Factors influencing challenging behaviour on secure wards
Research type
Research Study
Full title
Predictors of aggression in a secure unit: Comparing ward social climate and service user risk
IRAS ID
326239
Contact name
Rebecca Williams
Contact email
Sponsor organisation
Elysium Healthcare
Duration of Study in the UK
0 years, 6 months, 1 days
Research summary
The use of restrictive practices in psychiatric care to manage aggressive behaviour by patients, such as physical restraint, is argued to reflect the dominant view that aggressive behaviours are mainly caused by the patient. Less consideration is given to other factors such as the physical ward environment, and the influence of the ward social dynamics, in contributing to aggressive incidents. There is currently a shift within forensic psychiatric care, encouraging a move away from restrictive practices, towards adopting more preventative and communication-based management strategies of aggression. Therefore, research is needed to strengthen the existing knowledge of which factors better explain aggression by service users detained in secure units, to support the moving away from restrictive strategies and towards holistic and preventative approaches.
Staff and patients in a low and medium secure unit will be asked to complete a questionnaire called the Essen Climate Evaluation Schema (EssenCES; Schalast, Redies, Collins, Stacey & Howells, 2008). This questionnaire yields ratings of the 'ward social climate', measuring various aspects of the ward dynamics. Patient participants will be asked to consent to the researcher accessing their HCR-20v3 risk assessments, which shall be used as a proxy for 'patient aggression risk'. The researcher will gather data from the organisation's incident recording system within a given time period, to assess frequency of aggressive incidents in the unit. Incidents will be identified as having involved 'aggressive' behaviour using the Modified Overt Aggression Scale (MOAS; see Hallett & Dickens, 2020). The MOAS will allow the researcher to categorise incidents according to whether they involved physical aggression, verbal aggression, property damage, or auto-aggression. A multiple regression analysis will be used to examine the proportion of variance in incidents explained by ward social climate and patient risk.
The researcher will have collected all data by end of November 2023. This study is self-funded.
REC name
Social Care REC
REC reference
23/IEC08/0026
Date of REC Opinion
11 Aug 2023
REC opinion
Further Information Favourable Opinion