New care practices may reduce the occurrences of challenging and violent situations on psychiatric wards. Maritta Välimäki, Professor of Nursing Science at the University of Turku, leads a high-risk project funded by the Academy of Finland, studying psychiatric hospitals as nursing environments and challenging situations occurring in these. The study will examine whether it is possible to reduce the occurrences of violence on the ward in collaboration with staff, clients and relatives by developing the nursing culture.
According to the research, physicians and nurses are often exposed to patient violence. Verbal abuse is the most common form of violence, experienced by one in four people in the mental health or substance abuse sector. In addition, every fifth employee has experienced physical violence. According to Välimäki, nurses even consider this a normal part of their work, and therefore no-one knows how to pay special attention to it. These situations become emphasised in psychiatric hospitals in particular.
People with mental illness often have a distorted vision of reality and they may experience the environment as a threat, which may lead to violent behaviour. In extreme situations, coercive measures permitted by law have to be used in nursing at the ward every now and then. Extreme measures, such as restraint and seclusion, are mentally and physically hard for both patients and staff.
“We want to investigate what the occurrences of violence are like, which matters lead to these situations, and what their consequences are. We lack a deeper understanding of the risk factors and consequences linked with these challenging situations, even though the matter has been studied both nationally and internationally. Reducing occurrences of violence would produce direct savings in healthcare, because such situations often require additional resources,” says Välimäki.
Increasing the involvement of patients
The intention is to use the study as a basis for developing new care practices by which the occurrence of challenging and violent situations on psychiatric hospital wards could be reduced. The impacts of new practices will be studied by assessing the atmosphere on the ward and final outcomes of treatment.
“The most essential part of the project is to develop care practices and the nursing culture in collaboration with staff, relatives and patients. By using these concrete measures, it’s possible to increase the patients’ share in their own treatment, and improve common understanding of matters concerning treatment,” explains Välimäki.
According to Välimäki, major changes can be generated by increasing the involvement of patients and taking their opinion into account. In the light of earlier experience, quite minor steps can already reduce conflicts and improve the atmosphere on a ward. Such measures include better acknowledgement of suggestions for development made by clients, and more regular meetings between nursing staff and patients.
“Increasing the range of recreational opportunities has also calmed down the atmosphere on hospital wards. Furthermore, when unnecessary rules are lifted, the staff have more working hours available for other tasks, and, at the same time, the atmosphere becomes more open and permissive.”
The study will serve as a basis for drafting general principles, from among which the units can adopt the measures best suited to them. The research group will also produce a series of systematic reviews about the impact of various treatment methods in psychiatric work. “If successful, the study will shed new light on an area of research that is challenging both in terms of ethics and research,” Välimäki says.
Bigger changes in nursing by risk-taking
According to Välimäki, the project entails various elements of risk. The extent of the research project is one such factor, because every hospital district in Finland has been invited to participate in the study. “At the moment, about two dozen hospital districts have already expressed an interest. Managing such an extensive project, motivating the staff, and the long distances make the project particularly risky. Putting the methods into practice may also constitute a risk, because the application of the method would have to be as similar as possible, but individually adjusted to a sufficient extent at the various facilities.”
The study also uses extensive register data, the availability and use of which always involves risks related to research methodology. However, Välimäki praises the Finnish databases, which could well be used more extensively for research purposes. It is not necessary to ask everything face to face, when the same information can be acquired from registers or existing materials. This saves the patients much inconvenience and the working hours of the staff.
The ethical side of the research also creates challenges. “Questions related to violence and restraint require high-standard ethics and sensitivity from the researchers. Researchers can’t ask whatever they want, but the interviews must always be conducted on the terms of those being interviewed and with due respect for their privacy. We have very accurate and versatile ethical guidelines for this.”
According to Välimäki, taking risks can generate significant changes in nursing practices. “Usually, in nursing science, we’re used to doing things on a small scale and in silence. In such cases, the results can’t be applied in other facilities. Now we want to do more comprehensive and generalised research. This study will give us comprehensive information on how the method used affects the practice, care atmosphere and wellbeing of staff.”
Välimäki praises the high-risk funding opportunity: “There’s always talk that high risks should be taken in research studies so that, if proven successful, they could produce major breakthroughs. This new form of funding enables risk-taking. The Academy of Finland has selected a broad range of projects relating to various sectors, which is great. At the opening seminar for the funded projects, I also got valuable tips from research council members and from colleagues who also received this type of funding.”
Finnish text: Anna-Riikka Oravakangas
Photo: Anita Westerback
- Academy of Finland supports scientific risk-taking with purpose-made funding (Academy press release, 2 Sep 2015)