Relationship between the nurse's level of fear, anger and need for control, and the nurse's decision to physically restrain the aggressive patient

This study attempted  to  identify factors which impact on  decision  making relating  to  physical restraints. It was hypothesized that  nurses  who scored higher on instruments used  to  measure  levels   of   fear ,  anger  and  need   for   control  would  restrain   patients  earlier in  the  progression  of  aggression.  The  collective effect  of  these three emotions on  the   decision   to   physically   restrain  was examined using multiple regression analysis.  The  individual effect  of  each  of  these emotions was examined using Pearson product-moment correlations.  Decision   to   restrain  was measured by an audio visual tool created by  the  researcher (Moylan Assessment  of  Progressive Aggression Tool - MAPAT).

One hundred and six female  nurses  were given  the   Fear  Survey Schedule III (FSSIII),  the  Multidimensional  Anger  Inventory (MAI), and  the  Desirability  of   Control  Scale (DCS) in random order. They then were given  the  MAPAT measure. None  of   the  hypotheses were confirmed.  The  collective effect  of  these emotions were not statistically significant (p =.135). When measured individually,  the   level   of   fear  was found  to  be statistically significant (r =.179 at p =.030) in a positive direction. When scoring  of   the  MAPAT was revised  to  reflect  the  progression  of  aggression as ordinal  level   of  measure rather than an interval  level   of  measure,  anger  also had a significant positive correlation with  decision   to   restrain  scores (r =.167 at p =.045), in  the  opposite direction  of   the  proposed hypothesis.

Supplemental analyses using demographic data were done.  Nurses  who had a history  of  injury from  patient  assault significantly later than uninjured  nurses  (p =.032).  The  mean score  for   the  injured group (253.346) represented a time in progression  of  aggression when  the   patient  was dangerously violent. These findings indicate a pattern  of  higher  fear   levels , history  of  injury, and later  decision   to   restrain , which could lead  to  cyclical assault.

The  failure  to  find validity  for   the  proposed hypothesis may have resulted from problems with  the  MAPAT tool or with  the  application  of  fight or flight theory. Further testing  for  construct and criterion validity is indicated.  The  finding that  fear  and  anger  were significantly related  to  later restraining may result from an application  of  fight or flight theory different from that originally proposed.  The  dynamic  of  "freezing" (failure  to  take action) rather than neutralization may be occurring.

Findings which identified groups whose scores reflected unsafe  decision  making is a cause  for  concern. This study confirmed findings relating  to   the  frequent  level   of  assault and variability in restraint use discussed in  the  literature. Sixty nine percent  of   the  subjects in this study had been assaulted. MAPAT scores varied greatly both  between  and within each  of   the  demographic groups. These findings indicate a  need   for  continued assessment  of  safety issues in acute psychiatry.