The maintenance of order on an adolescent inpatient unit: an analysis of work on the evening shift

This paper attempts to explain a subset of aggressive interactions between a group of staff members and male adolescent inpatients in a large residential mental health facility. The interactions center around staff use of physical confrontation as a method of managing contranormative or noncompliant patient behaviors. My explanation is based on the notion that certain system variables--i.e., the importance for some staff to demonstrate their competence as effective crisis managers--may promote and support a staff culture of confrontation. Four concepts are used to analyze this culture of confrontation: (a) shift style, (b) shift role, (c) staff values, and (d) group character. In making use of these concepts, the analysis is able to incorporate aspects of aggression in institutional settings which remain anomalous in many accepted theories and to indicate a possible means of reducing staff confrontation. Evidence for this view is derived mainly from participant observation data.