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SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
MR. MANJUNATHA C.S
FIRST YEAR M.SC (NURSING)
PSYCHIATRIC NURSING
YEAR 2010-2011
THE KARNATAKA COLLEGE OF NURSING
# 12, KOGILU MAIN ROAD, YELAHANKA
BANGALORE – 560 064
1
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BANGALORE, KARNATAKA
SYNOPSYS PROFORMA FOR REGISTRATION OF SUBJECT
FOR
DISSERTATION
Mr. MANJUNATHA C.S
1.
NAME
OF
THE 1ST YEAR M.Sc (NURSING)
AND THE KARNATAKA COLLEGE OF NURSING,
CANDIDATE
#12 KOGILU MAIN ROAD, YELAHANKA,
ADDRES
BANGALORE – 560 064
2.
NAME
OF
THE THE KARNATAKA COLLEGE OF NURSING,
BANGALORE-560064
INSTITUTION
3.
COURSE
OF
THE 1ST YEAR M.Sc (NURSING),
STUDY AND SUBJECT
4.
PSYCHIATRIC NURSING
DATE OF ADMISSION
TO THE COURSE
26-04-2010
“A STUDY TO ASSESS THE EFFECTIVENESS OF
5.
TITLE OF THE STUDY
STRUCTURED
TEACHING
KNOWLEDGE
LEVEL
MANAGEMENT
OF
PROGRMME
VIOLENT
ON
REGARDING
PATIENTS
AMONG NURSING PERSONNEL IN A SELECTED
HOSPITAL HOSPITAL AT BANGALORE”.
2
6. BRIEF RESUME OF THE INTENDED WORK
INTRODUCTION
“Great spirits have often encountered violent opposition from weak minds”
– Albert Einstein
Mental health nursing is the practice of promoting mental health as well as
caring for people who have mental illness, potentiating their independence and restoring their
dignity. During the course of practice, a mental health nurse has to face violence from acute
psychiatric patients. Violence towards nurses’ in workplace is an endemic worldwide
multifaceted problem. Violence has a detrimental effect on nurses’ psychological, cognitive,
emotional and behavioural spiritual wellbeing, and a negative impact on public healthcare
costs and organisations effectiveness. In order to overcome the above problems a mental
health nurse must possess sound knowledge base and requisite skills in management of
violent psychiatric patients1.
Violence and aggressive behaviour are the serious problems in the health sector.
Multinational data reports that approximately 75% of all psychiatric nurses have been
assaulted at least once in their careers and nurses experience high rates of verbal assault from
82% to 97%3. Whilst extensive efforts have been made to understand the processes involved
in violence in psychiatric wards, the mental state of the patient at the time of the assault was
often cited as an important factor in many assaults. The high-risk mental states were induced
following self-poisoning, a part of a prolonged organic brain syndrome (dementia); alcohol
or illegal drug intoxication or withdrawal; concurrent mental illness or mental handicap
(mania, psychosis), and the patients finding themselves in an environment they had not
expected2
3
According to the National Patient Safety Agency Survey it was estimated that in
England and Wales there were 3,00,000 aggression/minor assaults, 50,000 absconding,
45,000 sexual assault/harassment, 25,000 self-harm, 4,500 physical threat, 200 deaths by
suicide, 85 unnatural deaths of detained patients and 1.3 homicides by inpatients per year.It
has been estimated that in the UK nursing staff have a 10% risk of being subjected to
physically violent attacks by psychiatric inpatients during the course of one year. According
to a survey that was conducted by Shah et al (1991) on “violence and aggression in acute
psychiatric wards, London,” about 105 assaults were recorded a rate of nearly two assaults
per ward; out of these one resulted in major physical injury. In addition to this there were 281
reports of verbal assaults, 53 of sexual harassment and eight sexual assaults 3.
In a cross-sectional survey conducted in Australia on the prevalence and
precipitants of aggression in psychiatric inpatients, reported that 174 patients (13.7%) were
found aggressive and were actively psychotic, out of 1269 admitted psychiatric patients 7.
According to the Royal College of Psychiatrists, London (2004), out of the 1515 reported
violent incidents, 766 were found to be major assaults. A survey conducted in 1999 of 266
emergency department nurses in metropolitan and regional hospitals in New South Wales
revealed that all nurses had experienced physical violence during their career but over 70% of
incidents were not reported to the authorities4.
Williams and Hunter( 2006) In India, it is estimated that approximately 15 million
people suffer from serious mental disorders, that is, schizophrenia (2.7/1000), affective
disorders(12.3/1000), and organic psychosis (0.4/1000). The present prevailing data on
violent. Behaviour in psychiatric patients is insufficient to assess the exact number of such
cases. It is presumed that the number of cases may not be less in developing countries like
India as compared to developed countries. Therefore the management of this problem faced
4
by medical services in India is not readily apparent . According to Bureau of Labour Statistics,
in US major assaults on psychiatric nurses occurred at a rate of 8.3 per 10,000 amounting to
total assaultive incidents of 23675.
Cembrowiez (2007)described that particular concerns have been raised about assaults
on staff in mental services, with about two-thirds of all violent incidents being directed at
nursing staff. When a potentially violent situation arises or when there is actual violence, the
nurse has to defuse and control the situation by maintaining calm and quiet environment,
giving emergency medication, maintaining effective communication, seclusion and by
physical restraint and according to the Department of Biostatistics and Computing, Institute
of Psychiatry, Canada (2003), out of 106 emergency psychiatric nurses, 38% were
exposed to major violent assaults.6
6.1. NEED FOR THE STUDY
Violence is a significant issue for occupational health professional says National
Institute of Occupational Safety and Health (NIOSH).. The Queensland Nurses’ Union says
hundreds of nurses at psychiatric hospitals across the state are assaulted every year during the
course of their duties. For many the attack leaves them so traumatised that they are unable to
return to work7.
The nurses need to have appropriate skills to manage disturbed or violent behaviour
in psychiatric inpatient setting. Training that highlights awareness of racial,cultural, social
and religious or spiritual needs and gender difference along with otherspecial concerns also
mitigates against disturbed/violent behaviour. Such training should be properly audited to
ensure the effectiveness. A survey was conducted on nurse perceptions of the incidence and
nature of verbal and physical assault by psychiatric patients in an acute psychiatric hospital in
5
North Florida (2002). Large percentage of nurses reported being victims of verbal and
physical assaults by psychiatric inpatients; 85% reported being verbally assaulted and 74%
reported being physically assaulted. Assaults were commonly perpetrated by patients with
cognitive dysfunction (79%) and those with substance abuse (60.5%)8.
Lehmann LS (2003) was conducted a study on training personnel on the prevention
and management of violent behaviour among 50 staff of a veteran administration hospital in
San Antonio. This study showed that trainees had 80.6% of improved knowledge in handling
violent behaviour after completing the programme. The study predicted the need for
repetition of such training programmes. A study conducted on training programme for
prevention of assaultive behaviour in a psychiatric setting in Denver. Three hundred
seventeen staff nurses from a mental health centre were sent for a two-day training workshop
on preventing and dealing with patients’ assaultive behaviour over a period of two years. The
result of the workshop was that the number of patient-related assaults on staff dropped from
174 in 1978 to 117 in 1979.9
Recently published studies show that thousands of assaults occur in American
hospitals each year; the mental health sector and emergency departments are becoming
serious occupational hazard sites. It is well documented that mental health workers are at
an increased risk of experiencing work-related violence, and studies conducted on board
certified psychiatrists have shown that there is a 5% to 48% chance of being physically
assaulted by a patient during their careers. Surveys conducted on psychiatry residents
have found that assaults are twice as high among psychiatry residents as among medical
residents. Studies have shown that 40% to 50% of psychiatry residents will be attacked
physically during their 4-year training program. In a survey of psychiatry residents, two
thirds of the residents felt either untrained or undertrained in dealing with violent
6
patients. Even in the pre hospital sector, emergency medical service providers are at an
increased risk for encountering violence; factors highly associated with episodes of
violence were male gender, age, and hour of the day. As the front-line sta! in patient care,
nurses also are at an increased risk of experiencing emotional, verbal and even physical
abuse by not only the patients but family members and visitors as well.3
Acute care settings such as emergency departments, psychiatric emergency
rooms, and inpatient or outpatient psychiatric settings should be considered high-risk
work sites, given the degree of acuity and potential for seeming chaos. These settings are
prime examples of workplaces that can create or exacerbate volatile situations, potentially
ending in violent acts. Because these are volatile work places, potentially fraught with
danger and at times violence, it is imperative that safety is a top priority and that
education and continuous in service training of all sta! is an ongoing part of an acute care
setting. Studies have shown that educational programs can help to reduce the number of
violent events, especially when the events are focused at sta! who are less experienced or
have less formal training. Violence prevention management, in service training on the use
of restraints, careful screening of violence-prone individuals, and security personnel
training and response are methods that have been recognized to be elective in improving
safety and increasing awareness among sta! . Many studies have shown that some form of
pre- and post-critical incident stress management can significantly reduce sta! assaults.7
Additionally, psychiatrists are frequently required to assess violent
patients, especially in acute care settings. Because all of these settings are di!erent in
terms of size, sta! composition, room and patient allocation, and security presence and
especially in training institutions (with the presence of new and untrained sta!), the
7
following principles are discussed as general recommendations in the assessment and
management of the violent patient. First, basic safety considerations are crucial, and it is
imperative to have a clear management approach when dealing with these situations and
patients. There are some basic tenets of safety that must be adhered to at all times when
in an acute care setting. The key is to make sure at all times that patients’, sta! members’,
and personal safety are maintained and that patients are always monitored for possible
violence. It is the adequate and prompt assessment of the situation and the
implementation of well-coordinated management responses to a potentially violent
patient that maximize the outcome for the patient and safety for the sta!3
Grassi L (2001)was conducted a study in an acute psychiatric unit of Italy on the
characteristics of violence among 1534 psychiatric patients. The study showed that 116
patients were responsible for 329 aggressive episodes. Most violent patients had an ICD-9
diagnosis of schizophrenia and/or delusional syndrome (55.1%), a history of violence
(80.7%) and previous psychiatric admissions (92%). Approximately half of the incidents had
no specific cause, occurring during daytime and in the first week of admission, and most
cases were directed towards individuals (77.8%). The data therefore proved the prevalence of
various forms of violence in psychiatric units10.
Pieters G (2005) was conducted a study on “assaults by patients on psychiatric
trainees: frequency and training issues in Belgium.” The data was collected from 99
psychiatric trainees representing 60% of the response rate to training. As many as 56% of the
respondents had been confronted with at least one physical assault by patients during their
residency, whereas 72% had already been threatened by patients11.
Hence the researcher felt that there was a need to conduct a study on the management
of violent patients to suggest the steps to be taken in order to prevent or minimise the
8
likelihood of violence among nurses in the hospital. Taking into consideration all the above
facts, the researcher felt to develop a structured teaching plan on the management of violent
patients among nurses in a selected hospital.
6.2. REVIEW OF LITERATURE
The review of literature is an important step in the development of research work.
Literature refers to the activities involved in searching for information on a topic as well as
the actual written report that summarises the state of the existing knowledge on research
problems.
Review of literature helps in selecting appropriate methodology, developing tool,
analysing data and relating the findings from one study to another so as to establish
knowledge in a professional discipline from which valid and pertinent theories may be
developed.
Review of literature has been grouped into the following categories:
 Review of literature related to Concept of violence and causes of violence..
 Review of literature related to effect of violence
 Review of literature related to effectiveness of training for management of violence
for nurses.
Review of literature related to Concept of violence and and causes of violence
Farooq A. Mustafa D. Singh(2007) conducted a prospective study was
carried out at Sher-i-Kashmir Institute of Medical Sciences Srinagar (India) for a period
of six months to collect data regarding all instances of violence reported during study
period. Study population was employees of Sher-i-Kashmir Institute of Medical Sciences.
9
Instances of violence were reported more often during evening hours. Accident and
Emergency department is more vulnerable to violence. Type II Violence is the most
frequent category. The results says
that all the security attendants and medical
postgraduates faced some sort of violence. Among the prominent reasons of violence are
arrogant staff and attendants, huge rush of patient attendants, patients not satisfied with
treatment and also they recommended training is needed for
the staffs regarding
development of communication skills among staff is essential. Policies and procedures
need to be laid down to ensure patient safety. Instances of violence in hospitals will
decrease only when quality patient care is ensured.15
Whittington R (2009) was conducted an exploratory study on violence to staff in a
psychiatric hospital located in Northwest India. The aim of the study was to estimate the
prevalence of violence towards the nurses and to analyse the reason for violence. A total of
396 staffs provided information on their experience of violence in the past years. The
findings suggested that 72% nurses had been physically assaulted and 90% of these assaulted
staff worked in emergency and psychiatric department. Most of the patients had the diagnosis
of acute psychosis, personality disorder, mania and the patients who received delayed
treatment.12.
Lin Y and Liu H (2005) was conducted a study on the impact of violence on
psychiatric ward nurses in South Taiwan. The purpose of the study was to explore the
prevalence of violence committed by the psychiatric patients against nurses. Two hundred
and thirty nurses from a 400-bedded hospital in southern Taiwan were chosen. The results
showed that 44.7% nurses had received training regarding violence; 61% of the nurses
reported experiencing verbal and physical threat. The verbal expressions of violence were
10
mainly due to drunkenness and physical expression of threat commonly seen in psychotic
patients.13.
Park De C (2004) was conducted a study on management of psychiatric in-patient
violence in a large psychiatric hospital in South London. The aim of the study was the
management of violent incidents in all general wards in a large psychiatric hospital. Most of
the 4464 untoward incidents recorded were on the 14 general adult wards, 1380 (31%) were
in learning disability, 256 (6%) were on the forensic wards, and 29 (<1%) were on the
addiction ward. As far as the patients’ status under the Mental Health Act (1983) was
concerned, 1137 incidents (75%) involved patients on a civil section, 43(3%) involved
patients on a criminal section and for 333 incidents (22%) the patient was informal.14
Raja M (2005) was conducted a research study on hostility and violence of acute
psychiatric in patients in Chennai. The aim of the study was to find out the extent of hostility
and violence in a psychiatric intensive care unit. Out of 165 in patients 18% to 25% exhibited
violent behaviour while in the hospital. Of these 78% were directed towards nurses; 10-45%
of patients with schizophrenia exhibited aggressive and threatening behaviour during
hospitalisation.16
Michael D (2010) was conducted a study on nurses’ short-term prediction of
violence in acute psychiatric ward in Australia. The study was conducted for a 18-month
period on a total of 1215 psychiatric inpatients and out of these 181 were recorded as being
aggressive. Patients with bipolar affective disorder and schizophrenia had a 2.81 and 1.96
significantly increased risk of aggression.17
Gudjonsson GH (2009) conducted a study on management of psychiatric inpatient
violence in a psychiatric hospital in South London for a period of 3 years (1994, 96 and 98).
The aim of the study was to study the management of violent incidents in a psychiatric
11
hospital. The study showed that out of 1515 incidents data regarding psychiatric diagnosis
were missing for 594 (39%) incidents; for the remainder the most common diagnosis were
psychosis (766), learning disability (91), and personality disorder (64).18
Review of literature related to effect of violence
Joncy Philip, MA (2005) conducted a research in Vellore regarding the
pharmacological management of violence in people with psychiatric disorders is underresearched. And also she compare interventions commonly used for controlling agitation
or violence in people with serious psychiatric disorders. The results At blinded
assessments 4 h later (99.5% follow-up), equal numbers in both groups (96%) were
tranquil or asleep. However, 76% given the haloperidol–promethazine mix were asleep
compared with 45% of those allocated lorazepam (RR=2.29,95% CI 1.59–3.39;
NNT=3.2,95% CI 2.3–5.4). The haloperidol–promethazine mix produced a faster onset of
tranquillisation/sedation and more clinical improvement over the first 2 h. Neither
intervention differed significantly in the need for additional intervention or physical
restraints, numbers absconding, or adverse effects. The conclusion was the Both
interventions are effective for controlling violent/agitated behaviour. If speed of sedation
is required, the haloperidol–promethazine combination has advantages over lorazepam. 19
Nolan P(2004) conducted a study on “violence in mental healthcare: the experience of
mental health nurses and psychiatrists in UK.” The study aimed to ascertain the extent and
nature of violence against mental health nurses and psychiatrists. The sample size was 375 of
which 74 were psychiatrists and 301 were nurses. Though both groups experienced violence
in the workplace, nurses were found to have been exposed to violence significantly more than
psychiatrists (
2(3)=21.7,
P<0.05) and suffered with physical injuries.20
12
Quintal SA(2002) conducted on the violence against psychiatric nurses. Many
psychiatric nurses have been assaulted repeatedly by patients of hospital psychiatric units.
The assaults cause physical, and sometimes lasting emotional injuries.21
Zimmer KK (2003) conducted a study on psychological effects of violence in forensic
nurses. The authors conducted a retrospective study to examine the effects of violence on
forensic nurses who experienced a traumatic event in their work. The study was conducted on
12 practicing forensic nurses, and they were asked to describe one event that took place at
their work that they found particularly traumatic and disturbing. Six participants reported
feeling anger and frustration after the event, 2 participants refocused their anger to advocate
for changes on their communities to prevent those events. The most commonly reported
mechanism was informal discussion with colleagues and friends.22
Celik SS (2004) conducted a study on staff nurse of psychiatric ward in Ankara,
Turkey. A structured questionnaire was administered to 225 staff nurse. Participants said that
they were assaulted verbally (100%), sexually (53.3%) and physically (5.7%). All the staffs
who experienced verbal and sexual assault felt anger towards the psychiatric patient.23
Carmel H (2009) conducted one-year study on staff injuries from inpatient violence at
a maximum security forensic state hospital in California. The aim of the study was to record
injuries sustained by staffs as a result of inpatient violence. The subjects were in three
categories, ward nursing staff (N=749), psychiatric technician trainees (N=106), and
professionals (N=162). They found that 121 staff members sustained 135 injuries. Of these,
nursing staff sustained 120 of the injuries. The majority of injuries to nursing staff (9.9 per
100 staff) were sustained while containing patientviolence.24
Fernandes CM (2002)
was
conducted study on perceived incidence and
consequences of violence on 106 emergency psychiatric department staff in Canada. They
13
found that nurses reported consideration of job change (38%), short, medium and long- term
impaired job performance (25%, 24% and 19% respectively), fear of patients (73%), and
impaired job statisfaction.25
3. The effectiveness of training for management of violence for nurses
Ilkiw-Lavalle O(2002) conducted study on the effect of prior training and staff
occupation on the Influence of knowledge acquisition from an aggression management
training programme in a mental hospital, Australia. The training programme included 103
mental health staff comprising three groups of nurses, allied and medical staff, and ancillary
staff. All occupations had significant knowledge gain following training. Results suggested
previously trained staff would be better suited to short-term, more frequent, on ward skillsbased refresher training.26
Grenyer BFS (2004) conducted a study on the development and evaluation of an
aggression and violence minimisation programme for all mental health nurses in New South
Wales, Australia. Forty-eight experienced staff nurses completed the training and they were
assessed for satisfaction, knowledge and skills acquired, attitudes towards managing
aggression, and confidence in dealing with violent incidents. Evaluation of the programme
showed that all staff nurses were satisfied, and increased their knowledge and skills, and
improved attitude towards working with aggressive patients. A significant increase in staff
confidence for dealing with violent incidents was also found. Commonly reported coping
mechanism was informal discussion with colleagues and friends.27
Infantiro JA (2009) conducted a study on assaults and injuries among psychiatric
staff with and without training in aggression control techniques in a state psychiatric hospital
in Gains-Wille. The objective was to assess the effectiveness of training in aggression control
14
technique by a training programme. The study subjects were 96 unit staff nurses and shift
supervisors. Of the 31 staff nurses who had received aggression control training, only one
was assaulted; of the 65 untrained staff, 25 were assaulted. The trained staff member who
was assaulted did not sustain injury. Yet 19 of the 24 untrained staff who were assaulted were
injured. The findings support the implementation of aggression control training to provide
staff with techniques to diffuse potentially violent situations.28
Carmel H(2003) study conducted on compliance with training in management of
assaultive behaviour and injuries from inpatient violence at a forensic hospital in California.
Twenty-seven wards were included in the study. They were divided into two groups: 18
wards with low compliance with requirement for training in management of assaultive
behaviour (less than 60% of the staff in compliance) and nine wards with high compliance
(more than 60% of the staffing compliance). The results showed that the rate of staff injury
from patient violence in the wards with low compliance, with training in managing assaultive
behaviour (20.00 per 100 staff) was almost three times the rate in the ward with high
compliance (7.4 per 100 staff). These findings suggest that ward staff may benefit from
overall compliance with training requirements in management of assaultive behaviour.29
STATEMENT OF THE PROBLEM
“A study to assess the effectiveness of structured teaching progrmme on knowledge level
regarding management of violent patients among nursing personnel of spandana hospital at
Bangalore”.
15
6.3. A) OBJECTIVES OF THE STUDY
1. To assess the pre-interventional level of knowledge of nursing personnel regarding
management of violent patients
2. To assess the effectiveness of structured teaching program regarding management
of violent patients.
3. To associate the post interventional knowledge regarding management of violent
patients with selected demographic variables.
B) OPERATIONAL DEFENITIONS USED IN THIS STUDY
Operational definitions
1. Effectiveness: In this study ‘effectiveness’ refers to the extent to which structured teaching
programme has achieved the effect in the management of violent patients, as measured by
gain in knowledge score.
2 Structured teaching program :It refers to the systematically developed instruction
and teaching aids, designed for giving instruction and teaching regarding management of
violent patients.
3. Management: In this study ‘management’ involves handling and caring of violent patients
by maintaining effective interpersonal relationship, administering emergency medications
and by seclusion and restraint.
4. Violent patient: In this study violent patient refers to mentally ill patients who have the
potential to cause verbal threat and physical harm to self and to others.
5. Nursing personnel: In this study nursing personnel refers to registered nurses
16
HYPOTHESIS
H1. - There will be significant difference between pre test and post test level of
knowledge among nursing personal regarding management of violent patients
H2. - There will be significant association between post test level of knowledge and
selected demographic variables.
C) LIMITATIONS
 The study will be limited to management of violent patients.
 The study will be limited to selected nursing staffs of Spandana hospital, Bangalore.
7. MATERIALS AND METHOD
7.1. SOURSE OF DATA
Data will be collected from nursing personal of of Spandana hospital, Bangalore.
7.2. METHOD OF COLLECTION OF DATA
For the present study the date will be collected using demographic perform and
structured knowledge questionnaire. The tool for present study will be developed by the
investigator based on the objectives, review of the related literature and suggestion of the
experts in the field of mental health.
17
i) RESEARCH DESIGN
One group pretest post test research design a type of pre - experimental research will be
used for the present study.
ii) RESEARCH APPROACH
Research approach for the present study is Evaluative approach
iii) RESEARCH VARIABLE
Independent variable: In the present study the independent variable is the management of
violent patients.
Dependent variable: In the present study the dependent variable is the knowledge of the
staff nurses on management of violent patients.
Extraneous variables: Age, sex and educational status, staffs experience.
iv) RESEARCH SETTING
Study will be conducted in Spandana Hospital at Bangalore.
v) POPULATION
Population for the present study will be the nursing personals of
Bangalore.
vi) SAMPLE SIZE
60 the nursing personals of Spandana hospital, Bangalore.
18
Spandana hospital,
vii) SAMPLE TECHNIQUE
Convenient sampling technique, a type of non-probability sampling approach.
viii) SAMPLLING CRITERIA
a) Inclusion criteria
Nursing personal working in Spandana Hospital, Bangalore .
Nursing personal. willing to participate in study.
Nursing personal. available during the period of data collection.
b) Exclusion criteria
Nursing personal who are not willing to participate in the study.
Nursing personal who are not present during the data collection
ix) TOOL FOR DATA COLLECTION
Based on the objectives of the study, a structured knowledge questionnaire will be
prepared which will have two sections.
Section 1: Include items related to the demographic variables of the respondents about
age, sex, education, staffs experience, subjects handled, classes being handled, source of
information.
Section 2: Consists of multiple choice questions to assess the knowledge before and after
administering the structured teaching on management of violent patients
19
x) METHOD OF DATA COLLECTION
Permission will be obtained from the Head of the institution and the participants before
collecting the data. The participants will be selected by non probability convenient
sampling technique.
Phase-I
The data collection was scheduled from July 1st to 31st 2010. Prior permission was
obtained from concerned authority of Spandana Hospital, Bangalore.
Phase-II
During the data collection schedule, the nursing personal who met the inclusion criteria
were selected by using non probability convenient sampling technique.
Phase-III
 Before administering the questionnaire the purpose of the study was explained to
the entire nursing personal with self- introduction and a written consent was
obtained from them.
 A separate place was selected for the data collection and privacy was maintained
and the subjects were made comfortable.
 The investigator took an average time of 20-30 minutes for each session. The
investigator got co-operation from the nursing personal.
Phase-IV
At the end of the pre-test session, the STP were administered & the nursing personal
were encouraged to get their doubts clarified.
20
Phase-V
After 1 week post-test was done by using the same structured questionnaire on the
same subjects.
xi) DATA ANALYSIS AND METHOD
The date will be analyzed by using descriptive and inferential statistics.
Descriptive statistics
Descriptive statistics such as Mean, Median, Percentage and standard deviation will be
used for assessing demographic data.
Inferential statistics
The paired t test will be used in analyzing the effectiveness between pretest and post test
7.3.
DOES
THE
STUDY
REQUIRE
ANY
INVESTIGATIONS
OR
INTERVENTIONS TO BE CONDUCTED ON PATIENTS OR OTHER HUMAN
OR ANIMAL?
Yes
7.4. HAS THE ETHICAL CLEARENCE BEEN OBTAINED FROM YOUR
INSTITUTION IN CASE OF 7.3?
1. Permission will be obtained from the research committee. The Karnataka College
of Nursing.
21
2. Informed consent will be obtained from the Head of the schools.
3. Informed consent will be obtained from the selected nursing personal from
Spandana Hospital, Bangalore.
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3. Marshall H. Lelliott P, Hill K. Safer wards for acute psychiatry. British
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4. Cameron L. Verbal abuse: a proactive approach. Nursing Management
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6. Cembrowiez. Management of psychiatric in patient violence: use of
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8. May DD, Laurie M, Grubbs. The extent, nature and precipitating factors of
nurses assault among nurses in a psychiatric hospital. Journal of Emergency
Nursing 2002;28(1).
9. Lehmann LS, Padilla M. Training personnel in the prevention and
22
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Jan;34:40-3.
10. Grassi L. Characteristics of violent behaviour in acute psychiatric inpatients –
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12. Whittington R, Wykes T. Invisible injury. Nursing Times 1989;85(42):30.
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implications for nursing students. Int J Nurs 2007;42:229-41.
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Clinical Practice and Epidemiology in Mental Health 2005;1:11.
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psychiatric ward. Austria New Zealand Journal of Psychiatry 2006.
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19. Joncy Philip MA, Caldwell MF. Incidence of violence among staff victims of patient
violence, Hospital Community Psychiatry 2005;43(8):838-9.
20. Nolan P, Dallender J. Violence in mental healthcare. The experiences of
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23
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9. SIGNATURE OF THE CANDIDATE
:
10. REMARKS OF THE GUIDE
:
11. NAME AND SIGNATURE OF THE
11.1. GUIDE
:
11.2. SIGNATURE
:
11.3. CO-GUIDE
:
11.4. SIGNATURE
:
11.5. HEAD OF THE DEPARTMENT
:
11.6. SIGNATURE
:
12.1. REMARKS OF THE PRINCIPAL
:
12.2. SIGNATURE
:
25