An international comparative study on the reliability and validity of the attitudes towards aggression scale

One of the factors known to be associated with the management of patient aggression is the attitude of staff members towards the aggressive behaviour of patients. The construct validity of an instrument measuring the attitudes of staff towards inpatient aggression in psychiatry was evaluated in this international multi-centre study. Factor analysis and simultaneous component analysis were performed with data from a convenience sample of 1769 psychiatric nurses working in psychiatric hospitals and student nurses from nursing schools. The samples were recruited by fellow researchers in their home country. The original 32-item version (POAS) was reduced to 18 items comprising five attitude scales with solid psychometric properties. The types of attitudes were labelled offensive, communicative, destructive, protective and intrusive. The format of the correlations between the types of attitudes suggested the existence of two basic underlying divergent domains in the scale. The 'communication' and 'protection' scale components on the one hand, and the 'offence', 'destruction' and 'intrusion' components on the other. The five types of attitude proved to be invariant across samples from five European countries. The Aggression Scale (ATAS) is a reliable and valid measure that will enable researchers to perform international comparative research on attitudes and aggression.     

Psychiatric nurses' anxiety and cognition in managing psychiatric patients' aggression

This study explored the anxiety, attitudes, and cognition of the need for aggression management among Taiwanese psychiatric nurses caring for psychiatric patients. Data were collected with self-report questionnaires from 180 psychiatric nurses in the acute wards of three large psychiatric centers in Taiwan. Results showed increased threat of cognitive appraisal of aggression, increased trait anxiety, and decreased positive attitudes toward aggression predicted higher levels of state anxiety. There were significantly higher levels of state anxiety among psychiatric nurses when patients exhibited verbal and physical aggression rather than just physical aggression. An important outcome of this study is the added understanding of cognitive appraisal, trait anxiety, and attitudes, that influence the anxiety of psychiatric nurses.     

精神科护士患者安全文化态度现状及其影响因素分析

目的 了解精神科护士患者安全文化态度的现状,探讨精神科护士患者安全文化态度的影响因素,为提高精神科护士患者安全文化态度水平,保障患者安全提供参考。方法 采用医院护理人员患者安全文化态度调查问卷及护理不良事件报告障碍问卷对广东省精神病专科医院434名护士进行调查。结果 精神科护士患者安全文化态度总分(86.78±14.53)分,护理不良事件报告障碍总分为(54.38±12.0)分,单因素分析显示,不同性别、职称、职务、每月夜班数的护士,患者安全文化态度得分比较,差异有统计学意义(P＜0.05)。不良事件报告障碍得分与患者安全文化态度得分呈显著的负相关(r=-0.537,P＜0.001)。多元线性回归分析显示,不良事件报告障碍为患者安全文化态度的独立影响因素(R²=0.295,_△R²=0.287,F=35.876,P＜0.001)。结论 精神科护士患者安全文化态度水平有待提高,医院管理者应该重视影响精神科护士患者安全文化态度的因素,深入探索精神科安全文化的建设,提高安全文化水平,增强安全防范意识,保障患者的安全。     

The effect of a training course on nursing students' attitudes toward, perceptions of, and confidence in managing patient aggression

Patient aggression is a problem in many health care settings, and nursing students are among the most vulnerable to experiencing such aggression. Training courses have been suggested to help nurses better manage patient aggression. Such courses can lead to changes in attitudes toward and perceptions of, as well as greater confidence in managing, aggression. In this quasi-experimental study, we investigated the effect of a training course on nursing students' attitudes toward, perceptions of, and confidence in managing patient aggression. Students in the intervention group demonstrated enhanced confidence but no change in attitude after the training course, while students in the control group remained stable on all measures. The short time frame of the study, the training course itself, and the instruments used for monitoring attitudes toward aggression are possible reasons for these results. We tentatively conclude that it is possible to enhance nursing students' perceived confidence in managing patient aggression without changing their fundamental views of it.     

The dying patient: a comparative study of nurse caregiver characteristics

The nurse's interaction with the dying patient is thought to be influenced by death anxiety, attitudes toward death, and perceptions of control. Differences relative to these three variables between nurses who work on a continuous basis with the dying and those who rarely encounter a dying patient were examined. Using 3 paper and pencil questionnaires, data were collected from 105 nurses (32 palliative care nurses, 44 psychiatric nurses, 29 orthopedic nurses). Significant differences were found between the palliative care nurses and nonpalliative care nurses on attitudes toward death and on 3 of the 4 subscales that assessed death anxiety. Suggestions for future research include a systematic examination of the relationship of attitudes and feelings about death to patient care.     

Perception of legal liability by registered nurses in Korea

Liability to the nursing profession is imperative if nurses are to act as an autonomous body. Assessing and communicating effectively is a vital part of nursing for patient safety. This study was designed to identify the attitudes of Korean nurses toward liability in assessment and communication and to investigate the relationship among the variables (i.e., legal awareness, attitudes toward doctor's duty to supervise nurses). The attitudes toward doctor's duty reflect the status of nurses' dependency on doctor's supervision. The study participants were 288 registered nurses in RN-BSN courses at two colleges in Korea. The level of legal awareness was measured using a 25-item Legal Awareness Questionnaire developed by the authors. The measuring instrument for attitudes toward doctor's duty to supervise nurses and nurses' liability was the Attitude toward Duty and Liability Questionnaire, which was modified by the authors. There were significant correlation between attitude toward doctor's duty and nurses' liability, but not between legal awareness and liability attitude. The results of this study suggest that the present educational content aimed at improving liability attitudes of nurses should be refocused with attitude-oriented education and should include an understanding of the increased accountability that comes with greater autonomy in nursing practice.     

Student psychiatric nurses' approval of containment measures: relationship to perception of aggression and attitudes to personality disorder

Difficult and challenging behaviour by inpatients is a feature of acute psychiatric ward life. Different methods are used to contain these behaviours, and there is international variation in which are approved of or used. Previous research suggests that staff attitudes to patients may affect their willingness to use, or choice of, method. The aim of this study was to explore the relationship between approval of containment measures, perception of aggression and attitude to personality disorder. A survey of student psychiatric nurses was conducted, and using three attitudinal questionnaires related to aggression and containment. An association was found between positive attitude to patients and the approval of containment methods that involved nurses being in personal contact with patients. There was evidence that students' attitudes to patients deteriorated over time. The results highlighted the importance of (and linkage between) staffs' feelings of anger and fear towards patients, and their preparedness to use containment measures.     

The Management of Aggression and Violence Attitude Scale (MAVAS): a cross-national comparative study

Title.  The Management of Aggression and Violence Attitude Scale (MAVAS): a cross-national comparative study.
Aim.  This paper is a report of a study to determine the transferability of the Management of Aggression and Violence Attitude Scale to European mental health inpatient settings.
Background.  Incidents of patient aggression and violence are common in psychiatric in-patient facilities, and nurses' attitudes may play a part in how they are managed.
Methods.  Nursing staff from acute psychiatric in-patient units in Switzerland and the United Kingdom completed the Management of Aggression and Violence Attitude Scale. Data were collected in the UK in 2001 and Switzerland in 2003. The Swiss sample comprised 75 respondents: 45 female, mean age 36·24, mean experience 7·35 years, 60 Registered Nurses. The United Kingdom sample was 75 respondents: 58 female, mean age 32, mean experience 5·25 years, 48 Registered Nurses. T -tests identified differences between the groups in their responses to each Management of Aggression and Violence Attitude Scale statement.
Results.  There was 66% concordance of views between the groups. Swiss nurses were, however, more likely to regard factors internal to the patient as contributory to aggression while United Kingdom nurses perceived environmental factors to be more important. Both groups endorsed physical means of aggression management, Swiss nurses more so.
Conclusion.  There are both commonalities and differences between the attitudes of Swiss and United Kingdom nursing staff regarding patient aggression. Differences may relate to rates of aggression, variations in management approaches, training and policy. The Management of Aggression and Violence Attitude Scale is a potentially effective tool for making comparisons about perspectives on patient aggression.     

The effect of a training course on mental health nurses' attitudes on the reasons of patient aggression and its management

Aggression in healthcare systems poses a major problem for nurses because they are the most susceptible to suffer violence. Studies demonstrate that attitudes of nurses influence their behaviour regarding aggression and violence. Training programmes can positively change nurses' attitudes. This quasi-experimental study aimed to examine the effects of a systematic training course in aggression management on mental health nurses' attitudes about the reasons for patients' aggression and on its management. Sixty-three nurses (29 in the intervention and 34 in the control group) participated in this quasi-experimental pre-test and post-test study. The attitude of the participants of a training course was recorded by the German version of the Management of Aggression and Violence Attitude Scale (MAVAS). No significant attitude changes occurred in the intervention group at post-test. It is concluded that trainings intending to influence attitudes regarding the reason for patient aggression should consider the impact of the pedagogical quality of the training course, organizational support, and the user's perception. Moreover, it remains questionable to what extent a single instrument of measurement can record attitude changes.     

Computers in nursing practice. A comparison of the attitudes of nurses and nursing students

This study was undertaken to compare the attitudes of nurses and nursing students toward computer use in nursing practice and to clarify factors that influence these attitudes. Three factors within the student sample were examined: changes over time, prior experience with computers, and attitudes toward technology in general. Second, the attitudes of the nursing students were compared with those of a sample of practicing nurses. Finally, the multidimensional structure of Stronge's attitude scale was analyzed. A total of 353 sophomore nursing students and 358 staff nurses participated in the study. The analysis produced a refined 17-item attitude scale composed of three identifiable subscales: computers and patient care, computers and personal security, and general attitude. It was found that students had less experience with computers than the investigators had anticipated, and there was little change over three successive cohorts of students. However, in general, students' attitudes toward computer use in nursing were positive, and the more computer experience students had, the more positive their attitudes. The attitudes of the practicing nurses also were generally positive, but differences between students and nurses were observed.     

The perception of aggression by nurses: psychometric scale testing and derivation of a short instrument

Patient aggression is a serious problem in psychiatric nursing. Nurses' attitudes towards aggression have been identified as mediating the choice of nursing interventions. To date, investigations are lacking which elucidate the stability of one of the few scales for measuring the attitude of aggression. This study aimed to investigate the test-retest stability of the Perception of Aggression Scale and to derive a shortened version. In order to test the reliability of the Perception of Aggression Scale items, three groups of psychiatric nurses were requested to fill in the Perception of Aggression Scale twice (30 student nurses after 4 days, 32 qualified nurses after 14 days and 36 qualified nurses after 70 days). We derived the shortened version from an independent data set obtained from 729 psychiatry nurses using principal component analysis, aiming to maximize parsimony and Cronbach's alpha. Amongst competing short versions, we selected those with the highest reliability at 70 or 14 day retest. A scale using 12 of the original 32 items was derived yielding alphas of r = 0.69 and r = 0.67 for the two POAS factors with retest reliabilities of r = 0.76 and r = 0.77. The shortened scale offers a practical and viable alternative to the longer version.     

Detecting nurse-perceived patient treatment difficulty of psychiatric patients in hospital: an evaluation of a patient assessment sheet

Many changes have occurred in hospital psychiatric care, including decreased length of hospital stay and increased patient acuity. These changes highlight the need for nurses to adequately assess and formally document patient treatment difficulties. The purposes of this study were to determine the ability of the Patient Assessment Sheet (PAS) to predict patient 'problems' that psychiatric nurses perceived as associated with patient treatment difficulty, and to identify the patient problems missing from the PAS. These purposes were accomplished by comparing the PAS to the Hospital Treatment Rating Scale (HTRS). A correlational design and multiple linear regression technique were used. Eight psychiatric registered nurses assessed a total of 110 patients, admitted consecutively to one inpatient psychiatric unit. The HTRS and the PAS were used independently for each patient. Four PAS items (active affect, passive affect, aggression toward self, and patient confusion) significantly predicted 38% of the variance from the HTRS; and three HTRS items (isolation and withdrawal from relationships, noninvolvement in treatment, and wide variability in mood) significantly predicted 22% of the residual variance from the HTRS. The identified PAS and HTRS items help to make visible patient problems associated with nurse-perceived patient treatment difficulty. This identification is potentially important for both clinical and political purposes.     

Assessing attitudes toward elderly among nurses working in the city of Ilam

ObjectiveSeveral factors affect the quality of care in the elderly, such as nurses' attitudes. This study aimed to assess nurses' attitude toward elderly in the city of Ilam.MethodThis cross-sectional study was conducted among 230 nurses working at public hospitals in the city of Ilam. Participants were selected using simple random sampling from the list of staff. The Kogan's attitude questionnaire was used to measure nurses' attitudes toward the elderly.ResultsThe mean age of respondents in this study was 32.65 (SD = 7.67), and the score of attitudes toward the elderly was 144.96 (SD = 51.75) in average. More than half (54.3%) of the nurses had negative attitudes toward the elderly. The results of ANOVA analysis showed significant differences (P < 0.05) were observed in the attitudes toward the elderly among the nurses as their ages, marital status, work experiences, and ward types differed.ConclusionIn conclusion, nurses in this study have marginally negative attitudes toward the elderly. Therefore, promoting nurses' attitudes toward the elderly is important to provide high-quality care.     

Relationship Between Cross-Cultural Health Attitudes and Community Health Indicators

Improving health standards both nationally and cross-culturally is a goal for all community health nurses. Previous research has supported links between health attitudes and behavior. The purpose of the present study was to investigate the relationship between attitudes toward health and indexes of community health using a cross-cultural data set. Concepts selected from the data set were I (myself), body, sickness, disease, life, doctor, health, medicine, hospital, nurse, death, and insane. Community health indicators were male and female life expectancy, infant mortality, economic and public health expenditures, and net social progress. The original sample included 1200 high school males within each of 30 language and cultural communities. Data were derived from students' ratings of the dimensions of evaluation, potency, and activity for each concept. The results supported the association between attitudes and objective community health indicators. Unexpected negative correlations were found between attitudes toward medicine and nurse attitudes toward body and life, perhaps indicating that extended contact with health care providers may result in negative attitudes toward them. Positive relationships were found between public health expenditures and nurses, indicating that in countries with more expenditures for community and public health, attitudes toward nurses were more positive.     

Factors Influencing Clinicians’ Attitudes about Aggression in Australian Acute Old Age Psychiatry Inpatient Units: A Cross Sectional Survey Design

Patient aggression occurs in old age psychiatry and is problematic. The aim of this study is to identify the factors that influence clinicians’ attitudes toward aggression in old age psychiatry. Eighty-five individuals, comprising nurses (n = 75) and medical and allied health staff (n = 10), completed the questionnaire. The results show that gender, profession, and work experience do not affect attitudes toward aggression. A low score indicated agreement with an attitudinal statement. However, younger age, better higher level of completed education, and place of work increased the likelihood of participants endorsing the questionnaire's attitudinal statements about aggression. The findings suggest clinicians’ attitudes may affect the way they attempt to prevent and manage aggression.     

Student nurses'' attitudes to psychiatry: the influence of training and personality

Fifty-one second-year students completed the Attitudes to Treatment Questionnaire (ATQ), the Conservatism Scale (CS), the Defence Style Questionnaire (DSQ) and an open-ended questionnaire before and after components of their psychiatric training programme, which included a 1-week placement in a psychiatric hospital. CS scores indicated that the nurses were moderately conservative. ATQ scores and CS scores correlated significantly, with the more conservative nurses reporting more traditional attitudes to psychiatric nursing. ATQ scores fell significantly after psychiatric hospital placement, indicating more progressive attitudes. Mean scores on the DSQ were within normal limits, although men scored significantly higher than women on the Immature Defences Scale immediately after placement. The open-ended questionnaire revealed mainly positive comments about the psychiatric hospital placement. Almost half the nurses expressed surprise at the relaxed, informal atmosphere on the wards, and as many stated that personal interaction with the patients rapidly removed any stereotyped attitudes that they held previously. Over 40% of nurses stated that the patients were much less aggressive or dangerous than they had expected, although nearly 20% said they were concerned about the levels of aggression that they observed.