Mental Health Nursing
Mental Health Nursing
Mental Health Nursing
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152 Acute <strong>Mental</strong> <strong>Health</strong> <strong>Nursing</strong><br />
individual legal accountability is increased (Gupta, 1995) and their<br />
professional judgement will inevitably be subjected to closer scrutiny, particularly<br />
should things go wrong.<br />
Clearly then, the knowledge, skills and experience that mental health<br />
nurses possess are crucial to clinical interventions involved in the process<br />
of assessing and managing risk.<br />
Risk factors for violence<br />
The factors that provide information about who in a given population is<br />
going to be violent have been termed risk factors, which are measurable<br />
factors that correlate with and precede the outcome of interest<br />
(Kraemer et al., 1997), in this case violence. Increasing knowledge of what<br />
factors best predict challenging/aggressive behaviour could help mental<br />
health nurses to (1) recognise factors predictive/protective of violent and<br />
aggressive behaviour; (2) identify targets for intervention and (3) equip<br />
them with knowledge and skills to reduce risk to the service user, staff and<br />
the public. This should also highlight training needs and areas where<br />
improved approaches to care, treatment and management are required as,<br />
until clinicians are better informed of the factors associated with violent<br />
behaviour, there is little chance of improving the accuracy of risk assessments<br />
(Monahan and Steadman, 1994).<br />
There are many studies that have attempted to identify which factors<br />
are most closely associated with an increased risk of violence from people<br />
with mental disorder. However, the field has been blighted by a number<br />
of problems and it is recognised that research in this area is flawed<br />
with methodological shortcomings with little consistency in the research<br />
approaches (Monahan, 1984). Despite the importance of the subject area<br />
there are few consistent studies which investigate fully the heterogeneous<br />
nature of violent behaviour in mental health services. However, a number<br />
of large multi-factorial studies have explored risk factors for in-patient<br />
violence (e.g., Crichton, 1995; Royal College of Psychiatrists, 1998;<br />
Almvik et al., 1999); community violence (e.g. Klassen and O’Connor, 1988;<br />
Swanson et al., 1990; Monahan et al., 2000); and differences between the<br />
mentally disordered and non-mentally disordered in terms of which risk<br />
factors predict violence (Bonta et al., 1998). The literature is far from consistent<br />
in concluding the most valid risk factors for violence. However,<br />
there is evidence that a number of characteristics relating to past history,<br />
current functioning, protective influences and the individual’s<br />
context/environment need to be taken into account when assessing violence<br />
risk. These factors, derived from previous research, are summarised<br />
in Table 7.2. Consideration of some or all these factors should make the<br />
risk assessment process more systematic and transparent, while improving