Abstract
PurposeThis study aimed to examine the relationship between the physical design of mental health care facilities and the occurrence of aggressive behaviour. MethodsA cross-national survey including a large number of forensic and non-forensic inpatient wards (n = 101) across seven National Health Service (NHS) trusts was conducted. A detailed Ward Features Checklist was designed and completed for each ward. These ward features were then compared on two dimensions with records of aggressive incidents on the wards. Clinical ward staff on participating wards (n = 191) also completed an online survey including questions from the Work Safety Scale (WSS) to assess subjective perceptions of safety at work. ResultsPhysical aggression was associated with higher staffing and greater space availability (Ward Features Checklist Dimension 1: Incident Rate Ratio = 2.19); and increased comfort and facilities and external views of urban environments (Ward Features Checklist Dimension 2: Incident Rate Ratio = 1.24). ConclusionThe findings here are amongst the first to challenge ideas about the relationship between staff-patient ratios, certain space characteristics and aggressive incidents. The observed associations are, however, underpinned by complex organisational and relational factors which need to be further explored to fully understand the overall context. There are implications for service user and staff safety training initiatives and for future mental health ward design.
Highlights
The majority of assaults on UK National Health Service (NHS) staff occur in mental health or learning disability settings
Single sex wards had significantly higher levels of verbal aggression than mixed sex wards; this difference from mixed sex wards was statistically significant for male only wards
In relation to property damage, there were fewer significant differ ences between ward types; only Medium Secure Unit (MSU) wards had significantly lower levels of aggression related to property than acute wards
Summary
The majority of assaults on UK National Health Service (NHS) staff occur in mental health or learning disability settings (data from 2013/ 14, NICE guidance, 2015). The NICE (2015) guideline for reducing aggression in inpatient wards recommends that the environment should be optimised by unlocking doors when possible; having a simple layout and enhanced decoration; and offering access to outside space and pri vacy. Despite such recommendations, a Care Quality Commission report (CQC, 2017) cited the poor physical environment as one of the most common safety concerns. The CQC found current inpatient wards were not designed sufficiently to meet service user needs and did not always allow for adequate observation
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