Methodology:
Study design and setting:
The present investigation was a quantitative cross-sectional study carried out in Shahid Hemin Mental Health Center, a general teaching hospital facility in Sulaimani city, Kurdistan, Iraq— This hospital provides treatment and care to patients with a variety of mental health problems from the period of data started January 2023 to April 2023.
The sample:
Sample size estimation:
This was determined using G -the power correlation analysis approach; it was estimated that 50 Nurses working in Shahid Hemin Mental Health Hospital are needed to compute a medium effect size of (0.5- 0.8) power, with 95% confidence intervals and a level of significance of (0.05). , n=50 nurses; 20 female nurses and 30 male nurses.
The Sample:
A non-probability, convenience sample of 50 Nurses working in Shahid Hemin Mental Health Hospital.
Inclusion and exclusion Criteria:
Nurses who have worked at Shahid Hemin Mental Health Hospital for a year and more. Nurses working in primary or private mental health centers are excluded; nurses with less than 1-year experience in a hospital are also excluded.
Tool of the study:
A questionnaire was developed by the investigator of this study and used as an instrumental tool for data collection; then, the questionnaire was translated into the Kurdish language through the forward-backward method. The validity was achieved by five experts, the computation of Cronbach’s Alpha, and the result was statistically adequate and reliable of p 0.001 level. The questionnaire consists of the following parts.
The questionnaire was used which is comprised of three sections:
Section A: A Socio-Demographic Questionnaire: designed by the author to obtain variables such as age, gender, duration of experience in mental health nursing, work shift, job satisfaction, scientific level, and workplace.
Section B: Attitudes toward aggression scale (ATAS) developed by Collins (1994), consists of 47 statements about aggression; this 47-item self-report scale is designed to assess staff attitudes toward in-patient aggression.
The 47 statements on the ATAS comprise relevant themes on aggression with response options varying on a 5-point Likert scale from totally agree (5) to disagree (1) totally. This scale comprises eight sub-scales: offensive attitude (seeing aggression as unpleasant, hurtful, and an unacceptable behavior); communicative attitude (aggression as a signal resulting from a patient‘s powerlessness aimed at enhancing a therapeutic relationship); destructive attitude (aggression as a threat or act of physical harm); protective attitude (aggression as shielding or defending of physical and emotional space), intrusive attitude (viewing aggression as the expression to damage or injure others), normal reaction (viewing aggression as a normal reaction from the patient because of his mental condition, functional attitude (considering aggression as an opportunity to focus on the patient conditions) and harmful attitude (viewing aggression as an assault reaction).and harmful attitude (viewing aggression as an assault reaction).
The ATAS questionnaire was created to determine” Attitudes toward aggression scale “. The questionnaire consisted of a 47-item self-report scale designed for the assessment of staff attitudes toward in-patient aggression (i.e., 47 “items”) (i.e., 47 “items”). 67 people completed the questionnaire. Each question was measured using a 5-point Likert item from “strongly disagree” to “strongly agree”. A Cronbach’s alpha test was performed to determine whether the questions in this questionnaire were internally consistent. The ATAS was a reasonably reliable questionnaire in this study, with a Cronbach’s alpha of 0.732.
Section C: Management of Aggression and Violence Scale; MAVAS
It consists of 27 statements about factors related to and management of aggression and violence based on nurses’ attitudes. It is divided into the following categories: internal causative factors, external causative factors, situational/interactional causative factors, general management, medication use, seclusion use, restraint use, and non-physical methods.
Ethical Approval:
Ethical approval was obtained from the scientific committee of the psychiatric and mental health nursing department, college of nursing, and the ethical committee college of medicine, University of Sulaimani. Also, permission was granted by Sulaimani general health directorate. Dignity, integrity, right to self-determination, privacy, and confidentiality of the personal information of the participants were considered. Participants were adequately informed of the aims, methods, any possible conflicts of interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the study, and the discomfort it may entail. The study’s aims were explained to participants; also, participants have informed the right to refuse to participate or withdraw consent to participate at any time without reprisal.
Methodology:
Study design and setting:
The present investigation was a quantitative cross-sectional study carried out in Shahid Hemin Mental Health Center, a general teaching hospital facility in Sulaimani city, Kurdistan, Iraq— This hospital provides treatment and care to patients with a variety of mental health problems from the period of data started January 2023 to April 2023.
The sample:
Sample size estimation:
This was determined using G -the power correlation analysis approach; it was estimated that 50 Nurses working in Shahid Hemin Mental Health Hospital are needed to compute a medium effect size of (0.5- 0.8) power, with 95% confidence intervals and a level of significance of (0.05). , n=50 nurses; 20 female nurses and 30 male nurses.
The Sample:
A non-probability, convenience sample of 50 Nurses working in Shahid Hemin Mental Health Hospital.
Inclusion and exclusion Criteria:
Nurses who have worked at Shahid Hemin Mental Health Hospital for a year and more. Nurses working in primary or private mental health centers are excluded; nurses with less than 1-year experience in a hospital are also excluded.
Tool of the study:
A questionnaire was developed by the investigator of this study and used as an instrumental tool for data collection; then, the questionnaire was translated into the Kurdish language through the forward-backward method. The validity was achieved by five experts, the computation of Cronbach’s Alpha, and the result was statistically adequate and reliable of p 0.001 level. The questionnaire consists of the following parts.
The questionnaire was used which is comprised of three sections:
Section A: A Socio-Demographic Questionnaire: designed by the author to obtain variables such as age, gender, duration of experience in mental health nursing, work shift, job satisfaction, scientific level, and workplace.
Section B: Attitudes toward aggression scale (ATAS) developed by Collins (1994), consists of 47 statements about aggression; this 47-item self-report scale is designed to assess staff attitudes toward in-patient aggression.
The 47 statements on the ATAS comprise relevant themes on aggression with response options varying on a 5-point Likert scale from totally agree (5) to disagree (1) totally. This scale comprises eight sub-scales: offensive attitude (seeing aggression as unpleasant, hurtful, and an unacceptable behavior); communicative attitude (aggression as a signal resulting from a patient‘s powerlessness aimed at enhancing a therapeutic relationship); destructive attitude (aggression as a threat or act of physical harm); protective attitude (aggression as shielding or defending of physical and emotional space), intrusive attitude (viewing aggression as the expression to damage or injure others), normal reaction (viewing aggression as a normal reaction from the patient because of his mental condition, functional attitude (considering aggression as an opportunity to focus on the patient conditions) and harmful attitude (viewing aggression as an assault reaction).and harmful attitude (viewing aggression as an assault reaction).
The ATAS questionnaire was created to determine” Attitudes toward aggression scale “. The questionnaire consisted of a 47-item self-report scale designed for the assessment of staff attitudes toward in-patient aggression (i.e., 47 “items”) (i.e., 47 “items”). 67 people completed the questionnaire. Each question was measured using a 5-point Likert item from “strongly disagree” to “strongly agree”. A Cronbach’s alpha test was performed to determine whether the questions in this questionnaire were internally consistent. The ATAS was a reasonably reliable questionnaire in this study, with a Cronbach’s alpha of 0.732.
Section C: Management of Aggression and Violence Scale; MAVAS
It consists of 27 statements about factors related to and management of aggression and violence based on nurses’ attitudes. It is divided into the following categories: internal causative factors, external causative factors, situational/interactional causative factors, general management, medication use, seclusion use, restraint use, and non-physical methods.
Ethical Approval:
Ethical approval was obtained from the scientific committee of the psychiatric and mental health nursing department, college of nursing, and the ethical committee college of medicine, University of Sulaimani. Also, permission was granted by Sulaimani general health directorate. Dignity, integrity, right to self-determination, privacy, and confidentiality of the personal information of the participants were considered. Participants were adequately informed of the aims, methods, any possible conflicts of interest, institutional affiliations of the researcher, the anticipated benefits and potential risks of the study, and the discomfort it may entail. The study’s aims were explained to participants; also, participants have informed the right to refuse to participate or withdraw consent to participate at any time without reprisal.