• Assessment of risk and special observations in mental health practice: A comparison of forensic and non-forensic settings

      Whitehead, Elizabeth; Mason, Tom; University of Chester (Blackwell, 2006-10-26)
      This article discusses research into the use of special observations in both forensic and non-forensic psychiatric settings. A comparative approach was adopted to establish if the perceived risk factors leading to the adoption of special observations were similar in both settings. Three groups of nursing staff were requested to assess 30 patients who were placed on special observations. Before this, nurses were requested to rate the risk factors in terms of their severity on a 7-point Likert scale. The rank-ordering analysis revealed a similarity of identified risk factors and anova (one-way, unrelated) and the Jonckheere Trend Test revealed that there were significant differences between the scores in the forensic and the non-forensic settings.
    • De-escalation of Violence in the Context of Learning Disability: Working with complexity

      Lovell, Andy; University of Chester (Oud Consultancy, 2017-10-26)
      The use of physical interventions as a response to violence has come under increasing critique over recent years, particularly when the service user group is perceived as vulnerable, such as with elderly populations and those with intellectual disabilities. A 2-day educational workshop was devised for a whole population of qualified nurses and support workers currently working with people with intellectual disabilities detained under conditions of security in the north of England. The workshops were delivered between October 2016 and March 2017, and evaluated on an ongoing basis to ensure immediate feedback to service management. The basis of the workshop was a model of understanding the de-escalation of violence derived from several inter-linked components. Firstly, the process of violence is analysed in relation to how a situation becomes enflamed and violent behaviour results. The concept of de-escalation is then deconstructed so that the various components can be considered in relation to each other. Finally, the concept of complexity is unpicked, specifically around intellectual disability, and this constitutes the final element of the model. The three elements are subsequently developed in relation to each other to constitute a better way of understanding the process of de-escalating violence. The workshop, in effect, demands that participants reflect on their own work, and the therapeutic relationships developed over time with service users. The relationship between knowledge and practice is explored in some detail. The emphasis is placed on how the successful de-escalation of potentially violent situations directly relates to the effective translation of this knowledge, in all its diversity, into practice; and, perhaps, this is less understood than might immediately appear.
    • The discrepancy between actual and unreported incidents of violence in a learning disability nursing service

      Skellern, Joanne; Lovell, Andy; University of Chester (South West Yorkshire Mental Health NHS Trust and the University of Huddersfield, 2008-10)
      This study reports on research carried out within the Learning Disability Division of a major Mental Health NHS Trust in the North of England, and relates to the discrepancy between the actual number of incidents of violence and aggression and those reported. The literature review demonstrated that violence is a particular issue for nurses, particularly those working in the areas of mental health and learning disability where studies have indicated that as many as one in five may be affected. A questionnaire was distributed to all learning disability nurses currently employed in the Trust, a total of 411, with a response rate in excess of 40%. The study revealed that a discrepancy does exist between actual and reported incidents of violence within the Trust. It confirmed previous claims that the predominant difficulty is cultural, violence being regarded as part of the job and non-reporting primarily revolving around perceptions of incidents being considered 'minor', not worth the time to complete the paperwork. The paper concludes that more work is needed to achieve a united, consistent approach across the NHS, in order that a high quality, accessible service for people with learning disabilities and complex needs can be delivered without violence being considered an acceptable part of the job.
    • Forensic psychiatric nursing: Skills and competencies: II Clinical Aspects

      Mason, Tom; Coyle, David L.; Lovell, Andy; University of Chester (Blackwell, 2008-01-18)
      This study reports on research undertaken to identify the skills and competencies of forensic psychiatric nurses working in secure psychiatric services in the UK. The rationale for this research is the lack of clarity in the role definition of nurses working in these environments and the specific content that may underscore the curriculum for training forensic nurses. Over 3300 questionnaires were distributed to forensic psychiatric nurses, non-forensic psychiatric nurses and other disciplines and information obtained on (1) the perceived clinical problems that give forensic nurses the most difficulty, (20 the skills best suited to overcome those problems and (3) the priority aspects of clinical nursing care that needs to be developed. A 35% response rate was obtained with 1019 forensic psychiatric nurses, 110 non-forensic psychiatric nurses and 43 other disciplines. The results highlighted a 'top-ten' list of main problems with possible solutions and main areas for development. the conclusions drawn include a focus on skills and competencies regarding the management of personality disorders and the management of violence and aggression.
    • Intellectual disability and violence: Conclusions from a trilogy of projects

      Skellern, Joanne; Lovell, Andy; University of Chester (Kavanah, 2011-10)
      This conference paper discusses a series of studies undertaken between 2007 and 2011 exploring different dimensions of the relationship between intellectual disability and violence.
    • Investigation of the development of a 'career' of aggressive behaviour by people with learning disabilities

      Lovell, Andy; Skellern, Joanne; University of Chester (Kavanah, 2010)
      This paper aims to study the development of aggression over time in the lives of a group of individuals with learning difficulties.
    • Tolerating violence: A follow up study to a survey identifying the extent of, and reasons for, the non-reporting of incidents of aggression in one NHS Trust

      Lovell, Andy; Skellern, Joanne; University of Chester (Kavanah, 2009-10)
      This paper reports on a study of people in NHS Trusts working with people with learning difficulties where aggression and violence is a concern.
    • ‘Tolerating violence’: A qualitative study into the experience of professionals working in one UK learning disability service

      Lovell, Andy; Skellern, Joanne; University of Chester (Wiley-Blackwell, 2013-05-06)
      This article reports on a qualitative follow-up study to a whole-population survey investigating the underreporting of violence within one learning disability service. The survey had identified a pronounced level of under-reporting but suggested an unexpected degree of complexity around the issue, which warranted further study. Design. A qualitative research design was employed. Semi-structured interviews were conducted with 22 professionals working in learning disability services; data were subsequently transcribed verbatim and subject to stringent thematic analysis. The findings confirmed that the decision to report an incident or not was complicated by professional interpretation of violence. Three themes were produced by the analysis: the reality of violence, change over time and (zero) tolerance. Conclusion. The study indicates that both experience of violence and ways of understanding it in relation to learning disability are shared across professional groups, although nurses are both more inured and generally more accepting of it. The study suggests that the relationship between learning disability nurses and service users with a propensity for violence is complicated by issues of professional background and concerns about the pertinence of zero tolerance. The availability of effective protocols and procedures is important, but services need also to acknowledge the more ambiguous aspects of the therapeutic relationship to fully understand under-reporting of service user violence in the context of learning disability.
    • Violence and under-reporting: Learning disability nursing and the impact of environment, experience and banding

      Lovell, Andy; Skellern, Joanne; Mason, Tom; University of Chester (Wiley-Blackwell, 2011-11-23)
      The study explores the implications of a survey into the discrepancy between actual and reported incidents of violence, perpetrated by service users, within the learning disability division of one mental health NHS Trust. Violence within the NHS continues to constitute a significant issue, especially within mental health and learning disability services where incidence remains disproportionately high despite the context of zero tolerance. A whole-population survey of 411 nurses working within a variety of settings within the learning disability division of one mental health NHS Trust. A questionnaire was administered to learning disability nursing staff working in community, respite, residential, assessment and treatment and medium secure settings, yielding a response rate of approximately 40%. There were distinct differences in the levels of violence reported within specific specialist services along with variation between these areas according to clinical environment, years of experience and nursing band. The study does not support previous findings whereby unqualified nurses experienced more incidents of violence than qualified nurses. The situation was less clear, complicated by the interrelationship between years of nursing experience, nursing band and clinical environment. The conclusions suggest that the increased emphasis on reducing violent incidents has been fairly successful with staff reporting adequate preparation for responding to specific incidents and being well supported by colleagues, managers and the organisation. The differences between specific clinical environments, however, constituted a worrying finding with implications for skill mix and staff education. The study raises questions about the relationship between the qualified nurse and the individual with a learning disability in the context of violence and according to specific circumstances of care delivery. The relationship is clearly not a simple one, and this group of nurses’ understanding and expectations of tolerance requires further research; violence is clearly never acceptable, but these nurses appear reluctant to condemn and attribute culpability.
    • Violence in health and social care settings: A training resource package for organisations and individuals

      Skellern, Joanne; Lovell, Andy; University of Chester (University of Chester Press, 2013-03)
      Violence in health and social care settings is now recognised as a major international concern. Training in the recognition and management of potentially violent situations can assist to prevent situations escalating to the point where violence occurs. This training resource pack contains: • A DVD of 25 simulated scenarios • A training manual on how to use the DVD which also includes a ‘notes for trainers’ section The aim is to provide you with the materials needed to: • Create a forum where violence can be discussed • Encourage reflection on your own and colleagues responses to threatening situations • Facilitate assessment of potentially violent or threatening situations • Enable you and your colleagues to plan for adverse situations • Encourage a review of practices in relation to National and local policies and procedures This training resource package can provide a welcome contribution to induction and training programmes for individuals, managers and trainers working within organisations providing a range of health and social care services.
    • Women’s narratives on their interactions with the first response police officer following an incidence of domestic violence in the UK

      Keeling, June J.; Van Wormer, Katherine; Taylor, Paul J.; University of Chester ; University of Iowa ; University of Chester (OMICS Group International, 2015-06)
      Historically police responses towards the treatment of domestic disturbances regard them as a noncriminal problem. Recent changes to societal and Criminal Justice System attitudes to domestic violence now places an emphasis on first response officers to effectively deal with offenders, manage victim safety and gather evidence. This study explored fifteen women’s interactions with the attending first response police officer following an episode of domestic violence within the home. A qualitative approach using unstructured narrative interviews was chosen to ensure that each woman remained in control of the research interview. Thematic analysis revealed three main themes concerning power relations and officer attitudes, suggesting that personal and cultural factors may negatively impact on officers’ handling of complaints of partner assault, offsetting policy initiatives that guide officers in engaging with victims of domestic violence. The order of the themes reflects the sequential nature of the women’s dialogue. The first theme explores the initial police response, followed by the women’s narratives around feelings of personal disregard for their experiences and evidential considerations. The final theme explores the police response to retraction of statements. Women’s interactions with first response officers following domestic violence illuminates societal issues previously unmentioned. Making womens’ stories visible provides an important insight, contribution and opportunity to examine first response officer’s responses to domestic violence. Integrating the voices of the women (service users) themselves, is arguably an advantageous consideration towards continuing professional development training for all first response police officers.