Culturally safe management of aggression and violence in mental health care institutions

Abstract

Aggression and violence in Health Care is common course in mental health care facilities. Literature informs that staff finds it difficult to managing aggression and violence. This is exacerbated in the South African context where we deal with diverse cultures despite the fact that the majority of our mental health care users rely heavily on care from their own indigenous healers according to their Indigenous Knowledge System. This adherence to a Western Based Knowledge System often makes care not culturally safe or appropriate. Most of the research done in this regard focusses on pure management of aggression and violence and the effect of training programmes in the European context. This research project, however explored the methods used by indigenous healers and combining that knowledge and practices with additional training in cultural sensitivity and awareness, to determine the effect of a treatment interventions which includes inter alia with understanding the phenomenon of aggression and violence, de-escalation techniques, safe restraint and dignified break away techniques. The research objectives addressed aspects such as Indigenous Knowledge and skills, attitudes of staff with regards to the management of aggression and violence, cultural sensitivity of staff, refinement of a training programme on the management of aggression and violence to include skills and knowledge used by indigenous healers which is applicable to the management of aggression and violence and determining the effect of the training programme on the above. An exploratory sequential mixed method was followed, with a qualitative phase which used makgotla as novel data collection method, the information generated during this data analysis was utilised to augment current literature and refine an existing training programme. The indigenous healers used in this study were from the same geographical area where the participants in the experimental groups are employed, as they would be dealing with mental health care users from the same cultural group their respective mental health care institutions would serve. The quantitative phase consisted of a pretest and posttest after a training programme (the refined training course). The researcher primarily made use of purposive sampling, based on findings in the literature study and, thereafter, proceeded to perform randomised cluster sampling. In the latter, the researcher randomly selected which hospitals will fall into which experimental group. Participants completed the MAVAS (management of aggression and violence attitude scale) and the lntercultural sensitivity questionnaires for both the pretest and the posttest, after the administration of the training programme. Questionnaires for the posttest were administered after the presentation of different parts of the training programme in the different mental health care institutions, these pretests and posttest results were compared both within the groups and between the experimental groups. Descriptive statistics were used to describe the demography of the participants and inferential statistics were used to determine the effect of the training programme. The findings revealed that the experimental group constituted of participants with the least amount of experience in mental health care had the most significant attitudinal change with regards to the management of aggression and violence. All the experimental groups showed a significantly improved understanding of how the environment in the mental health care facility can contribute to mental health care user related violence and aggression and that improved communications between mental health care providers and mental health care users can contribute to a decrease in aggression and violence. The most remarkable result was however the group who only received training on cultural sensitivity and awareness had the most significant change in attitude in the management of aggression and violence. This experimental group was coincidentally the least experienced in mental health care. Therefore it can be concluded training programme which included cultural sensitivity and awareness showed the most significant effect on the attitudes towards the management of aggression and violence and the youngest least experienced group were more influenced by the training. These findings have implications for nursing curricula in foundational programmes with reference to cultural sensitivity and awareness and the management of mental health care user related aggression and violence. Mental health care facilities and management must be made aware of the benefit of such a training programme when orientating the neophyte to the services and also for continuous professional development of permanent employees to improve their ability to deal with aggression and violence and to render cultural safe care. The community can also benefit from this research through equipping them with the skills to deal with aggression and to avoid harmful practices as identified during the makgotla. Finally this study suggests avenues for further research, namely determining the perception of mental health care users with reference to whether they render the care received to be culturally sensitive and appropriate, exploration of the culturally safe mental health care environment and research focused on "unlearning" destructive attitudes in mental health care providers.