Falls in older adult psychiatric patients: equipping nurses with knowledge to make a difference

Falls are the most common cause of accidental death among older adults and are associated with increased morbidity and mortality. A particularly serious sequela of falls is osteoporotic fractures. Older adults with mental illness are at increased risk of both falls and subsequent fractures, because of a range of complex risk factors. Many falls are preventable and an awareness of the risk factors for falls among nurses will empower them to promptly refer a patient at risk to the multidisciplinary team. A multidisciplinary approach is required to be successful in any efforts to reduce an individual's risk of falls and nurses have a central role in achieving this. This article reviews the relevant literature on the causes and consequences of falls in older adults with mental illness in order to enable nurses to reduce falls and subsequent fractures.

The shoulder: taking the strain during restraint

The decision to use or utilize physical intervention techniques is a contentious one. There has been much discussion on the complex legal and ethical dimensions framing the use of force. The risk of injury has also been considered in detail, but almost all of the published work has focused on restraint asphyxia, the prone restraint hold and the use of particular pain compliance techniques such as the wrist flexion hold. This paper focuses on the structure and function of the shoulder and examines how physical interventions and a variety of risk factors can threaten its physical integrity. This paper is for practitioners such as training commissioners, trainers, frontline staff and investigators or regulators who have to make considered determinations on the potential immediate physical impact of a variety of holds and escape manoeuvres. Sound risk assessment must be premised on a sound understanding of anatomy and physiology.

Antipsychotic-induced hyperprolactinaemia in patients with schizophrenia: considerations in relation to bone mineral density

Schizophrenia affects about 1% of the world's population. Those with schizophrenia are at elevated risk of a variety of physical health conditions, including diabetes, coronary heart disease, hypertension and osteoporosis. Osteoporosis secondary to antipsychotic-induced hyperprolactinaemia (i.e. raised prolactin levels) has received little attention, when compared with reports on metabolic syndrome for instance. A recent study established that schizophrenia and prolactin-raising antipsychotic medication is directly associated with hip fractures. This is important and concerning as osteoporotic fractures are associated with much morbidity and mortality. This paper reviews the literature on antipsychotic-induced hyperprolactinaemia and its subsequent effects on bone mineral density.

Physical assault by patients against physiotherapists working in mental health settings

OBJECTIVES

There is a lack of empirical research about physical assault by patients against physiotherapists who work in mental health settings. This study aimed to ascertain the lifetime prevalence and 12-month incidence of assault by patients against physiotherapists in UK mental health settings. This research will inform the development of pre- and post-registration training programmes for physiotherapists.

DESIGN

Postal questionnaire survey.

PARTICIPANTS

Members of the Chartered Society of Physiotherapists' special interest group for physiotherapists working in the field of psychiatry.

MAIN OUTCOME MEASURES

Self-reported experience of physical assault by patients. Secondary outcome was self-reported training received to manage violent and aggressive patients.

RESULTS

Questionnaires were returned by 116/178 (65%) special interest group members. Fifty-one percent (59/116) reported that they had been assaulted at work during their career, and 24% (28/116) had been assaulted by a patient in the previous 12 months. Physiotherapists in mental health settings appear to be at greater risk of assault by patients than other non-nursing clinicians.

CONCLUSIONS

Physiotherapists who work in mental health are at similar risk of physical assault by patients as their nursing colleagues, who are required by the UK Nursing and Midwifery Council to receive education and training in the prevention and management of aggression and violence in their pre-registration training. The authors recommend that appropriate training should be included in pre-registration programmes for physiotherapists.

The manual handling of the aggressive patient: a review of the risk of injury to nurses

Staff are injured more frequently than patients during the implementation of physical interventions. In essence the application of physical interventions is a form of manual handling, where the aggressive patient is the 'load'. In the non-mental healthcare environment, manual handling contributes to a large chunk of work-related musculoskeletal disorders. Applying physical interventions against an agitated and aggressive human load is a risk factor for injuries being sustained. This paper discusses physical interventions as a manual handling procedure as a possible explanation of injuries sustained to nursing staff from being in a team applying physical interventions. Possible strategies to reduce the risk of developing musculoskeletal disorders from physical interventions are discussed.

Physical intervention: a review of the literature on its use, staff and patient views, and the impact of training

As a principal control measure, physical intervention is intended to be a skilled manual, or hands-on, method of physical restraint implemented by trained individuals, with the intention of controlling the aggressive patient, to restore safety in the clinical environment. Physical intervention is however a contentious practice. There have been reports in the literature of negative psychological views from staff and patients on the procedure. Although formal structured training was introduced in response to concerns around patient safety during restraint, concerns remain that PI is sometimes construed as a stand-alone violence prevention initiative. Its potential for misuse, and overuse, in corrupted cultures of care has emerged as a social policy issue. The following paper critically explores the literature on training in physical intervention in the United Kingdom.

Habituating pigs for in-pen, non-invasive biophysical skin analysis

The purpose of this study was to develop a method for habituating pigs (Sus scrofa domestica, middle white strain) to enable non-invasive, biophysical measurements of dorsal skin to be obtained on a daily basis over a 7-week period, thus eliminating the need for anaesthesia or restraint. This was accomplished by associating measurements of transepidermal water loss (TEWL) and skin reflectance spectroscopy (SRS) with feeding times, and with positive reinforcement by allowing exercise outside the home pen. During the pig habituation period, a well-defined series of behavioural changes were observed that included dominant/ submissive leadership changes. Values of TEWL (6.29 +/- 1.25g.m(-2) x h(-1)) were in agreement with previous studies (7.56+/-2.90g.m 2 x h(-1)) obtained from unrestrained Yucatan hairless micro-pigs (Gabard et al. 1995). The coefficient of variance of TEWL and SRS measurements were comparable with those reported previously using anaesthetized pigs (Chilcott et al. 2000). These data imply that biophysical skin measurements obtained from unrestrained, conscious animals are comparable to those obtained from anaesthetized pigs and therefore, support the use of unrestrained pigs for non-invasive biophysical skin measurements. Habituating animals for in-pen, non-invasive, biophysical measurements has substantial implications for reducing and refining laboratory animal experiments in dermatological research without compromising animal welfare.