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Ahmad Badruddin N, Roseliza-Murni A, Kamaluddin MR, Ahmad Badayai AR, Munusamy S. Intervening factors between risk of violence and aggressive behaviours among forensic inpatients: a scoping review. BMC Psychol 2024; 12:155. [PMID: 38491550 PMCID: PMC10943838 DOI: 10.1186/s40359-024-01649-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/07/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Risk of violence is closely associated with aggression propensity. However, there is a lack of research to explain the mechanisms behind this association, especially among the patients of forensic secure facilities. This review aimed to identify and synthesize the available literature concerning the intervening factors (mediating or moderating factors) in the relationship between the risk of violence and aggressive behavior in forensic secure facilities. METHODS Two electronic academic databases were searched: Scopus and Web of Science (WoS) using specific keywords as search terms derived from the PCC framework with no specific time limit. The search strategy was developed based on the JBI Manual for Evidence Synthesis and utilised the PRISMA-ScR guidelines. Data on the risk of violence, intervening factors, and aggressive behavior were extracted from the included studies. Further analysis was performed whereby similar data were grouped and synthesised together. RESULTS The initial search produced 342 studies. However, only nine studies fulfilled the inclusion criteria. The nine studies included 1,068 adult forensic inpatients from various psychiatric hospitals. Only mediation studies reported significant mechanisms of influence between the risk of violence and aggressive behavior. It is postulated that the human agency factor may be the underlying factor that influences a person's functioning and the subsequent series of events between the risk of violence and aggression. CONCLUSIONS In light of the paucity of evidence in this area, a generalised conclusion cannot be established. More studies are warranted to address the gaps before conclusive recommendations can be proposed to the relevant stakeholders.
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Affiliation(s)
- Norhameza Ahmad Badruddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
| | - AbRahman Roseliza-Murni
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia.
| | - Mohammad Rahim Kamaluddin
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
| | - Abdul Rahman Ahmad Badayai
- Centre for Research in Psychology and Human Well-Being, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600, Bangi, Selangor, Malaysia
| | - Shalini Munusamy
- International Medical University, Federal Territory of Kuala Lumpur, 126, Jln Jalil Perkasa 19, Bukit Jalil, 57000, Kuala Lumpur, Malaysia
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Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, Drukker M. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One 2021; 16:e0258346. [PMID: 34624057 PMCID: PMC8500453 DOI: 10.1371/journal.pone.0258346] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. METHOD In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. RESULTS The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. CONCLUSION Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.
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Affiliation(s)
- Irene Weltens
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Simone Verhagen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Emma Vandenberk
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Patrick Domen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Folgo AR, Iennaco JD. Staff perceptions of risk factors for violence and aggression in ambulatory care. Work 2020; 65:435-445. [PMID: 32007986 DOI: 10.3233/wor-203096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management of violent acts of patients and their visitors in psychiatric and hospital settings has been studied. However, violence has not yet been addressed in the ambulatory care environment. OBJECTIVE To identify potential risk factors for patient and visitor violence [PVV] and staff perceptions of the impact of these risk factors in ambulatory care. METHODS A review of psychiatric inpatient research was conducted examining violence and aggression including risk factors for PVV. Identified risk factors for violence were incorporated into a survey tool and distributed to staff in a community clinic asking for their perception of the impact of these risk factors on aggression in their work environment. RESULTS Risk factors for violence and aggression were categorized as static or dynamic or as related to characteristics of staff or the environment of care. All of the risk factors were identified as possible contributors to PVV by the staff while items related to substance abuse and the clinic environment were selected by the staff as "highly likely" to contribute to PVV in their setting. CONCLUSIONS Continued research is needed in this area to better understand risk factors for PVV and develop appropriate safety interventions and crisis training for ambulatory care settings.
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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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Gunenc C, O'Shea LE, Dickens GL. Structured risk assessment for reduction of multiple risk outcomes in a secure mental health setting: Use of the START. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2018; 28:61-71. [PMID: 28568744 DOI: 10.1002/cbm.2036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 11/15/2016] [Accepted: 02/14/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Structured risk assessment is commonly used in secure settings to aid prediction and prevention of risky behaviours; the expected benefits have rarely been investigated. AIMS The aim of the study is to determine whether adverse outcomes (physical and verbal aggression, self-harm, victimisation, self-neglect, unauthorised leave and substance abuse) reduced after patients were assessed with the Short-term Assessment of Risk and Treatability (START). METHODS In a naturalistic study, anonymised demographic and clinical information was collected from 50 male patients. Data included START assessment and frequency of target behaviour for 3 months before and after first assessment. Chi-square and linear mixed models analyses were used to determine whether there was any change in the behaviours of interest. RESULTS There were no significant changes in physical or verbal aggression over time, although a tendency towards fewer incidents was apparent. Other adverse behaviours were very infrequent at baseline, precluding adequate analysis. CONCLUSIONS In this small sample, START did not achieve its primary purpose of significant reduction in adverse behaviours. Although our sample size was informed by a power calculation, we may have over-estimated the size of anticipated change. Further, the 3-month comparison periods before and after the assessment follow-up period were rather short. Accordingly, we recommend more research on the value of this tool in practice rather than discontinuing its use. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Geoffrey L Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Dundee, UK
- NHS Fife, Kirkcaldy, UK
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Byrt R, Spencer-Stiles TA, Ismail I. Evidence-Based Practice in Forensic Mental Health Nursing: A Critical Review. JOURNAL OF FORENSIC NURSING 2018; 14:223-229. [PMID: 29912027 DOI: 10.1097/jfn.0000000000000202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
METHOD Literature searches of databases, particularly CINAHL, using key phrases were undertaken. RESULTS Some authors argue that there is a lack of evidence in forensic mental health (FMH) nursing, with few randomized controlled trials and other methods providing definitive, generalizable evidence. However, literature searches revealed randomized controlled trials of relevance to FMH nursing, many qualitative studies by FMH nurses, and arguments for clinical experience and knowledge of service users, and the latter's views, as sources of evidence. DISCUSSION AND IMPLICATIONS FOR NURSING PRACTICE Research findings can be applied to practice, both directly and indirectly. Examples are given of ways that evidence can be used to inform FMH nursing interventions related to therapeutic ward environments, including communication, therapeutic relationships, preventing retraumatization, and enabling physical health. The complex nature of "evidence" is considered in relation to risk assessment and management. CONCLUSIONS FOR NURSING PRACTICE FMH nursing can be based on a wide range of sources of evidence. The types of evidence used in practice depend on individual service users' needs and views. In evaluating evidence, it is necessary to be aware of its complex, diverse nature. A distinction can be made between definitive, widely generalizable research findings and evidence with limited generalizability, requiring FMH nurses' judgments about whether it is applicable to their own area of practice. Recommendations for related education and research are made.
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Affiliation(s)
- Richard Byrt
- School of Nursing and Midwifery, De Montfort University
- School of Health, Sport and Professional Practice, University of South Wales
- Arnold Lodge Medium Secure Unit, Nottinghamshire Healthcare NHS Foundation Trust
| | | | - Ismail Ismail
- Arnold Lodge Medium Secure Unit, Nottinghamshire Healthcare NHS Foundation Trust
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