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Lenk-Adusoo M, Kangro R, Haring L. The risk assessment of imminent inpatient aggression: A cross-cultural validation study of the dynamic appraisal of situational aggression in Estonia. J Psychiatr Ment Health Nurs 2024; 31:560-571. [PMID: 38095026 DOI: 10.1111/jpm.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 10/17/2023] [Accepted: 11/23/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION The reason for this study was void of a data-driven imminent risk assessment instrument for aggression in psychiatry clinics in Estonia. The predictive accuracy of the observer-rated Dynamic Assessment of Situational Aggression (DASA) has been repeatedly demonstrated. However, the research gap remains regarding a deeper conceptual understanding of the underlying latent structure of the DASA. AIM Comprehensively evaluate the psychometric properties of the Estonian DASA version for cross-cultural clinical use. METHOD We used a prospective repeated measure design and collected 6097 risk evaluations from 381 adult inpatients, 151 of whom committed 1013 aggressive incidents during the study. RESULTS The Estonian DASA version has acceptable inter-rater reliability (Kendall's τ = 0.74) and is a useful instrument with excellent predictive validity (AUC = 0.86) for identifying potentially aggressive inpatients. In our sample, the DASA has a bi-factorial structure which explains 83% of the total variance. DISCUSSION The adapted DASA has acceptable validity and reliability indices for measuring imminent aggression risk in adult inpatient units. IMPLICATIONS FOR PRACTICE Evidence-based risk assessment of aggression in psychiatric clinics enhances recognition of the signs of potentially aggressive behaviour in order to apply preventive actions and reduce aggression, thereby improving the quality of the care provided.
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Affiliation(s)
- Margit Lenk-Adusoo
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
- Department of Nursing and Midwifery, Tartu Health Care College, Tartu, Estonia
| | - Raul Kangro
- Institute of Mathematics and Statistics, University of Tartu, Tartu, Estonia
| | - Liina Haring
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia
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2
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Conlon Bn Bcl Hons Llm Grad Cert University Teaching Grad Dip Legal Practice PhD Candidate U Syd D, Raeburn Np Rn Ma PhD Facmhn T, Wand Np Rn Mn Hons PhD T. Mental Health Risk Assessments of Patients, by Nurses Working in Mental Health Settings: A Qualitative Study Using Cognitive Continuum Theory. Issues Ment Health Nurs 2024; 45:488-497. [PMID: 38502217 DOI: 10.1080/01612840.2024.2320731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Mental health risk-assessments are an important part of nursing in mental health settings, to protect patients or others from harm. Even so, nurses often have difficulty identifying patients posing a credible risk (either to self or others), so guidance is recommended. However, despite an extensive and growing body of risk-oriented literature, comparatively little expands upon contemporary knowledge of nurses and patient risk assessment. Therefore, it remains unclear how nurses understand risk and undertake their risk assessments. To address this knowledge gap in nurses' decision-making processes, this study used the established Cognitive Continuum Theory as a novel means to explore the risk-assessment of patients by nurses working in mental health settings.
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Conlon D, Raeburn T, Wand T. Risk-Actuated Public Interest Disclosure Practices of Nurses Working in Mental Health, Pertaining to Confidential Information of Patients. Issues Ment Health Nurs 2023:1-8. [PMID: 37279391 DOI: 10.1080/01612840.2023.2214225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
For nurses working in mental health, the inappropriate handling of confidential information may cause issues for stakeholders. However, there is a paucity of research literature to guide nurses. Therefore, this study aimed to add to the extant literature on risk-actuated public-interest disclosure practices of nurses. The study found participants understood exceptions to confidentiality, but not the concept of public interest. Furthermore, disclosure for risk management in perceived risk laden scenarios, was described by participants as a collaborative endeavour, albeit one where peer advice was not necessarily followed. Finally, participants' risk-actuated disclosure-related decision-making focussed on protecting a patient or others from harm.
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Affiliation(s)
- Darren Conlon
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
- School of Nursing and Midwifery, University of Notre Dame, Sydney, NSW, Australia
| | - Toby Raeburn
- School of Nursing and Midwifery, University of Notre Dame, Sydney, NSW, Australia
| | - Timothy Wand
- Sydney Nursing School, The University of Sydney, Sydney, NSW, Australia
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Hamrick B, Van Hassel T, Snyder D, Stephens C. Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence. J Emerg Nurs 2023; 49:403-414. [PMID: 36272824 DOI: 10.1016/j.jen.2022.09.010] [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: 02/25/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings. METHODS This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation. RESULTS Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation. DISCUSSION Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.
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Sammut D, Hallett N, Lees-Deutsch L, Dickens GL. A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings. J Emerg Nurs 2022; 49:371-386.e5. [PMID: 36585335 DOI: 10.1016/j.jen.2022.11.006] [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: 07/26/2022] [Revised: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. METHODS CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. RESULTS Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. DISCUSSION There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.
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Conlon D, Raeburn T, Wand T. Cognitive Continuum Theory: Can it contribute to the examination of confidentiality and risk-actuated disclosure decisions of nurses practising in mental health? Nurs Inq 2022; 30:e12520. [PMID: 36065121 DOI: 10.1111/nin.12520] [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: 02/26/2022] [Revised: 07/19/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Abstract
Nurses practising in mental health are faced with challenging decisions concerning confidentiality if a patient is deemed a potential risk to self or others, because releasing pertinent information pertaining to the patient may be necessary to circumvent harm. However, decisions to withhold or disclose confidential information that are inappropriately made may lead to adverse outcomes for stakeholders, including nurses and their patients. Nonetheless, there is a dearth of contemporary research literature to advise nurses in these circumstances. Cognitive Continuum Theory presents a single-system intuitive-analytical approach to examining and understanding nurse cognition, analogous to the recommended single-system approach to decision-making in mental health known as structured clinical judgement. Both approaches incorporate cognitive poles of wholly intuition and analysis and a dynamic continuum characterised by a 'common sense' blending of intuitive and analytical cognition, whereby cues presented to a decision-maker for judgement tasks are weighed and assessed for relevance. Furthermore, Cognitive Continuum Theory promotes the importance of determining pattern recognition and functional relations strategies, which can be used to understand the operationalisation of nurse cognition.
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Affiliation(s)
- Darren Conlon
- Sydney Nursing School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,School of Nursing & Midwifery (Sydney), Faculty of Medicine, Nursing & Midwifery, and Health Sciences, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Toby Raeburn
- School of Nursing & Midwifery (Sydney), Faculty of Medicine, Nursing & Midwifery, and Health Sciences, The University of Notre Dame Australia, Darlinghurst, NSW, Australia
| | - Timothy Wand
- Sydney Nursing School Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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Amunrud A, Bjorklund P. Implementation of the dynamic appraisal of situational aggression in inpatient mental health. Perspect Psychiatr Care 2022; 58:1153-1159. [PMID: 34263454 DOI: 10.1111/ppc.12915] [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: 01/02/2021] [Revised: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To implement structured violence risk assessment (VRA) using the Dynamic Appraisal of Situational Aggression (DASA) on a 25-bed, adult, inpatient psychiatric unit. DESIGN AND METHODS Inpatient DASA screening for 13 weeks with nursing communication orders (NCOs) to highlight patients at high risk for violence. Pre/posttests measured registered nurse (RN) knowledge and perceptions of the DASA. FINDINGS DASA completion rate equaled 81.8% with an NCO issue rate of only 32.8%. RN perceptions of the DASA were positive, and knowledge of structured violence risk assessment increased. PRACTICE IMPLICATIONS Structured violence risk assessment with the DASA is feasible and well-accepted on psychiatric units.
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Affiliation(s)
- Alina Amunrud
- Department of Graduate Nursing, The College of St. Scholastica, Duluth, Minnesota, USA
| | - Pamela Bjorklund
- Department of Graduate Nursing, The College of St. Scholastica, Duluth, Minnesota, USA
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An observational study of a cross platform risk assessment mobile application in a forensic inpatient setting. J Psychiatr Res 2021; 138:388-392. [PMID: 33957301 DOI: 10.1016/j.jpsychires.2021.04.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 03/28/2021] [Accepted: 04/25/2021] [Indexed: 02/08/2023]
Abstract
Consumer-focused healthcare mobile applications have seen widespread adoption in recent years. Enterprise mobile applications in hospital settings have been slower to gain traction. In this study we examine the Dynamic Appraisal of Situational Aggression: Inpatient version (DASA), a short-term risk assessment tool which is well validated and widely used in the prediction of violent incidents, within an inpatient forensic setting. The application was piloted over a period of three months, collecting 847 total DASA scores on 21 different patients. Time stamping allowed for accurate correlation between risk assessment scoring and the violent risk incidents. The internal validity of the app was measured using Cronbach's alpha and was calculated at 0.798 indicating good internal validity. Using violent incidents as the dependent factor and the total DASA score as the independent factor, predictive validity of the app was calculated at 0.85, p = 0.007. The use of this application in a forensic setting was successful with good internal and predictive validity. A major benefit of this form of data collection was the electronic time stamping so that the correlation between risk estimation and events could be more closely correlated. Deployment of such an application in a general hospital setting would bring its own challenges but would be useful in other types of risk assessment and screening tools.
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9
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Rentrop M, Sassenberg S, Massold L, Hofmann J, Wolf E, Seidl O, Huhn M, Schwerthöffer D. [Delusional Misidentification Syndrom and Violent Behavior - Risk Assessment and Management]. PSYCHIATRISCHE PRAXIS 2020; 48:99-105. [PMID: 32871598 DOI: 10.1055/a-1219-2111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE AND METHOD A case series of three patients with Delusional Misidentification Syndroms (DMS) and violent behavior is presented with respect to the correlation between DMS and violence as well as to the management of such occurrences. RESULTS AND CONCLUSION DMS could be one of the reasons for violent behavior of patients with psychiatric disorders. In such case violent behavior is not just restricted to intimates and relatives but also turns on non-familiar caregivers. DMS could be a risk factor for violent behavior and should therefore be registered with help of a nuanced psychopathological exploration at the time of clinical admission and in course of treatment. Moreover risk assessment tools and safety measures (e. g. medication, monitoring) could be considered for patients with DMS.
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Affiliation(s)
| | | | | | | | | | - Otmar Seidl
- Klinik für Psychiatrie und Psychotherapie der LMU München
| | - Maximilian Huhn
- Klinik für Psychiatrie, Psychosomatische Medizin und Psychotherapie der Sozialstiftung Bamberg, Lehrkrankenhaus der Universität Erlangen.,Klinik für Psychiatrie und Psychotherapie der TU-München
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10
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Connor M, Armbruster M, Hurley K, Lee E, Chen B, Doering L. Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to Predict Violence and Aggression by Behavioral Health Patients in the Emergency Department. J Emerg Nurs 2020; 46:302-309. [DOI: 10.1016/j.jen.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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11
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Dickens GL, O'Shea LE, Christensen M. Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis. Int J Nurs Stud 2020; 104:103526. [DOI: 10.1016/j.ijnurstu.2020.103526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
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12
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Conlon D, Raeburn T, Wand T. Disclosure of confidential information by mental health nurses, of patients they assess to be a risk of harm to self or others: An integrative review. Int J Ment Health Nurs 2019; 28:1235-1247. [PMID: 31402539 DOI: 10.1111/inm.12642] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/16/2019] [Indexed: 01/03/2023]
Abstract
There is a duty of confidentiality on the part of mental health nurses when they handle confidential patient information. Nonetheless, it may be necessary to disclose confidential information of a patient if the patient is assessed as being a risk to self or others, to protect the patient or others from harm. However, disclosing information inappropriately may constitute a breach of confidentiality. There is a paucity of information on how mental health nurses understand the rules of confidentiality when deciding to withhold or disclose confidential information in these circumstances. An integrative review of the literature was undertaken to explore the disclosure of confidential information by mental health nurses when they assess a patient as being a risk of harm. The findings indicate the rules of confidentiality are not well understood, or are not adhered to by mental health nurses. Risk assessments were found to underpin deliberations to withhold or disclose confidential information of a patient, despite risk being difficult to predict with any certainty. For risk assessment, mental health nurses were noted to prefer their unstructured clinical judgement over actuarial methods; and defer to their clinical intuition over scores of a structured risk assessment instrument, when making structured clinical judgement-backed decisions in this area of their practice. Gaps in the literature that may be addressed by future empirical research were revealed during this integrative review.
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Affiliation(s)
- Darren Conlon
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Toby Raeburn
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
| | - Timothy Wand
- Sydney Nursing School, The University of Sydney, Sydney, New South Wales, Australia
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13
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Ghosh M, Twigg D, Kutzer Y, Towell-Barnard A, De Jong G, Dodds M. The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review. Int J Ment Health Nurs 2019; 28:1248-1267. [PMID: 31454144 DOI: 10.1111/inm.12645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/27/2022]
Abstract
To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases - CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty-one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user-friendly, standardized evidence-based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability.
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Affiliation(s)
- Manonita Ghosh
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Di Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Yvonne Kutzer
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gideon De Jong
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mary Dodds
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Anderson KK, Jenson CE. Violence risk-assessment screening tools for acute care mental health settings: Literature review. Arch Psychiatr Nurs 2019; 33:112-119. [PMID: 30663614 DOI: 10.1016/j.apnu.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/06/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Violence is a large concern for mental health professionals: 90% of physicians and nurses working in mental health areas have been subject to violence from patients. Approximately 80% of violent acts from patients are directed toward nurses. OBJECTIVE The purpose of this integrative literature review was to identify violence risk-assessment screening tools that could be used in acute care mental health settings. DESIGN The Stetler model of evidence-based practice guided the literature search, in which 8 violence risk-assessment tools were identified, 4 of which were used for further examination. RESULTS The Brøset Violence Checklist and Violence Risk Screening-10 provided the best assessment for violence in the acute care mental health setting. CONCLUSIONS Using a violence risk assessment screening tool helps identify patients at risk for violence allowing for quick intervention to prevent violent episodes.
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Affiliation(s)
- Kendra K Anderson
- Department of Nursing, Mayo Clinic, Rochester, MN, United States of America.
| | - Carole E Jenson
- Graduate Programs in Nursing, Winona State University-Rochester, Rochester, MN, United States of America
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Dutch SG, Patil N. Validating a Measurement Tool to Predict Aggressive Behavior in Hospitalized Youth. J Am Psychiatr Nurses Assoc 2019; 25:396-404. [PMID: 30569806 DOI: 10.1177/1078390318809411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND: The aggression of hospital patients costs money and affects outcomes. Most methods to assess risk for aggression are developed for adults. This study recommends the use of a predictive tool, the Dynamic Appraisal of Situational Aggression-Youth Version (DASA-YV) to improve accuracy in identifying aggression risk in youth. AIMS: To determine if aggressive behavior of youth is better predicted with DASA-YV versus instinct. We sought to validate the feasibility of DASA-YV and determine its predictive validity for aggressive behavior in a youth-specific psychiatric hospital population, which could lead to prevention of aggression and improve interventions or outcomes. METHOD: After establishing interrater reliability of the DASA-YV, a 6-month pilot study with a prospective validation design compared aggressive behavior outcomes predicted with those that occurred within the next 24 hours. RESULTS: DASA-YV was found to be reliable and valid in predicting aggression in a youth population. CONCLUSIONS: Predicting aggression with the DASA-YV tool demonstrates a useful best practice application for psychiatric nurses that positively affects safety.
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Affiliation(s)
- Stephanie G Dutch
- 1 Stephanie G. Dutch, MSN, APRN, PMHNP-BC, Greenville Health System, Greenville, SC, USA
| | - Nirav Patil
- 2 Nirav Patil, MBBS, MPH, Greenville Health System, Greenville, SC, USA
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Nqwaku M, Draycott S, Aldridge-Waddon L, Bush EL, Tsirimokou A, Jones D, Puzzo I. Predictive power of the DASA-IV: Variations in rating method and timescales. Int J Ment Health Nurs 2018; 27:1661-1672. [PMID: 29749085 DOI: 10.1111/inm.12464] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 11/27/2022]
Abstract
This project evaluated the predictive validity of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA-IV) in a high-secure psychiatric hospital in the UK over 24 hours and over a single nursing shift. DASA-IV scores from three sequential nursing shifts over a 24-hour period were compared with the mean (average of three scores across the 24-hour period) and peak (highest of the three scores across the 24-hour period) scores across these shifts. In addition, scores from a single nursing shift were used to predict aggressive incidents over each of the following three shifts. The DASA-IV was completed by nursing staff during handover meetings, rating 43 male psychiatric inpatients over a period of 6 months. Data were compared to incident reports recorded over the same period. Receiver operating characteristic (ROC) curves and generalized estimating equations assessed the predictive ability of various DASA-IV scores over 24-hour and single-shift timescales. Scores from the DASA-IV based on a single shift had moderate predictive ability for aggressive incidents occurring the next calendar day, whereas scores based on all three shifts had excellent predictive ability. DASA-IV scores from a single shift showed moderate predictive ability for each of the following three shifts. The DASA-IV has excellent predictive ability for aggressive incidents within a secure setting when data are summarized over a 24-hour period, as opposed to when a single rating is taken. In addition, it has moderate value for predicting incidents over even shorter timescales.
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Affiliation(s)
- Mphindisi Nqwaku
- Forensic Research and Development Domain, Broadmoor High Secure Hospital, West London Mental Health Trust, London, UK
| | - Simon Draycott
- Department of Psychology, University of Surrey, Guildford, UK.,Department of Psychology, Broadmoor High Secure Hospital, West London Mental Health Trust, London, UK
| | | | | | | | - Dominic Jones
- Department of Psychology, Plymouth University, Plymouth, UK
| | - Ignazio Puzzo
- Forensic Research and Development Domain, Broadmoor High Secure Hospital, West London Mental Health Trust, London, UK
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17
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Gerson R, Malas N, Mroczkowski MM. Crisis in the Emergency Department: The Evaluation and Management of Acute Agitation in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2018; 27:367-386. [PMID: 29933788 DOI: 10.1016/j.chc.2018.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acute agitation in children and adolescents in the emergency department carries significant risks to patients and staff and requires skillful management, using both nonpharmacologic and pharmacologic strategies. Effective management of agitation requires understanding and addressing the multifactorial cause of the agitation. Careful observation and multidisciplinary collaboration is important. Medical work-up of agitated patients is also critical. Nonpharmacologic deescalation strategies should be first line for preventing and managing agitation and should continue during and after medication administration. Choice of medication should focus on addressing the cause of the agitation and any underlying psychiatric syndromes.
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Affiliation(s)
- Ruth Gerson
- Department of Child and Adolescent Psychiatry, New York University Langone, 462 1st Avenue, New York, NY 10016, USA.
| | - Nasuh Malas
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, C.S. Mott Children's Hospital, University of Michigan Hospital System, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI 48109-5277, USA; Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan Hospital System, 1500 East Medical Center Drive, L5023, SPC 5277, Ann Arbor, MI 48109-5277, USA
| | - Megan M Mroczkowski
- Department of Psychiatry, Columbia University Medical Center, 3959 Broadway CHONY 6N, New York, NY 10032, USA
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18
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Maguire T, Daffern M, Bowe SJ, McKenna B. Risk assessment and subsequent nursing interventions in a forensic mental health inpatient setting: Associations and impact on aggressive behaviour. J Clin Nurs 2018; 27:e971-e983. [DOI: 10.1111/jocn.14107] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science; Swinburne University of Technology; Melbourne Vic. Australia
- Victorian Institute of Forensic Mental Health, Forensicare; Melbourne Vic. Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science; Swinburne University of Technology; Melbourne Vic. Australia
- Victorian Institute of Forensic Mental Health, Forensicare; Melbourne Vic. Australia
| | - Steven J Bowe
- Faculty of Health, Biostatistics Unit; Deakin University; Melbourne Vic. Australia
| | - Brian McKenna
- Centre for Forensic Behavioural Science; Swinburne University of Technology; Melbourne Vic. Australia
- School of Clinical Sciences; Auckland University of Technology; Auckland New Zealand
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Maguire T, Daffern M, Bowe SJ, McKenna B. Predicting aggressive behaviour in acute forensic mental health units: A re-examination of the dynamic appraisal of situational aggression's predictive validity. Int J Ment Health Nurs 2017; 26:472-481. [PMID: 28960740 DOI: 10.1111/inm.12377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval (CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
| | - Brian McKenna
- Department of Health Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
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Abstract
BACKGROUND Although aggressive behavior in psychiatric settings is a major concern, very few studies have focused exclusively on physical assault in a general inpatient psychiatric population. OBJECTIVES This study had 3 main goals: (1) to evaluate the prevalence of assaultive behavior in an acute psychiatric hospital; (2) to identify the clinical and socio-demographic factors associated with assaultive behavior during hospitalization; and (3) to explore whether a diagnosis of schizophrenia spectrum disorder increases the risk of assaultive behavior. METHODS We conducted a retrospective chart review of patients admitted to acute units in a psychiatric hospital between 2009 and 2012. A subset of occurrence reports identified by a multidisciplinary team as "physical assault" was included in the analysis. Using logistic multivariate regression analysis, these patients were compared with a randomly selected nonassaultive control group, matched for length of stay to identify factors associated with assaultive behavior. RESULTS Of 757 occurrence reports, 613 met criteria for significant assault committed by 356 patients over 309,552 patient days. The assault incident density was 1.98 per 1000 patient days. In the logistic regression model of best fit, the factors significantly associated with assaultive behavior were age, legal status, and substance use. A diagnosis of schizophrenia spectrum disorder was not significantly associated with assaultive behavior. CONCLUSIONS Clinicians should take extra precautions for involuntarily admitted young patients with a history of substance use, as they are more likely to exhibit assaultive behavior. A diagnosis of schizophrenia spectrum disorder in itself is not significantly associated with assaultive behavior. Screening instruments such as the Dynamic Appraisal of Situational Aggression may be useful in assessing risk of assault.
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Serrano-Blanco A, Rubio-Valera M, Aznar-Lou I, Baladón Higuera L, Gibert K, Gracia Canales A, Kaskens L, Ortiz JM, Salvador-Carulla L. In-patient costs of agitation and containment in a mental health catchment area. BMC Psychiatry 2017; 17:212. [PMID: 28583103 PMCID: PMC5460463 DOI: 10.1186/s12888-017-1373-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 05/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a scarce number of studies on the cost of agitation and containment interventions and their results are still inconclusive. We aimed to calculate the economic consequences of agitation events in an in-patient psychiatric facility providing care for an urban catchment area. METHODS A mixed approach combining secondary analysis of clinical databases, surveys and expert knowledge was used to model the 2013 direct costs of agitation and containment events for adult inpatients with mental disorders in an area of 640,572 adult inhabitants in South Barcelona (Spain). To calculate costs, a seven-step methodology with novel definition of agitation was used along with a staff survey, a database of containment events, and data on aggressive incidents. A micro-costing analysis of specific containment interventions was used to estimate both prevalence and direct costs from the healthcare provider perspective, by means of a mixed approach with a probabilistic model evaluated on real data. Due to the complex interaction of the multivariate covariances, a sensitivity analysis was conducted to have empirical bounds of variability. RESULTS During 2013, 918 patients were admitted to the Acute Inpatient Unit. Of these, 52.8% were men, with a mean age of 44.6 years (SD = 15.5), 74.4% were compulsory admissions, 40.1% were diagnosed with schizophrenia or non-affective psychosis, with a mean length of stay of 24.6 days (SD = 16.9). The annual estimate of total agitation events was 508. The cost of containment interventions ranges from 282€ at the lowest level of agitation to 822€ when verbal containment plus seclusion and restraint have to be used. The annual total cost of agitation was 280,535€, representing 6.87% of the total costs of acute hospitalisation in the local area. CONCLUSIONS Agitation events are frequent and costly. Strategies to reduce their number and severity should be implemented to reduce costs to the Health System and alleviate patient suffering.
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Affiliation(s)
- Antoni Serrano-Blanco
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Facultat de Farmàcia, Universitat de Barcelona, Barcelona, Spain
| | - Ignacio Aznar-Lou
- Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Luisa Baladón Higuera
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
- Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Barcelona, Spain
| | - Karina Gibert
- Statistics and Operations Research Department, Knowledge Engineering and Machine Learning group, Universitat Politècnica de Catalunya-Barcelona Tech, Barcelona, Spain
| | | | | | - José Miguel Ortiz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Sant Boi de Llobregat, Spain
| | - Luis Salvador-Carulla
- Centre for Mental Health Research, Research School of Population Health, ANU College of Medicine, Biology & Environment, The Australian National University, Canberra, Australia
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Kaunomäki J, Jokela M, Kontio R, Laiho T, Sailas E, Lindberg N. Interventions following a high violence risk assessment score: a naturalistic study on a Finnish psychiatric admission ward. BMC Health Serv Res 2017; 17:26. [PMID: 28077156 PMCID: PMC5225613 DOI: 10.1186/s12913-016-1942-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. METHODS The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. RESULTS There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. CONCLUSION In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.
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Affiliation(s)
- Jenni Kaunomäki
- Institute of Behavioural Sciences, University of Helsinki, Siltavuorenpenger 1A, P.O. Box 9, 00014, Helsinki, Finland
| | - Markus Jokela
- Institute of Behavioural Sciences, University of Helsinki, Siltavuorenpenger 1A, P.O. Box 9, 00014, Helsinki, Finland
| | - Raija Kontio
- Helsinki University and Helsinki University Hospital, Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland
| | - Tero Laiho
- Helsinki University and Helsinki University Hospital, Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland
| | - Eila Sailas
- Kellokoski Hospital, 04500, Kellokoski, Finland
| | - Nina Lindberg
- Helsinki University and Helsinki University Hospital, Forensic Psychiatry, Välskärinkatu 12 A, 00029, HUS, Helsinki, Finland.
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Lantta T, Anttila M, Kontio R, Adams CE, Välimäki M. Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study. Int J Ment Health Syst 2016; 10:27. [PMID: 27051463 PMCID: PMC4820948 DOI: 10.1186/s13033-016-0059-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/22/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses' use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses' experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention. METHODS This study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis. RESULTS Nurses' experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward. CONCLUSIONS This study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed through which nurses' experiences and ideas concerning prevention of violent events are acknowledged.
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Affiliation(s)
- Tella Lantta
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
| | - Minna Anttila
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
| | - Raija Kontio
- />Helsinki University and Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland
| | - Clive E. Adams
- />Division of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Maritta Välimäki
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
- />School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- />Turku University Hospital, Turku, Finland
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Lantta T, Kontio R, Daffern M, Adams CE, Välimäki M. Using the Dynamic Appraisal of Situational Aggression with mental health inpatients: a feasibility study. Patient Prefer Adherence 2016; 10:691-701. [PMID: 27175069 PMCID: PMC4854232 DOI: 10.2147/ppa.s103840] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE This paper aims to explore the acceptability of Dynamic Appraisal of Situational Aggression (DASA) from the perspective of patients, its actual use by mental health nurses, and the predictive validity of the DASA instrument. METHODS A feasibility study design incorporating quantitative and qualitative components was used. The study was conducted in three mental health inpatient units at three hospitals in southern Finland. Quantitative data were used to explore demand (nurses' actual use of the DASA), limited efficacy (predictive validity), and acceptability (measured through patients' participation in the project). Qualitative data were collected to enhance the understanding of acceptability by describing patients' perceptions of the strengths and weaknesses of the DASA. RESULTS Nurses used the DASA for most patient assessments. The predictive validity of the DASA was outstanding or excellent, depending on the type of aggression predicted, although the patient recruitment ratio was low. Patients reported both strengths and weaknesses of the DASA, providing complementary information regarding the instrument's acceptability and clinical application. CONCLUSION The DASA accurately predicts inpatient aggression. The patients' preferences and concerns regarding risk assessment have been noted. More patient involvement in risk assessment research and violence prevention efforts is required.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
- Correspondence: Tella Lantta, Department of Nursing Science, University of Turku, FI-20014 Turku, Finland, Tel +358 2 333 8492, Email
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland
- Helsinki University, Helsinki, Finland
- Helsinki University Hospital, Hospital District of Helsinki and Uusimaa, Helsinki, Finland
| | - Michael Daffern
- Centre for Forensic Behavioural Science (CFBS), Swinburne University of Technology, Melbourne, VIC, Australia
| | - Clive E Adams
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland
- Turku University Hospital, Turku, Finland
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
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Al-Sagarat AY, Hamdan-Mansour AM, Al-Sarayreh F, Nawafleh H, Moxham L. Prevalence of aggressive behaviours among inpatients with psychiatric disorders: A case study analysis from Jordan. Nurs Health Sci 2015; 18:172-9. [DOI: 10.1111/nhs.12239] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/21/2015] [Accepted: 07/08/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmad Y. Al-Sagarat
- Department of community and Mental Health Nursing; Mutah University; Al-Karak Jordan
| | | | - Faris Al-Sarayreh
- Department of community and Mental Health Nursing; Mutah University; Al-Karak Jordan
| | - Hani Nawafleh
- Nursing department; Al-Hussein Bin Talal University; Ma'an Jordan
| | - Lorna Moxham
- School of Nursing; University of Wollongong; New South Wales Australia
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Kasinathan J, Marsland C, Batterham P, Gaskin C, Adams J, Daffern M. Assessing the risk of imminent aggression in mentally ill young offenders. Australas Psychiatry 2015; 23:44-8. [PMID: 25512970 DOI: 10.1177/1039856214563845] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Aggression in adolescents presents a significant problem for psychiatric units. The Dynamic Appraisal of Situational Aggression (DASA) is an empirically validated measure designed to appraise the risk of imminent aggression (within the next 24 hours) in adult patients. Our aim was to examine the predictive validity of the DASA: Youth Version (DASA:YV) with youth-specific items, in young offenders hospitalised with a mental illness. METHODS This prospective validation study involved 4440 DASA:YV ratings of mentally ill adolescents in a secure hospital. At 24 hours post-assessment, the nursing staff documented whether patients had behaved aggressively: physically, verbally or towards property. Predictive accuracy was assessed using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. RESULTS The DASA:YV significantly predicted any imminent aggression (AUC = 0.754). Additional youth-specific items conferred a greater predictive yield, as compared to adult-derived items (p = 0.014). CONCLUSIONS It is possible to monitor the risk state of hospitalised mentally ill youth, so that heightened states can be detected early, thus facilitating interventions to reduce the risk of violence.
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Affiliation(s)
- John Kasinathan
- Consultant Forensic Psychiatrist, Adolescent Unit, The Forensic Hospital, Justice Health, New South Wales Health, Sydney, NSWConjoint Lecturer, Faculty of Medicine, School of Psychiatry, University of New South Wales, Sydney, NSWForensic Mental Health Service Australian Capital Territory Health, Canberra, ACTVisiting Fellow, Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Christopher Marsland
- Clinical Nurse Consultant, Adolescent Unit and Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSW, Australia
| | - Philip Batterham
- Fellow in Mental Health Research, Centre for Mental Health Research, The Australian National University, Canberra, ACT, Australia
| | - Claire Gaskin
- Clinical Director Adolescent Mental Health, Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSWConjoint Lecturer, Faculty of Medicine, School of Psychiatry University of New South Wales, Sydney, NSW, Australia
| | - Jonathon Adams
- Consultant Forensic Psychiatrist, Justice Health, The Forensic Hospital, New South Wales Health, Sydney, NSWConjoint Lecturer, School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Michael Daffern
- Principal Consultant Psychologist, Centre for Forensic Behavioural Science University of Swinburne, Melbourne, VICVictorian Institute of Forensic Mental Health, Melbourne, VIC, Australia
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Chan O, Chow KKW. Assessment and determinants of aggression in a forensic psychiatric institution in Hong Kong, China. Psychiatry Res 2014; 220:623-30. [PMID: 25175913 DOI: 10.1016/j.psychres.2014.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 08/03/2014] [Accepted: 08/07/2014] [Indexed: 10/24/2022]
Abstract
Institutional aggression in forensic psychiatric setting is an under-researched subject, despite the magnitude of the problem. No studies have been conducted on the assessment of risk and the examination of predictors of aggression among the Chinese forensic psychiatric population. Our study aimed to examine the determinants of aggression in the only forensic psychiatric institution in Hong Kong, and to test the psychometric properties of a risk-assessment instrument, the Dynamic Appraisal of Situational Aggression (DASA). We recruited a representative sample of 530 consecutively admitted detainees. Qualified nurses completed two risk-assessment instruments, the DASA and the Brøset Violence Checklist (BVC), once daily during the participants׳ first 14 days of admission. Aggressive incidents were recorded using the revised Staff Observation Aggression Scale (SOAS-R), and participants׳ data were collected for multivariate analyses. We showed that female gender, diagnoses of personality disorder and substance-related disorder, and admission at other correctional institutions were associated with institutional aggression. Aggression was perpetrated by 17.7% of the participants, and the DASA was demonstrated to have good psychometric properties in assessing and predicting aggressive incidents. Our findings preliminarily support the use of daily in-patient risk-assessment and affirm the role of dynamic factors in institutional aggression.
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Affiliation(s)
- Oliver Chan
- Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong.
| | - Kavin Kit-wan Chow
- Department of Forensic Psychiatry, Castle Peak Hospital, 3-15 Tsing Chung Koon Road, Tuen Mun, Hong Kong
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Bullock R, McKenna B, Kelly T, Furness T, Tacey M. When reduction strategies are put in place and mental health consumers are still secluded: an analysis of clinical and sociodemographic characteristics. Int J Ment Health Nurs 2014; 23:506-12. [PMID: 25069674 DOI: 10.1111/inm.12078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Internationally, seclusion practices continue to be the subject of intense clinical health service and academic scrutiny. Despite extensive efforts to reduce and eliminate this controversial practice, seclusion remains a clinical intervention widely used in contemporary mental health service settings. Early identification of people who are at risk for seclusion and the timely application of alternative evidence-based interventions are critical for reducing incidents of seclusion in real-world practice settings. This retrospective study aimed to determine the relationship between sociodemographic and clinical characteristics, and the use of seclusion for those mental health consumers for whom evidence-based seclusion-reduction initiatives had little impact. A 12-month centred moving average was fitted to seclusion data from a psychiatric inpatient unit over 2 years to determine stabilization in seclusion reduction. The number of consumers admitted was calculated from the point of stabilization for 1 year (n = 469). In this cohort, univariate analysis sought to compare the characteristics of those who were secluded and those who were not. A multivariate logistic regression model was undertaken to associate future seclusion based on significant independent variables. Of those people admitted, 88 (19%) were secluded. The majority of seclusions occurred in the first 5 days (70/88, 79%). Multivariate logistic regression indicated that three variables maintained their independent associative risk of seclusion: (i) age less than 35 years; (ii) assessment of risk of violence to others; and (iii) a history of seclusion. The implications of these findings for nursing practice are discussed.
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Affiliation(s)
- Rebecca Bullock
- Northern Area Mental Health Service, NorthWestern Mental Health, Melbourne Health, Melbourne, Victoria, Australia
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Affiliation(s)
- Lauren Taylor
- Mental Health Services, The Prince of Wales Hospital, Sydney, New South Wales, Australia
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