Experiencing violence in a psychiatric setting: Generalized hypervigilance and the influence of caring in the fear experienced.

Abstract

Exposure to violence in the mental health sector both affects employees and has implications for the quality of care provided. This phenomenological study aims to describe and understand the ways in which acts of aggression from a patient might affect workers in a psychiatric institute, their relationships with the patients and the services offered. Two semi-structured interviews were conducted with each of the 15 participants from various professions within a psychiatric hospital. Our analysis reveals four themes: hypervigilance, caring, specific fear toward the aggressor and generalized fear of all patients. A state of hypervigilance is found among all participants. An emphasis on caring is present among the majority and unfolds as a continuum, ranging from being highly caring to showing little or no caring. A feeling of fear is expressed and is influenced by the participant's place on the caring continuum. Caring workers developed a specific fear of their aggressor, whereas those showing little or no caring developed a generalized fear of all patients. Following a violent event, caring participants maintained this outlook, whereas those demonstrating little to no caring were more inclined to disinvest from all patients. Hypervigilance and fear caused by experiences of violence impact the quality of care provided. Considerable interest should thus be paid to caring, which can influence fear and its effects.