Exposure of Violence and Working Alliance between Mental Health Nurses and Patients Iyus

Iyus, Yosep (2021) Exposure of Violence and Working Alliance between Mental Health Nurses and Patients Iyus. PhD thesis, Universiti Malaysia Sarawak.

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Abstract

Work-related violence including physical assaults and nonphysical violence against nurses has become a major public health problem particularly in mental health hospitals. In addition, nurses are deemed responsible for the violation of patients' rights such as isolation, drug administration without informed consent and exercising restraint over patient's aggressive behaviors. Working Alliance between nurses and patients has been established as successful in reducing the high burden of psychiatric nurses associated with complete patient dependency on nurses. Therefore, violence risk assessments in clinical nursing practice and established its association with working alliance are important core mental health skills. The purpose of this study was to explore work-related violence toward mental health nurses and its relationship with the working alliance, and to explore the experience of workplace violence among nurses at Mental Hospital West Java Province, Indonesia. This study adopted a sequential explanatory mixed method. In qualitative study, 40 nurses were recruited using purposive sampling. The data was collected using focus group discussions. Data analysis was perform using Colaizzi’s methods. For quantitative part of the study, a cross-sectional design was conducted at Mental Hospital West Java Province among a convenience sample of 120 nurses. Data were collected from the respondents using the Bahasa Indonesia version of the Working Alliance Inventory-Short Revised-Therapist (WAI-SRT), and Survey Questionnaire on Workplace Violence in the Health Sector. Logistic and linear regression was used to determine workplace violence in relation to working alliance and their associated factors. In qualitative analysis, this study found that nurses experienced violence included: physical assault, verbal violence, sexual harassment, and intimidation of family, the threat of a lawsuit. Their responses to the violence were unpredictable situation, desire to leave the job, anticipatory and spiritual responses. While, a total of 56 (46.7%) of nurses reported being verbally abuse, 29.2% claimed to be physically attacked, and 24.2% experienced both verbal abuse and physical attack. The mean score of working alliance was 44.46 (SD = 11.32), agreement on goals had higher score than other domains with mean 17.65 (SD = 3.45), followed by task (16.56 ± 5.81), and bond (22.10 ± 7.23). There was a negative correlation between workplace violence with the working alliance, meaning that nurse who experienced high intensity of physical or verbal violence had low working alliance. The mental health hospital director needs to provide continue and routinely Prevention and Management of Violence and Aggression (PMA) training for all mental health staff on wards, to apply de-escalation technique rather than restraint practices, and to design working alliance training and therapeutic strategies for nurses. Also, developing an electronic system to facilitate nurses when asking for help from the security team, if needed, or when patients are rowdy, anxious, uncontrollable and disruptive, aggressive, threatening their life and environment. Besides that, it is very important to provide nurses with legal protection against lawsuits and to establish an ethics team that can protect nurses’ or patients’ rights. Future research exploring the factors associated with workplace violence among mental health nurses in Indonesia is also warranted to understand the main problems of workplace violence in Indonesia deeply.

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