Cognitive factors in NHS staff responses to violence and aggression
NHS staff frequently experience violence and aggression, and post-traumatic stress disorder (PTSD) is amongst the potential psychological consequences. Using a prospective design, the present study sought to establish whether cognitive factors, specified in Ehlers and Clark's (2000) model, could predict symptom severity over and above other established risk factors. The aim was to develop and refine a predictive tool, which could be used to identify individuals who may benefit from early, targeted interventions. Forty-eight healthcare workers completed questionnaires assessing a range of cognitive factors, immediately following an incident of violence or aggression. Of these participants, twenty provided data concerning PTSD symptoms at three-month follow-up, despite implementing strategies to maximise response rates. It was therefore not possible to address the original research question owing to the small sample size. However, several participants reported experiencing symptoms, and for some these were moderate to severe. Several potential reasons for non-response were identified, including the possibility that healthcare workers appraise workplace incidents in such a way that subsequent effects are minimised. An experimental analogue study examined this hypothesis. Student nurses (N = 190) read a vignette as an analogue for a violent incident, in which the context was manipulated. Results indicated that neither organisational setting (work / non-work), nor cause of the perpetrator's behaviour (illness / non-illness) influenced the type of appraisals endorsed, or ratings of perceived distress. It therefore seems likely that other factors contributed to the low response rate observed in Study 1. However, in line with Ehlers and Clark's (2000) cognitive model, appraisals explained a significant amount variance in dysfunctional behaviours after controlling for perceived distress. Study 1 indicated that a proportion of staff were adversely affected by incidents of violence and aggression. Replication of this research is warranted in light of the current literature, and recommendations are made for modification.