Violence in a high security psychiatric service for women : its effects on nursing staff

Seventy five nursing staff working in a high-security psychiatric service for women completed the Maslach Burnout Inventory and a measure of emotional reactions in response to one of three vignettes depicting a commonly experienced violent siutation: an attack by a patient on a patient, on a member of staff and an episode of self-harm. An attack on a member of staff was associated with more negative feelings but less Depersonalisation than an attack on a patient, and with more negative feelings than self-harm. However, staff felt more Personal Accomplishment in the case of an attack on a member of staff than in the case of self-harm. Male staff experienced more Depersonalisation than female staff in association with an attack on a patient. Overall, the longer that staff had worked at Ashworth Hospital and in particular in the Women's Services, the greater their negative feelings and Emotional Exhaustion. Length of service with the women patients was associated with reduced Personal Accomplishment in relation to self-harm. The results are discussed in terms of the communicative function of violence, in particular self-harm which appears to elicit particularly strong feelings of helplessness and incompetence in staff. The use of unconscious and cognitive coping strategies are considered along with role-conflict for forensic nurses and the organisational context of Ashworth Hospital.