Care staff attributions for violent incidents involving male and female patients: A field study

Objectives. This article presents a study of naturally occurring attributions recorded by care staff following incidents of restraint in a psychiatric secure unit. The relationship between control for patient, control for staff and behavioural outcomes including use of medication, seclusion and duration of restraint were explored for male and female patients. 

Design and methods. In all, 557 forms documenting incidents of control and restraint, and completed over a four-year period by nurses in a UK psychiatric hospital, were content analysed using the Leeds Attributional Coding System (LACS; Munton, Silvester, & Hanks, 1999). Additional information concerning duration of restraint, severity of injuries sustained by patient and care staff, use of medication and seclusion, and patient was also gathered. It was hypothesized that perceived patient control over causes of the restraint incident would be associated with duration of restraint, use of seclusion and medication. It was also predicted that male patients would be perceived as having more control over incidents, and thus be more likely to be secluded and less likely to be prescribed medication, than female patients. 

Results. Seclusion was associated with controllable attributions for patient and uncontrollable attributions for care staff. Use of medication was associated with uncontrollable attributions for patient, but only for male patients. Contrary to prediction, female patients were more likely to be secluded than males and less likely to receive medication. Staff were also more likely to state that they had 'no explanation' for restraint incidents involving female patients. 

Conclusions. The investigation of naturally occurring attributions raises important questions regarding the relationship between patient gender and attributional models of helping behaviour. The results are discussed in terms of their potential implications for future research and health care practice.