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Nibbio G, Pinton IC, Barlati S, Stanga V, Bertoni L, Necchini N, Zardini D, Lisoni J, Deste G, Vita A. Predictors of psychosocial functioning in people diagnosed with schizophrenia spectrum disorders that committed violent offences and in those that did not: Results of the Recoviwel study. Schizophr Res 2024; 270:112-120. [PMID: 38896937 DOI: 10.1016/j.schres.2024.06.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 04/07/2024] [Accepted: 06/15/2024] [Indexed: 06/21/2024]
Abstract
Psychosocial functioning represents a core treatment target of Schizophrenia Spectrum Disorders (SSD), and several clinical and cognitive factors contribute to its impairment. However, determinants of psychosocial functioning in people living with SSD that committed violent offences remain to be more thoroughly explored. This study aims to separately assess and compare predictors of psychosocial functioning in people with SSD that did and that did not commit violent offences considering several clinical, cognitive and violence-related parameters. Fifty inmates convicted for violent crimes in a forensic psychiatry setting diagnosed with SSD (OP group) and fifty participants matched for age, gender, education, and diagnosis (Non-OP group) were included in the study. A higher risk of violent relapse as measured by HCR-20 clinical subscale scores (p < 0.002) and greater global clinical severity as measured by CGI-S scores (p = 0.023) emerged as individual predictors of worse psychosocial functioning, as measured by PSP scores, in the OP group. Greater global clinical severity (p < 0.001), worse performance in the processing speed domain as measured by the BACS Symbol Coding (p = 0.002) and TMT-A tests (p = 0.016) and higher levels of non-planning impulsivity as measured by BIS-11 scores (p < 0.001) emerged as individual predictors of worse psychosocial functioning in the Non-OP group. These results confirm that clinical severity impacts psychosocial functioning in all individuals diagnosed with SSD and suggest that while cognitive impairment clearly represents a determinant of worse functional outcomes in most patients, the risk of violent relapse is a specific predictor of worse psychosocial functioning in people with SSD that committed criminal offences.
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Affiliation(s)
- Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Daniela Zardini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy; Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Eweida R, Ibrahim N. Using Delphi method to address factors contributing to aggressive behaviour in mental health settings. J Psychiatr Ment Health Nurs 2024. [PMID: 38532533 DOI: 10.1111/jpm.13049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/29/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Nurses' perspectives and consensus on the possible key factors contributing to aggression at inpatient units can be summarized into patients' related factors, staff related factors and environment related factors. Results of the possible factors contributing to aggression at inpatient units reflect the complicated nature of this problem. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: Perspectives of nurses as frontline mental health professionals on factors contributing to aggression as one of the psychiatric emergencies were considered through an iterative process. This approach gave nurses an opportunity to revisit their own views in each round to provide an in-depth reflection in the light of the contribution of others. WHAT ARE THE IMPLICATIONS FOR MENTAL HEALTH NURSING PRACTICE?: Nursing curricula should focus on nurses' communication skills and emotion regulation training. An open dialogue between nurses and people with mental health issues should be initiated to discuss the possible key factors contributing to aggressive behaviour at inpatient units from both standpoints. Mental health nurses' turnover at inpatient settings could be targeted through the design and implementation of aggression prevention protocols ABSTRACT: Introduction Aggression at inpatient units is a universal problem leading to hazardous outcomes. Aim To generate group consensus about factors contributing to aggressive behaviour among patients with mental health issues at inpatient units. Methods Nurses working at inpatient psychiatric departments were approached, and purposive sampling was employed to implement Delphi technique. A total of three Delphi rounds were conducted online. The average percent of majority opinions method was followed to measure consensus in which questions with a cut-off rate below 69.7% were included in the next round. Results Twenty-one nurse experts with different skills participated in this study. Consensus increased among nurse experts across rounds for the following items: Patients' misinterpretation of the attitude of the healthcare providers, severity of mental health issues, attitude and communication style of the healthcare providers, nurses limited emotional regulation capacity and the inadequate staff-patient ratio in psychiatric wards. Discussion The complicated nature of aggressive behaviour displayed by people with mental health issues is reflected on the results of the current study; patients' related factors, staff related factors and environment related factors constitute interacting facets for this issue. Implications for Mental Health Nurses Nurse scientists could use insights derived from this study to design studies aiming at assessment and management of aggression at inpatient units guided by implementation science frameworks. Additionally, open dialogues between nurses and people with mental health issues could be initiated about factors contributing to aggression at inpatient units. Mental health nursing training should focus on nurses' communication and emotion regulation skills.
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Affiliation(s)
- Rasha Eweida
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
- Psychiatric and Mental Health Specialty, Nursing Department, College of Health and Sport Sciences, University of Bahrain, Zallaq, Bahrain
| | - Nashwa Ibrahim
- Psychiatric and Mental Health Nursing Department, Faculty of Nursing, Mansoura University, Mansoura, Egypt
- Mental Health Nursing Department, Faculty of Nursing, The British University in Egypt, El Sherouk City, Egypt
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Katayama M, Fujishiro S, Sugiura K, Konishi J, Inada K, Shirakawa N, Matsumoto T. Stigmatized attitudes of medical staff toward people who use drugs and their determinants in Japanese medical facilities specialized in addiction treatment. Neuropsychopharmacol Rep 2023; 43:576-586. [PMID: 37814500 PMCID: PMC10739075 DOI: 10.1002/npr2.12380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 10/11/2023] Open
Abstract
AIM Stigma within healthcare settings significantly impact the lives of people who use drugs (PWUD). Given the lack of quantitative data on stigma toward PWUD in healthcare settings and the unknown factors that contribute to it in the Japanese context, this study aimed to investigate the current status of stigma toward PWUD and its determinants. METHODS We conducted a survey in five specialized addiction medical facilities across three prefectures in Japan. The survey included questions related to stigmatizing attitudes toward PWUD, knowledge about illicit drug use, and personal and professional interactions with PWUD. RESULTS A substantial portion of respondents rejected the notion that drug addiction can be overcome through sheer willpower or attributed it solely to moral failings. However, the majority still considered them untrustworthy and viewing drug use as unacceptable and incomprehensible. Many respondents perceived PWUD as dangerous, despite the limited occurrence of hostile behavior from PWUD in clinical practice. A considerable proportion of respondents did not seek support for their own or their relatives' drug-related issues, and less than half had collaborated with recovered PWUD, which serves as potential indicators of reduced stigma. While healthcare professionals recognized that involving law enforcement does not contribute to the recovery of PWUD, a considerable number still believed it was necessary to report them to the authorities. CONCLUSION Healthcare professionals in specialized addiction medical facilities demonstrate strong stigmatizing attitudes toward PWUD. Comprehensive educational programs and large-scale awareness campaigns are necessary to address and mitigate stigma in this context.
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Affiliation(s)
- Munenori Katayama
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
- Department of Drug Dependence ResearchInstitute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
| | - So Fujishiro
- Aichi Prefectural Mental Health and Welfare CenterNagoyaJapan
| | - Kanna Sugiura
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
| | - Jun Konishi
- Mental Health and Welfare Center, City of YokohamaYokohamaJapan
| | - Ken Inada
- Department of Psychiatry, School of MedicineKitasato UniversitySagamiharaJapan
| | | | - Toshihiko Matsumoto
- Department of Drug Dependence ResearchInstitute of Mental Health, National Center of Neurology and PsychiatryKodairaJapan
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de Raeve P, Xyrichis A, Bolzonella F, Bergs J, Davidson PM. Workplace Violence Against Nurses: Challenges and Solutions for Europe. Policy Polit Nurs Pract 2023; 24:255-264. [PMID: 37475497 PMCID: PMC10563370 DOI: 10.1177/15271544231182586] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
We report the results of a mapping exercise by the European Federation of Nurses (EFN) on challenges and solutions related to violence against nurses. This is an issue of growing international concern, with the problem accentuated during and following the COVID-19 pandemic. Following a cross-sectional observational design, an online questionnaire was distributed among 35 national nurses' associations across Europe in March 2021. Face validity was achieved through an expert panel. Descriptive statistics were used for data analysis, including counts, percentages, and tabulation. Qualitative data analysis followed thematic synthesis techniques. Three main findings are noted. First, violent incidents against nurses are under-reported due to fear of victimization, employer discouragement, and the perception that reporting will not make any difference. Second, perpetrators of violent acts extend beyond patients and families to include health professionals of different ranks. Third, violent incidences have a significant adverse effect on nurses' health and retention, leading to nurses reducing their working hours or opting for part-time work. Violence against nurses is an expression of a broader problem that is rooted in the failure to recognize and manage violence at the level of the healthcare organization, and the absence of appropriate legislation to maintain minimum standards of safe working environments. This is partly the result of inadequate European Union-wide legislation targeting workplace violence in the health professions. Nurses need more institutional support through dedicated funding aimed at targeted interventions, more legislative commitment to ratify policies against discrimination, and an opportunity to voice the needs to the appropriate policymakers with the ability to bring significant change to existing conditions. Given the severity of the situation, inaction could lead to irreplaceable damage to the nursing workforce, compounding pressures resulting from the COVID-19 pandemic. Ultimately, this situation can further drive existing nurses out of the profession, weakening health systems worldwide.
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Affiliation(s)
- Paul de Raeve
- European Federation of Nurses Associations, Ixelles, Brussels, Belgium
| | - Andreas Xyrichis
- Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Francesco Bolzonella
- School of Business and Economics, Maastricht University, Maastricht, Limburg, The Netherlands
| | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Healthcare & Ethics Research Group, UHasselt – Hasselt University, Hasselt, Limburg, Belgium
| | - Patricia M. Davidson
- University of Wollongong, Dean Emerita Johns Hopkins University (US), Wollongong, New South Wales, Australia
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Aguglia A, Corsini GP, Berardelli I, Berti A, Conio B, Garbarino N, Gnecco GB, Magni C, Venturini E, Costanza A, Amerio A, Amore M, Serafini G. Mechanical Restraint in Inpatient Psychiatric Unit: Prevalence and Associated Clinical Variables. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1847. [PMID: 37893565 PMCID: PMC10607962 DOI: 10.3390/medicina59101847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/09/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: mechanical restraint (MR) is a controversial issue in emergency psychiatry and should be better studied to implement other alternative therapeutic interventions. The aim of this study was to estimate the prevalence of MR in an Italian psychiatric unit and identify the sociodemographic and clinical characteristics as well as the pharmacological pattern associated with MR. Materials and Methods: all subjects (N = 799) consecutively admitted to an Italian psychiatric inpatient unit were recruited. Several sociodemographic and clinical characteristics were recorded. Results: The prevalence of MR was 14.1%. Males, a younger age, and a single and migrant status were associated with the MR phenomenon. MR was more prevalent in patients affected by other diagnoses and comorbid illicit substance use, in patients with aggressive behaviors, and those that were involuntary admitted, leading significantly to hospitalization over 21 days. Furthermore, the patients that underwent MR were taking a lower number of psychiatric medications. Conclusions: Unfortunately, MR is still used in emergency psychiatry. Future research should focus on the dynamics of MR development in psychiatry, specifically considering ward- and staff-related factors that could help identify a more precise prevention and alternative intervention strategies.
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Affiliation(s)
- Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Giovanni Pietro Corsini
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Suicide Prevention Centre, Sant’Andrea Hospital, Sapienza University of Rome, 00189 Rome, Italy;
| | - Andrea Berti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Benedetta Conio
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Nicolò Garbarino
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Giovanni Battista Gnecco
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Caterina Magni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Enrico Venturini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Alessandra Costanza
- Department of Psychiatry, Adult Psychiatry Service, University Hospitals of Geneva (HUG), 1207 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI), 6900 Lugano, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1211 Geneva, Switzerland
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, 16132 Genoa, Italy; (A.A.); (A.B.); (N.G.); (G.B.G.); (C.M.); (E.V.); (A.A.); (M.A.); (G.S.)
- Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Ospedale Policlinico San Martino, 16132 Genoa, Italy; (G.P.C.); (B.C.)
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Lequin P, Suter C, Mazallon R, Brodard R, Abrahamyan Empson L, Robalo B, Conus P, Nguyen A, Favrod J. Integration of a peer practitioner in a hospital unit for patients with psychotic disorders: an exploratory qualitative study. Front Psychiatry 2023; 14:1244433. [PMID: 37822792 PMCID: PMC10562537 DOI: 10.3389/fpsyt.2023.1244433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/04/2023] [Indexed: 10/13/2023] Open
Abstract
Introduction Studies on the integration of peer mental health practitioners (PMHP) in hospitals are sparse, despite significant benefits being reported for patients and professionals. The integration of PMHP requires the consideration of several parameters and a change in the culture of care. This study aims to understand the impact of the integration of a PMHP in a hospital unit caring for patients with psychiatric disorders. Methods A qualitative content analysis of three focus groups with the interdisciplinarity team were conducted. A consulting PMHP was integrated into the entire research process. Results Data analysis revealed five main themes: the importance of integration, benefits for patients linked to the identification process, benefits for the team and institution, potentials risks, and perspectives. Discussion The study was conducted in a hospital setting with patients suffering from severe psychiatric disorders associated with behavioral disturbances. The benefits reported in the results outline the feasibility of PMHP integration in an acute psychiatric care setting. Nevertheless, further formalization of the PMHP role is required to minimize possible areas of tension between respective fields of activity of each professional.
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Affiliation(s)
- Pierre Lequin
- School of Nursing La Source, University of Applied Sciences and Arts of Western Switzerland (HES-SO), Delémont, Switzerland
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Caroline Suter
- School of Nursing La Source, University of Applied Sciences and Arts of Western Switzerland (HES-SO), Delémont, Switzerland
| | - Roxane Mazallon
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Rachèle Brodard
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Lilith Abrahamyan Empson
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Bruno Robalo
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Philippe Conus
- Department of Psychiatry, Service of General Psychiatry, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Alexandra Nguyen
- School of Nursing La Source, University of Applied Sciences and Arts of Western Switzerland (HES-SO), Delémont, Switzerland
| | - Jérôme Favrod
- School of Nursing La Source, University of Applied Sciences and Arts of Western Switzerland (HES-SO), Delémont, Switzerland
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Barlati S, Nibbio G, Stanga V, Giovannoli G, Calzavara-Pinton I, Necchini N, Lisoni J, Deste G, Vita A. Cognitive and clinical characteristics of offenders and non-offenders diagnosed with schizophrenia spectrum disorders: results of the Recoviwel observational study. Eur Arch Psychiatry Clin Neurosci 2023; 273:1307-1316. [PMID: 36309882 DOI: 10.1007/s00406-022-01510-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 10/19/2022] [Indexed: 11/26/2022]
Abstract
The association between schizophrenia spectrum disorders (SSD) and violent behavior is complex and requires further research. The cognitive correlates of violent behavior, in particular, remain to be further investigated. Aims of the present study were to comprehensively assess the cognitive and clinical profile of SSD violent offenders and evaluate individual predictors of violent behavior. Fifty inmates convicted for violent crimes in a forensic psychiatry setting and diagnosed with SSD were compared to fifty non-offender patients matched for age, gender, education, and diagnosis. Offender and non-offender participants were compared based on socio-demographic, clinical, and cognitive variables using non-parametric testing to select potential predictors of violent behavior. Multivariate logistic regressions were then performed to identify individual predictors of violent behavior. Offender participants showed more school failures, higher prevalence of substance use, higher Clinical Global Impression Severity Scale (CGI-S) and Positive and Negative Syndrome Scale Excited Component (PANSS-EC) scores, worse working memory and better attention performance, higher Historical Clinical and Risk Management scale 20 (HCR-20) and Hare Psychopathy Checklist (PCL-R) scores in all subdomains and factors. School failures, higher PANSS-EC scores, worse working memory and processing speed, better attention performance, higher scores in HCR-20 Management subscale and the PCL-R "Callous" factor emerged as predictors of violent behavior. Better attentional performance was correlated with higher PCL-R "Callous" factor scores, worse cognitive performance in several domains with higher PCL-R "Unstable" factor scores. In conclusion, the present study highlights the importance of carefully assessing SSD patients with violent behavior in all clinical, cognitive, and behavioral aspects.
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Affiliation(s)
- Stefano Barlati
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy.
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
| | - Valentina Stanga
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giulia Giovannoli
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
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Parakkal Kurian L, Rentala S, Belsiyal CX, Srinivasan P, Govindar Thimmajja S. Aggressive behavior and its associated factors among persons with mental illness: An observational study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:249. [PMID: 37727413 PMCID: PMC10506767 DOI: 10.4103/jehp.jehp_195_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 03/17/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND Aggressive behavior of psychiatric inpatients causes severe complications during treatment; nursing staff needs to understand the factors associated with aggression in inpatient units to prevent aggression. AIM This study aimed to examine the level of aggression and its associated factors. MATERIALS AND METHODS A descriptive observational design was conducted among aggressive patients. An aggressive behavior event was observed during the aggression episode. Data were collected from 55 patients with aggressive behavior using the Staff Observation Aggression Scale-Revised (SOAS-R) and Brief Psychiatric Rating Scale (BPRS). Patient-, staff-, and ward-related factors were assessed using a structured questionnaire. RESULTS About 69% of patients had a severe level of aggressive behavior. There was a significant association between gender, the severity of symptoms, staff-to-patient ratio, ward milieu, and the number of caregivers with levels of aggression. CONCLUSION The majority of the persons with mental illness exhibited severe aggression in a psychiatric setting. Being male, the presence of psychotic symptoms, ward milieu, staff-to-patient ratio, and availability of caregivers were significantly associated with aggression. This study adds to the existing literature by focusing on managing ward-related factors (avoiding noise and overcrowding) to prevent aggressive behavior among mentally ill patients.
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Affiliation(s)
| | - Sreevani Rentala
- Department of Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
| | - C Xavier Belsiyal
- Department of Psychiatric Nursing, College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - P Srinivasan
- Department of Psychiatric Nursing, College of Nursing, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
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Wong TY, Fang Z, Cheung C, Wong CSM, Suen YN, Hui CLM, Lee EHM, Lui SSY, Chan SKW, Chang WC, Sham PC, Chen EYH. Unveiling common psychological characteristics of proneness to aggression and general psychopathology in a large community youth cohort. Transl Psychiatry 2023; 13:255. [PMID: 37438366 DOI: 10.1038/s41398-023-02538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
Elevated aggression in individuals with psychiatric disorders is frequently reported yet aggressive acts among people with mental illness are often intertwined with proneness to aggression and other risk factors. Evidence has suggested that both general psychopathology and proneness to aggression may share common psychological characteristics. This study aims to investigate the complex relationship between general psychopathology, proneness to aggression, and their contributing factors in community youth. Here, we first examined the association between proneness to aggression and the level of general psychopathology in 2184 community youths (male: 41.2%). To identify common characteristics, we trained machine learning models using LASSO based on 230 features covering sociodemographic, cognitive functions, lifestyle, well-being, and psychological characteristics to predict levels of general psychopathology and proneness to aggression. A subsequent Gaussian Graph Model (GGM) was fitted to understand the relationships between the general psychopathology, proneness to aggression, and selected features. We showed that proneness to aggression was associated with a higher level of general psychopathology (discovery: r = 0.56, 95% CI: [0.52-0.59]; holdout: r = 0.60, 95% CI: [0.54-0.65]). The LASSO model trained on the discovery dataset for general psychopathology was able to predict proneness to aggression in the holdout dataset with a moderate correlation coefficient of 0.606. Similarly, the model trained on the proneness to aggression in the discovery dataset was able to predict general psychopathology in the holdout dataset with a correlation coefficient of 0.717. These results suggest that there is substantial shared information between the two outcomes. The GGM model revealed that isolation and impulsivity factors were directly associated with both general psychopathology and proneness to aggression. These results revealed shared psychological characteristics of general psychopathology and proneness to aggression in a community sample of youths.
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Affiliation(s)
- Ting Yat Wong
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA.
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.
- Department of Psychology, Education University of Hong Kong, Hong Kong SAR, China.
| | - Zhiqian Fang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Charlton Cheung
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Corine S M Wong
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Yi Nam Suen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.
| | - Christy L M Hui
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Edwin H M Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Simon S Y Lui
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
| | - Sherry K W Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Pak Chung Sham
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
| | - Eric Y H Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong SAR, China.
- State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China.
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10
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Hobyane AV, Ntshingila N, Poggenpoel M. Experiences of psychiatric nurses caring for mental healthcare users with a comorbid disorder. Curationis 2022; 45:e1-e11. [PMID: 36546508 PMCID: PMC9772734 DOI: 10.4102/curationis.v45i1.2354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/18/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Caring for mental healthcare users (MHCUs) with a comorbid disorder of human immunodeficiency virus (HIV) and schizophrenia has always been challenging and requires expertise, skill, intuition and empathy. OBJECTIVES The objective of this study was to explore and describe the experiences of psychiatric nurses caring for MHCUs with a comorbid disorder of HIV and schizophrenia. METHOD A qualitative, exploratory, descriptive and contextual research design was used. Eight participants were selected through purposive sampling for individual in-depth interviews to collect data. Thematic analysis was used to analyse data. RESULTS Three themes emerged from this study. The first theme is that the psychiatric nurses experienced deep frustration because they were capable but unable to manage MHCUs with HIV and schizophrenia because of poor infrastructure and other contributing barriers. The second theme identified that the psychiatric nurses experienced discrimination against MHCUs compromising their holistic recovery. Lastly, the psychiatric nurses identified the need for health care workers in general hospitals and communities and families of MHCUs with a comorbid disorder to be educated in mental health issues to ensure continuous medical care. CONCLUSION The results of this study showed that psychiatric nurses became exhausted when trying to cope with difficult nursing situations. The challenges they faced had negative consequences for the mental health of the psychiatric nurses and compromised patient care.Contribution: This study adds knowledge to nursing practice, nursing education and nursing research by implementing recommendations to mitigate the challenges of psychiatric nurses caring for MHCUs with HIV and schizophrenia.
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Affiliation(s)
- Annikie V. Hobyane
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa
| | - Nompumelelo Ntshingila
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa
| | - Marie Poggenpoel
- Department of Nursing, Faculty of Health Sciences, University of Johannesburg, Doornfontein, South Africa
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11
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Li L, Zhang Q, Yang H, Undergraduate SL. Incidence and related influencing factors of workplace violence among psychiatric nurses in China: A systematic review and Meta-analysis. Arch Psychiatr Nurs 2022; 40:68-76. [PMID: 36064248 DOI: 10.1016/j.apnu.2022.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/10/2022] [Accepted: 04/17/2022] [Indexed: 11/02/2022]
Abstract
AIM To analyze and integrate the incidence and its influencing factors on workplace violence among psychiatric nurses in China. BACKGROUND Despite the fact that an increasing number of studies in China and elsewhere have focused on workplace violence among psychiatric nurses, there is presently no research to thoroughly explain the determining variables of violence faced by psychiatric nurses. DESIGN A systematic review and meta-analysis was conducted. METHOD PubMed, Embase, Cohrane Library, CNKI database, Wanfang database, and VIP database were used to search for English-language literature. The search deadline is June 15, 2021. The quality of the included literature was assessed, data was retrieved, and the meta-analysis was performed using Stata 16.0 software. RESULTS A total of 19 works of literature, including 5926 patients, were included. Meta-analysis results showed that the incidence of workplace violence was about 78%[ES = 0.78, 95%CI(0.65,0.88)]. The possible factors for Chinese psychiatric nurses suffering from violence include gender, education, working years, whether they are an only child, age, height, working hours, and the form of employment. CONCLUSIONS The incidence of workplace violence incidence among psychiatric nurses in China is high, and managers should employ individualized intervention methods based on the variables that influence it. IMPLICATIONS FOR NURSING MANAGEMENT Managers should attach great importance to the occurrence of workplace violence. In training to prevent workplace violence, we should pay attention to the disparities in age and working abilities of nurses. Nurses should be trained in recognizing violent conduct, early warning indications, communication skills, and emergency response tactics. Managers should be able to schedule shifts in a flexible manner. Various techniques to enhance the nurse's working environment.
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Affiliation(s)
- Linbo Li
- Shanxi Medical University, Department of Psychiatric, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
| | - Qian Zhang
- Shanxi Medical University; Vascular Surgery, Shanxi Bethune Hospital, Taiyuan, 030001, Shanxi, China
| | - Hui Yang
- College of Nursing, Shanxi Medical University, Taiyuan 030001, Shanxi, China.
| | - Suping Li Undergraduate
- Shanxi Medical University, Department of Psychiatric, The First Hospital of Shanxi Medical University, Taiyuan 030001, Shanxi, China
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12
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Manning T, Bell SB, Dawson D, Kezbers K, Crockett M, Gleason O. The Utilization of a Rapid Agitation Scale and Treatment Protocol for Patient and Staff Safety in an Inpatient Psychiatric Setting. Psychiatr Q 2022; 93:915-933. [PMID: 36006571 PMCID: PMC9402403 DOI: 10.1007/s11126-022-10001-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 10/27/2022]
Abstract
Agitation is a common and potentially dangerous condition requiring rapid recognition and treatment in acute psychiatric units. Prompt intervention can prevent a patient with agitation from harming themselves, harming others, or needing restraints or seclusion. After the review of numerous guidelines, the Modified Agitation Severity Scale (MASS) agitation treatment protocol was developed to identify and manage agitation in an inpatient adult psychiatric setting. This protocol involved modifying an existing agitation scale and pairing scores with a treatment algorithm to indicate which behavioral and medication interventions would be most appropriate. All scoring and interventions were recorded in the electronic medical record (EMR). Three months of data were collected before and after the protocol was implemented. The new, modified scale had high reliability and correlated well with another validated agitation scale. Perceived patient safety was high during both study phases. Nurses' perceptions of safety trended upward after the protocol was implemented, though these differences were not significant, likely due to insufficient power. Although there was no decrease in seclusion events after implementation of the treatment protocol, there was a 44% decrease in restraint events and average restraint minutes per incident. Despite a potential increase in workload for nursing staff, implementation of the protocol did not increase burnout scores. Physicians continued to order the protocol for 55% of patients after the study period ended. These findings suggest that including a rapid agitation assessment and protocol within the EMR potentially improves nurses' perceptions of unit safety, helps assess treatment response, reduces time patients spend restrained, and supports decision making for nurses.
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Affiliation(s)
- Tessa Manning
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA.
| | - Sarah Beth Bell
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Drew Dawson
- Oklahoma City Indian Clinic, 5208 W Reno Ave, Oklahoma City, OK, USA
| | - Krista Kezbers
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA.,Health Promotion Research Center, The University of Oklahoma Health Sciences Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Micheal Crockett
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
| | - Ondria Gleason
- School of Community Medicine, The University of Oklahoma, Tulsa, OK, USA
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13
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Couzner L, Spence N, Fausto K, Huo Y, Vale L, Elkins S, Saltis J, Cations M. Delivering Trauma-Informed Care in a Hospital Ward for Older Adults With Dementia: An Illustrative Case Series. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:934099. [PMID: 36188945 PMCID: PMC9397751 DOI: 10.3389/fresc.2022.934099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
IntroductionUp to 70% of older adults have experienced a psychologically traumatic event in their life. Traumatic events can have lifelong effects on functioning and emotion regulation and can affect behavior and experiences in care settings. Common healthcare practices and environments can be re-traumatizing for trauma survivors. These features may trigger behavior change (e.g., aggression and agitation) particularly after the onset of dementia. However, very little research exists to understand how the effects of traumatic events manifest in aged care settings. Trauma-informed care is a framework in which the potential impact of trauma is acknowledged, and practices and procedures are adapted to maximize feelings of control and safety for the patient. Trauma-informed care is an innovative approach with little published evidence in acute geriatric settings.MethodsWe present a series of cases to demonstrate how psychological trauma can affect the experience of inpatient care for older people. The cases detail the patients' relevant background, triggers and behaviors followed by the steps taken by staff to support the patient and respond to their trauma-related needs. These cases describe how the principles of trauma-informed care can be applied to recognize when past psychologically traumatic events are impacting the older adult in hospital. The outcomes of these interventions are reported on in terms of their impact on challenging behavior, patient experiences and satisfaction with care, and/or staff confidence and skill.FindingsA range of past events negatively impacted the patients during their time in hospital, including childhood abuse, military service, and domestic violence. Staff implemented strategies to accommodate trauma-related needs while providing care that improved safety and reduced patient distress. Principles of trauma-informed care were applied where able, including providing choices and enabling autonomy. However, organizational and environmental features of inpatient wards continued to pose risks for re-traumatisation.ConclusionsTrauma-informed care is an under-utilized yet potentially beneficial approach to care for older adults in the hospital setting. The cases detailed here demonstrated that the impact of psychological trauma requires an individualized response from staff which when effectively implemented can promote staff and patient safety, reduce the risk of re-traumatisation, and minimize adverse events.
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Affiliation(s)
- Leah Couzner
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
| | - Natalie Spence
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Karina Fausto
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Yan Huo
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Lynn Vale
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Samantha Elkins
- Southern Adelaide Local Health Network, Adelaide, SA, Australia
| | - Johanna Saltis
- Central Adelaide Local Health Network, Adelaide, SA, Australia
| | - Monica Cations
- College of Education, Psychology and Social Work, Flinders University, Adelaide, SA, Australia
- *Correspondence: Monica Cations
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14
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Effects of Integrated Workplace Violence Management Intervention on Occupational Coping Self-Efficacy, Goal Commitment, Attitudes, and Confidence in Emergency Department Nurses: A Cluster-Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052835. [PMID: 35270527 PMCID: PMC8910583 DOI: 10.3390/ijerph19052835] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 02/20/2022] [Accepted: 02/25/2022] [Indexed: 11/30/2022]
Abstract
Patient and visitor violence (PVV), the most prevalent source of workplace violence, is largely ignored, underreported, and a persistent problem in emergency departments. It is associated with physical injuries, psychological distress, and occupational stress in nurses. A randomized controlled trial was conducted in Taiwan from January to December 2020. This study aimed to test the efficacy of an integrated Workplace Violence Prevention and Management Training Program on PVV in 75 emergency department (ED) nurses from a hospital. Cluster sampling was used because the policy of subdivision strategy was enforced during the COVID-19 pandemic. ED nurses received either the intervention or 1-hour in-service class. Data were collected from questionnaires. Data were analyzed mainly by the repeated measure analysis of variance and generalized estimating equations. The intervention had positive effects on developing stronger goal commitment, improving occupational coping self-efficacy, increasing confidence in ability to deal with violent situations, and modifying attitudes toward the causes and management of PVV in ED nurses (p < 0.05). The marginal R2 of the generalized estimating equation model for goal commitment, occupational coping self-efficacy, confidence, attitudes toward aggression in ED and aggressive behavior variables was high as 0.54 (p < 0.001), 0.45 (p < 0.001), 0.58 (p < 0.001), 0.29 (p < 0.05), and 0.72 (p < 0.001), respectively. These study models could effectively predict changes in the mean values. The benefit was driven by the effect of the intervention in ED nurses. Thus, the intervention, when applied in conjunction with routine in-service class, could exert synergistic improvements on outcomes measured in nurses.
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15
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Hsu MC, Chou MH, Ouyang WC. Dilemmas and Repercussions of Workplace Violence against Emergency Nurses: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052661. [PMID: 35270354 PMCID: PMC8909790 DOI: 10.3390/ijerph19052661] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/20/2022] [Accepted: 02/22/2022] [Indexed: 02/06/2023]
Abstract
Nurses received the highest rate of workplace violence due to their close interaction with clients and the nature of their work. There have been relatively few qualitative studies focus on nurses' perceptions of and experiences with the antecedents, dilemma and repercussions of the patient and visitor violence (PVV), leaving a considerable evidence gap. The aim of this study was to explore nurses' experience of PVV in emergency department, the impact of PVV on quality of care, and supports needed after exposure to such incidents. We conducted semi-structured interviews with a purposive and snowball sample of nurses, and analyzed the content of the interview transcripts. A total of 10 nurses were approached and agreed to participate. Those participants ranged in age from 24 to 41 years old, eight female and two male nurses, and the majority of them (80%) held a university Bachelor degree in nursing. The average time in nursing practice was 7.2 years. We conceptualized five analytical themes, which comprised: (1) multifaceted triggers and causes of PVV; (2) experiences following PVV; (3) tangled up in thoughts and struggle with the professional role; (4) self-reflexivity and adjustment; and, (5) needs of organizational efforts and support following PVV. This paper provides compelling reasons to look beyond solely evaluating the existence of workplace, and considering the perceived professional inefficacy, impacts of being threatened or assaulted in nurses. There are also urgent needs in provision of prevention and management of workplace training programs to ensure the high-quality nursing care.
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Affiliation(s)
- Mei-Chi Hsu
- Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan; (M.-C.H.); (M.-H.C.)
| | - Mei-Hsien Chou
- Department of Nursing, I-Shou University, Kaohsiung City 82445, Taiwan; (M.-C.H.); (M.-H.C.)
| | - Wen-Chen Ouyang
- Department of Geriatric Psychiatry, Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan City 71742, Taiwan
- Department of Nursing, Shu-Zen Junior College of Medicine and Management, Kaohsiung City 82144, Taiwan
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung City 80708, Taiwan
- Correspondence: ; Tel.: +886-6-2795019
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16
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Caruso R, Toffanin T, Folesani F, Biancosino B, Romagnolo F, Riba MB, McFarland D, Palagini L, Belvederi Murri M, Zerbinati L, Grassi L. Violence Against Physicians in the Workplace: Trends, Causes, Consequences, and Strategies for Intervention. Curr Psychiatry Rep 2022; 24:911-924. [PMID: 36445636 PMCID: PMC9707179 DOI: 10.1007/s11920-022-01398-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Violence against healthcare professionals has become an emergency in many countries. Literature in this area has mainly focused on nurses while there are less studies on physicians, whose alterations in mental health and burnout have been linked to higher rates of medical errors and poorer quality of care. We summarized peer-reviewed literature and examined the epidemiology, main causes, consequences, and areas of intervention associated with workplace violence perpetrated against physicians. RECENT FINDINGS We performed a review utilizing several databases, by including the most relevant studies in full journal articles investigating the problem. Workplace violence against doctors is a widespread phenomenon, present all over the world and related to a number of variables, including individual, socio-cultural, and contextual variables. During the COVID-19 pandemic, incidence of violence has increased. Data also show the possible consequences in physicians' deterioration of quality of life, burnout, and traumatic stress which are linked to physical and mental health problems, which, in a domino effect, fall on patients' quality of care. Violence against doctors is an urgent global problem with consequences on an individual and societal level. This review highlights the need to undertake initiatives aimed at enhancing understanding, prevention, and management of workplace violence in healthcare settings.
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Affiliation(s)
- Rosangela Caruso
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Tommaso Toffanin
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Federica Folesani
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121, Ferrara, Italy.
| | - Bruno Biancosino
- Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Francesca Romagnolo
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy
| | - Michelle B. Riba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA
| | - Daniel McFarland
- Department of Medicine, Northwell Health Cancer Institute, Lenox Hill Hospital, New York, NY USA
| | - Laura Palagini
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Zerbinati
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
| | - Luigi Grassi
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy ,Integrated Department of Mental Health and Pathological Addictions, S. Anna University Hospital and Local Health Trust, Ferrara, Italy
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17
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Luo J, Liu H, Liu Y, Jiang F, Tang YL. The Association Between Medical Liability Insurance Coverage and Medical Disturbances in Tertiary Psychiatric Hospitals in China: A National Survey. Risk Manag Healthc Policy 2021; 14:3767-3774. [PMID: 34548825 PMCID: PMC8447944 DOI: 10.2147/rmhp.s328046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 08/30/2021] [Indexed: 11/23/2022] Open
Abstract
Background Medical disturbances (MD), a severe type of medical disputes, are common in Chinese hospitals. Medical liability insurances were introduced to establish a new system of conflict resolution and risk management. However, data are scarce on the effects of medical liability insurance coverage and MD in psychiatric hospitals. This study was set to address it based on a nationwide survey. Methods A national cross-sectional survey was conducted in March 2019. Physicians in 41 tertiary psychiatric hospitals participated in a smartphone based anonymous questionnaire. Experience of MD, sociodemographic and occupational characteristics, and job satisfaction information were reported by physicians. The hospital medical liability insurance status was reported by participating hospitals. Multi-level logistic regression analysis was used to examine the association between medical liability insurance coverage and MD. Results In total, 4511 physicians completed the survey, 3760/4511 (83.35%) physicians in 32 hospitals had medical liability insurance coverage, and 1401/4511 (31.06%) physicians had encountered medical disturbances in the previous year. After adjusting for confounding factors, medical liability insurance coverage was not significantly associated with MD (OR=1.28, 95% CI: 0.93-1.76). Female gender, working in West China, and higher job satisfaction were protective factors for MD. Higher outpatient volume/week (>50 patients/week) and longer working hours/week were risk factors for MD. Conclusion Nearly one-third of physicians in Chinese top-tier psychiatric hospitals reported experience of MD. There was no significant association between medical liability insurance coverage and MD experienced among physicians in Chinese psychiatric hospitals. Policymakers and hospital administrators need to tailor the scope of medical liability insurance and to focus on other factors to reduce MD, including reducing workload and improving the doctor-patient relationship.
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Affiliation(s)
- Jin Luo
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, People's Republic of China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, People's Republic of China
| | - Feng Jiang
- Institute of Healthy Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, People's Republic of China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.,Atlanta VA Medical Center, Atlanta, Ga, USA
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18
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Effects of Integrated Violence Intervention on Alexithymia, Cognitive, and Neurocognitive Features of Violence in Schizophrenia: A Randomized Controlled Trial. Brain Sci 2021; 11:brainsci11070837. [PMID: 34202608 PMCID: PMC8301770 DOI: 10.3390/brainsci11070837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 01/17/2023] Open
Abstract
Patients with schizophrenia and repetitive violence express core impairments that encompass multiple domains. To date, there have been few interventions integrating neurocognition, social cognition, alexithymia, and emotion regulation together as an approach to manage repetitive violence. The aim of this open-label randomized controlled trial was to examine more comprehensively the effectiveness of a novel Integrated Cognitive Based Violence Intervention Program on management of repetitive violence in patients with schizophrenia (vSZ). Sixty recruited patients were aged ≥20 years, diagnosed with schizophrenia for >2 years, had repetitive violent behavior within one year, and were psychiatrically hospitalized. The vSZ patients were randomly allocated to two groups and received either the intervention or treatment as usual. The intervention module, consisting of all defined 11 cognitive and social cognitive domains as well as emotion regulation, which were grouped into four modules. The intervention placed emphasis on the patients’ behavioral problems or intrinsic conflicts in relation to repetitive violence. The results indicate a statistically significant trend toward reducing impulsivity, anger with resentment, physical aggression, suspicion, and hostility (p < 0.05). The intervention significantly alleviated the intensity of cognitive failure, improved the management of alexithymic features and attribution styles and errors, and fostered adequate decision-making styles and emotion regulation capacity (p < 0.05). The intervention, when applied in conjunction with psychiatric standard care, could exert synergistic effects on alexithymia and cognitive, clinical, and neurocognitive features of repetitive violence in schizophrenia. This intervention provided patients a more active role to manage their violent behavior with the involvement of alexithymia.
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