Sue Winstanley

Anxiety, burnout and coping styles in general hospital staff exposed to workplace aggression: A cyclical model of burnout and vulnerability to aggression

Although an increasing problem, the aggression ( physical assault, threatening behaviour and verbal aggression) directed toward general hospital staff rather than staff in psychiatric institutions has not been widely investigated. The present study first compared anxiety, coping styles and burnout according to the frequency of aggressive experiences. Second, a sub-sample was examined to determine any immediate after-effects from aggressive encounters. Healthcare staff ( n = 375) across professions completed the State-Trait Anxiety Inventory, the Maslach Burnout Inventory and the Coping Responses Inventory, which were analysed according to the type and frequency of aggression experienced within the preceding year. There were no significant differences in levels of anxiety or in coping styles. However, significant differences were determined in levels of burnout. Emotional exhaustion and depersonalization were significantly higher in those staff more frequently victimized suggesting that aggressive encounters might lead to an increase in burnout. Equally, the converse might be true. Therefore, a cyclical model is put forward in which we propose that elevated levels of burnout from all sources might increase vulnerability to victimization. Increases in emotional exhaustion lead directly to an increase in depersonalization as a coping mechanism, which subsequently manifests as a negative behavioural change toward patients, thus rendering staff more vulnerable to further aggression.

Violence in a general hospital: comparison of assailant and other assault-related factors on accident and emergency and inpatient wards.

Objective:  This study sought to compare the characteristics of aggressive incidents occurring on inpatient (medical and surgical) wards with those occurring in the accident and emergency department in terms of assailant, employee and other factors.

Cognitive model of patient aggression towards health care staff: The patient's perspective

Abstract Aggression towards health care staff has become the focus for research as well as for government intervention. Negative effects upon staff and organizations have been established, yet few detailed explanations are offered for this aggression, and none represents the patients perspective. This paper presents a model from the patients perspective that takes account of situational variables, while also focusing upon patient cognitions. It also considers physiological responses related to arousal that might underpin aggression in an anxiety-provoking situation. In a previous study the frequency with which aggression was preceded by some anxiety-provoking event and the extent to which assailants displayed diminished cognitive processing were established; these were incorporated into the model. Increased anxiety commonly experienced by patients can have a negative effect upon cognitive processing. Anxiety generates a hyper-vigilance for threatening stimuli, induces selective attentional bias for threat, and causes a narrowing of attention, thus reducing cues and information upon which to make accurate appraisals and attributions. With such impairments, patients may make negative rather than positive attributions regarding actions of staff, which are frequently anxiety provoking. Thus, patients perceive staff behaviour as threatening rather than benign, and in the absence of positive attributions it will invoke an aggressive response. What health care staff perceive as aggression may be seen by patients as a defence against perceived attack. Changes in policy that take this into account may reduce future aggressive incidents.

Effects of Optimism, Social Support, Fighting Spirit, Cancer Worry and Internal Health Locus of Control on Positive Affect in Cancer Survivors: A Path Analysis

The psychological impact of a cancer diagnosis can extend through treatment, well into cancer survivorship and can be influenced by a range of psychosocial resources. At different stages in this trajectory, optimism is known to affect well-being directly. This study focusing upon the potential to flourish after cancer, investigates the relationship between optimism and positive affect during cancer survivorship together with four possible mediators: social support, fighting spirit, internal health locus of control and cancer worry, all of which have been shown to be important predictors of well-being in cancer patients. Participants (n = 102) from online cancer forums completed standardized questionnaires, and path analysis confirmed that optimism had a direct effect on positive affect in cancer survivors. Social support and fighting spirit were also shown to be significant mediators of this relationship, accounting collectively for 50% of the variance in positive affect. Whilst cancer worry and internal health locus of control could be predicted from levels of optimism, they did not mediate the optimism-positive affect relationship. Efforts to promote optimism and thus encourage fighting spirit at diagnosis through treatment may be worthwhile interventions, as would ensuring appropriate social support through the trajectory.