable to violence at work. According to Duncan et al. (2016)'s results, MHCUs physically and emotionally assault professional nurses in Canada.
Employees from a multidisciplinary team, including nursing, social work, occupational therapy, psychology, and administration professionals, participated in a study by Tonso et al. (2016). 411 members in all answered to the poll; 83% of the sample overall reported experiencing some form of violence in the preceding 12 months. The most common form of violence was verbal abuse (80%), which was subsequently followed by physical assault (34%), and bullying/mobbing (30%). 33 percent of victims of violence reported experiencing psychological difficulty, with 54 percent of those reporting severe psychological anguish. The victims of various forms of violence described being in terrible emotional distress. For those working in the mental health field, the nature,
33 severity, and impact of this violence on their health pose major safety problems (Tonso et al., 2016).
A study conducted by Nui et al. (2019) alludes to psychological violence being higher than physical violence. They added that 78.8% of incidents involved verbal abuse, with patients accounting for 91.1% of those who engaged in it. According to Niu et al. (2019), four out of five acute psychiatric nurses had suffered psychological violence in the preceding year, and more than half had experienced physical violence. Patients made up the vast bulk of the assailants, followed by patients' families. Verbal warnings were used as the main defense against attackers. According to Forté et al. (2017), nurses caring for persons with chronic mental illness experience fear and are hypervigilant owing to verbal and physical abuse, aggression, and violence that some patients display towards them.