S.TRUEMAN PhD THESIS 2016

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They could do a lot better if they just believed in themselves a little bit more. [T17, p. 6] Another reason for stress in relation to delivering mental healthcare is violent and aggressive mental health patient presentations. This primarily relates to the unpredictability associated with drugs and alcohol. This study reports that alcohol is still the dominant drug causing remote violence and aggression, but that there is change occurring: A real increase actually in methamphetamine use, but THC is pretty much a given. [T10, p. 9] When one remote nurse participant was asked which type of mental health patient presentation was the most stressful, he stated: When they [mental health patients] are aggressive, either physically or verbally aggressive, and … they’re pissed or under the effect of—or they’re stoned. Very difficult to look after them. [T7, p. 15] Another nurse participant stated: I would say probably eight out of ten [mental health] presentations in … remote places … have had violence involved. [T17, p. 8] This then results in a self-reinforcing and perpetual belief that the environment is stressful. This results in the remote nurses anticipating intermittent violence and aggression, but are unable to know when. As a participant psychiatrist noted: For anyone it’s about anticipation … If you’re in an environment where every time you go on call there’s violence coming through the door then you know people [remote nurses] are arriving at work anxious. [T11, p. 14–15, emphasis added]