This thesis is comprised of a systematic literature review, empirical paper and critical appraisal. Firstly, a systematic literature review of qualitative studies exploring staff experiences of violence and aggression in the emergency department was conducted. A meta-ethnographic approach was used to review 12 papers. The results showed that staff working in the emergency department appeared to resign themselves to the inevitable experience of violence and aggression. Staff made attributions about the cause of violence and aggression which affected their emotional responses. They also often felt isolated when managing violent incidents and the experience of violence and aggression had significant consequences on their psychological and physical well-being. A consistent organisational response to violence and aggression was recommended through both frontline and management staff training.
Secondly, the empirical paper explores staff perceptions of well-being and resilience using a constructivist grounded theory framework. 11 staff were interviewed from a range of professional backgrounds across two forensic services. A model of staff perceptions of the factors which contribute to well-being and resilience when working in secure forensic services was developed. Staff resources were depleted through: working with clients who have complex difficulties, experiencing constant change and through the indirect impact of pressure from external organisations. This had a subsequent negative impact on their well-being. Factors including breaks and reflection in and out of work, support from colleagues and witnessing client progress allowed staff to feel ‘re-charged’ and motivated staff to continue working. Clinical implications included: organisations providing opportunities for time and reflection in work for staff, self-care training for new starters and advice for managers.
The final section outlined a critical reflection of the journey conducting research with staff in the current climate of healthcare and considering the findings within the existing resilience literature base.