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Shirk H, Kreider C, Bell T, Gervase S, Buchko BL, Danford CA. Predictive Ability of the Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) in Medical-Surgical Units. West J Nurs Res 2024; 46:685-691. [PMID: 39171446 DOI: 10.1177/01939459241271393] [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] [Indexed: 08/23/2024]
Abstract
BACKGROUND Workplace violence persists in health care with nurses reporting physical and verbal abuse from aggressive patients causing emotional stress and lost workdays. The Dynamic Appraisal of Situational Aggression-Inpatient Version (DASA-IV) was developed to measure risk for aggression in patients with behavioral health conditions in psychiatric and emergency department settings. The DASA-IV has not been validated with adult patients admitted to medical-surgical units. OBJECTIVE To determine whether DASA-IV scores are predictive of aggressive events in adults hospitalized on medical-surgical units. METHODS This multisite study used a case-control design. DASA-IV scores and acts of aggression were extracted from the medical record retrospectively to validate the appraisal's predictability. Receiver operating characteristic (ROC) and area under the curve (AUC) were used to correlate DASA-IV scores with aggressive events. RESULTS DASA-IV assessments (N=156 999; mean [SD] 10.1 [10.7]/patient; range 1-220) were collected from 13 611 patients. Patients were primarily White (86.1%) and female (51.7%). Aggression (n = 509 patients; 3.7%) was significantly associated with older age, male sex, smoking, illicit drug use, and high DASA-IV scores. AUC of the ROC analysis for the DASA-IV showed a 97% probability (95% confidence interval [CI] 0.964-0.977) that an aggressive patient would have a higher score on the DASA-IV than a nonaggressive patient. Binary logistic regression predicted that for every point increase in the DASA-IV, there was a 3.51 (95% CI 3.38-3.63) times increased risk for aggression (B = 1.255, SE = 0.18, Wald = 4766.6, P < .001). CONCLUSIONS This study is the first to validate use of the DASA-IV in medical-surgical populations, demonstrating predictive ability for aggressive incidents. The DASA-IV can be used successfully in medical-surgical populations for early identification of potential aggression.
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Affiliation(s)
| | | | | | | | | | - Cynthia A Danford
- Office of Nursing Research and Innovation, Cleveland Clinic, Cleveland, OH, USA
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Ilarda E, Senz A, Tynan A, McIlveen P. Risk factors for violence in an emergency department: Nurses' perspectives. Emerg Med Australas 2024; 36:459-465. [PMID: 38423987 DOI: 10.1111/1742-6723.14388] [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: 08/31/2023] [Revised: 02/01/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Work-related violence remains a significant problem in healthcare settings, including EDs. Violence risk assessment tools have been developed to improve risk mitigation in this setting; however, incorporation of these tools into standard hospital processes remains scarce. This research aimed to explore nurses' perspectives on the Bröset Violence Checklist used in routine violence risk assessment and their recommendations for additional items. METHODS Thirty nursing staff who used the Bröset Violence Checklist (BVC) as standard practice for 5 years participated in two focus groups where 23 violence risk factors were presented. Using multiple methods, participants were asked to select and elaborate from a pre-determined list what they considered most useful in violence risk assessment in respect to descriptors and terminology. RESULTS Quantitative data showed most risk factors presented to the group were considered to be predictive of violence. Ten were regarded as associated with risk, and overt behaviours received the highest votes. The terms 'shouting and demanding' was preferred over 'boisterous', and 'cognitive impairment' over 'confusion'. Patient clinical characteristics and staff perceptions of harm, inability to observe subtle behaviour, imposed restrictions and interventions and environmental conditions and impact were also important considerations. CONCLUSIONS We recommend that violence risk assessment include: history of violence, cognitive impairment, psychotic symptoms, drug and alcohol influence, shouting and demanding, verbal abuse/hostility, impulsivity, agitation, irritability and imposed restrictions and interventions. These violence risk factors fit within the four categories of historical, clinical, behavioural and situational.
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Affiliation(s)
- Elisa Ilarda
- School of Education, University of Southern Queensland, Ipswich, Queensland, Australia
| | - Ainslie Senz
- Department of Emergency Medicine, Footscray Hospital, Western Health, Melbourne, Victoria, Australia
| | - Anna Tynan
- Centre for Health Research, University of Southern Queensland, Ipswich, Queensland, Australia
- Research Development and Engagement Unit, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Peter McIlveen
- School of Education, University of Southern Queensland, Ipswich, Queensland, Australia
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Välimäki M, Lantta T, Kontio R. Risk assessment for aggressive behaviour in schizophrenia. Cochrane Database Syst Rev 2024; 5:CD012397. [PMID: 38695777 PMCID: PMC11064887 DOI: 10.1002/14651858.cd012397.pub2] [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: 05/04/2024]
Abstract
BACKGROUND Aggressive or violent behaviour is often associated with people with schizophrenia in common perceptions of the disease. Risk assessment methods have been used to identify and evaluate the behaviour of those individuals who are at the greatest risk of perpetrating aggression or violence or characterise the likelihood to commit acts. Although many different interventions have been developed to decrease aggressive or violent incidences in inpatient care, staff working in inpatient settings seek easy-to-use methods to decrease patient aggressive events. However, many of these are time-consuming, and they require intensive training for staff and patient monitoring. It has also been recognised in clinical practice that if staff monitor patients' behaviour in a structured manner, the monitoring itself may result in a reduction of aggressive/violent behaviour and incidents in psychiatric settings. OBJECTIVES To assess the effects of structured aggression or violence risk assessment methods for people with schizophrenia or schizophrenia-like illnesses. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PubMed, ISRCTN registry, ClinicalTrials.gov, and WHO ICTRP, on 10 February 2021. We also inspected references of all identified studies. SELECTION CRITERIA We included all randomised controlled trials (RCTs) comparing structured risk assessment methods added to standard professional care with standard professional care for the evaluation of aggressive or violent behaviour among people with schizophrenia. DATA COLLECTION AND ANALYSIS At least two review authors independently inspected citations, selected studies, extracted data, and appraised study quality. For binary outcomes, we calculated a standard estimation of the risk ratio (RR) and its 95% confidence interval (CI). For continuous outcomes, we calculated the mean difference (MD) and its 95% CI. We assessed risk of bias in the included studies and created a summary of findings table using the GRADE approach. MAIN RESULTS We included four studies in the review. The total number of participants was not identifiable, as some studies provided number of participants included, and some only patient days. The studies compared a package of structured assessment methods with a control group that included routine nursing care and drug therapy or unstructured psychiatric observations/treatment based on clinical judgement. In two studies, information about treatment in control care was not available. One study reported results for our primary outcome, clinically important change in aggressive/violent behaviour, measured by the rate of severe aggression events. There was likely a positive effect favouring structured risk assessment over standard professional care (RR 0.59, 95% CI 0.41 to 0.85; 1 RCT; 1852 participants; corrected for cluster design: RR 0.59, 95% CI 0.37 to 0.93; moderate-certainty evidence). One trial reported data for the use of coercive measures (seclusion room). Compared to standard professional care, structured risk assessment may have little or no effect on use of seclusion room as days (corrected for cluster design: RR 0.92, 95% CI 0.27 to 3.07; N = 20; low-certainty evidence) or use of seclusion room as secluded participants (RR 1.83, 95% CI 0.39 to 8.7; 1 RCT; N = 20; low-certainty evidence). However, seclusion room may be used less frequently in the standard professional care group compared to the structured risk assessment group (incidence) (corrected for cluster design: RR 1.63, 95% CI 0.49 to 5.47; 1 RCT; N = 20; substantial heterogeneity, Chi2 = 0.0; df = 0.0; P = 0.0; I2 = 100%; low-certainty evidence). There was no evidence of a clear effect on adverse events of escape (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence); fall down (RR 0.33, 95% CI 0.04 to 3.15; 1 RCT; n = 200; very low-certainty evidence); or choking (RR 0.2, 95% CI 0.01 to 4.11; 1 RCT; n = 200; very low-certainty evidence) when comparing structured risk assessment to standard professional care. There were no useable data for patient-related outcomes such as global state, acceptance of treatment, satisfaction with treatment, quality of life, service use, or costs. AUTHORS' CONCLUSIONS Based on the available evidence, it is not possible to conclude that structured aggression or violence risk assessment methods are effective for people with schizophrenia or schizophrenia-like illnesses. Future work should combine the use of interventions and structured risk assessment methods to prevent aggressive incidents in psychiatric inpatient settings.
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Affiliation(s)
- Maritta Välimäki
- School of Public Health, University of Helsinki, Helsinki, Finland
| | - Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Raija Kontio
- Department of Nursing Science, University of Turku, Turku, Finland
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Ilarda E, McIlveen P, Tynan A, Senz A. Emergency department staff experiences of the Bröset Violence Checklist. J Adv Nurs 2024; 80:2027-2037. [PMID: 37975436 DOI: 10.1111/jan.15961] [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: 04/28/2023] [Revised: 09/22/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
AIM Work-related violence is a significant problem in healthcare settings and emergency departments are one of the highest at-risk locations. There have been significant challenges in identifying successful risk-mitigation strategies to reduce the incidence and impact of work-related violence in this setting. This research explores the perspectives of clinical staff who routinely use violence risk assessment to provide recommendations for improvements. DESIGN This qualitative research used interviews of staff who routinely use of the Bröset Violence Checklist in an emergency department. The study was conducted in April 2022. METHOD Interview transcripts were subjected to Thematic Analysis to explore participants' clinical experiences and judgements about the utility of the Bröset Violence Checklist. RESULTS Eleven staff participated in semi-structured interviews. Participants described themes about the benefits of routine violence risk assessment and the influence of the subjective opinion of the scorer with respect to the emergency department patient cohort. Four categories of violence risk factors were identified: historical, clinical, behavioural and situational. Situational risks were considered important for tailoring the tool for context-specificity. Limitations of the BVC were identified, with recommendations for context-specific indicators. CONCLUSION Routine violence risk assessment using the Bröset Violence Checklist was deemed useful for emergency departments, however, it has limitations. IMPACT This study's findings offer potential solutions to reduce violence affecting front-line workers and practical processes that organizations can apply to increase staff safety. IMPLICATIONS The findings produced recommendations for future research and development to enhance utility of the Bröset Violence Checklist. REPORTING METHOD EQUATOR guidelines were adhered to and COREQ was used. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution was involved in this study.
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Affiliation(s)
- Elisa Ilarda
- School of Education, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Peter McIlveen
- School of Education, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Anna Tynan
- Centre for Health Research, University of Southern Queensland, Toowoomba, Queensland, Australia
- Research Support Unit, Darling Downs Health, Toowoomba, Queensland, Australia
| | - Ainslie Senz
- Department of Emergency Medicine, Footscray Hospital, Western Health, Footscray, Victoria, Australia
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Malone JE, Campbell TP, Curtis AM. A health system's journey to preventing workplace violence: Use of multidisciplinary teamwork to unify efforts across a health system. J Healthc Risk Manag 2024; 43:29-38. [PMID: 37756150 DOI: 10.1002/jhrm.21557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/09/2023] [Indexed: 09/29/2023]
Abstract
Workplace violence (WPV) is known to threaten the safety of patients and staff. In 2018, a wellness survey showed many employees had not received training on WPV prevention and felt unprepared to manage aggression. The health network's leaders knew they needed to take action. From various multidisciplinary committees, the leaders were able to create a comprehensive WPV prevention program. Some of the highlights of this program include forming a centralized security department, codes of conduct, and crisis response process, adopting tools to predict violence, and providing a range of education. Data from WPV events showed the health network had a statistically significant reduction in WPV events from 2020 to 2021. However, WPV events increased in 2022. This increase in 2022 mirrors national trends in WPV. There are a number of factors that may have impacted this increase. Regardless, the leaders at the health network are dedicated to continuously improving the WPV prevention program. Some of the ongoing projects include improving data collection methods and building a long-term notification for highly violent individuals. This WPV prevention program relies on the commitment of its multidisciplinary team members and focuses on taking care of patients while also prioritizing the wellness of the staff.
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Saatchi B, Olshansky EF, Fortier MA. Irritability: A concept analysis. Int J Ment Health Nurs 2023; 32:1193-1210. [PMID: 36929104 DOI: 10.1111/inm.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/15/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
Irritability is a term used to describe feelings of anger, annoyance and impatience, and is commonly experienced by individuals in daily life. However, there are diverse conceptualizations of irritability in public and clinical research, which often result in confusing irritability with anger and other overlapping concepts. This, in turn, leads to a lack of conceptual clarity. Accordingly, the purpose of this concept analysis was to explore the irritability concept, including its definitions, defining characteristics, antecedents, consequences and empirical referents. The findings showed that irritability is predominantly conceptualized as a psychophysiological concept in the literature. We demonstrated that irritability can be differentiated from overlapping concepts like anger by qualities, such as 'unpredictability and lowered emotion control', 'lowered threshold for negative emotional stimuli', 'being manifested in response to frustrative situations or physiological needs' and 'experience of disproportionate and unjustified emotional irritation'. Importantly, severe irritability prospectively predicts psychiatric disorders and greater impairments in health, financial, educational and social functioning in individuals. Taken together, our analysis showed that one should take into account the context, duration, intensity and importantly outcomes, when assessing irritability in an individual. Considering these findings and the presence of irritability in nursing practice, it is crucial for nurses to recognize and successfully identify this concept in the nursing care they provide within the diverse settings and patient populations.
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Affiliation(s)
- Babak Saatchi
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
| | - Michelle A Fortier
- Sue & Bill Gross School of Nursing, University of California, Irvine, USA
- Center on Stress & Health, University of California Irvine, Orange, California, USA
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Cabilan CJ, McRae J, Ganzon K, Appo C, Rogers S, O'Sullivan M, Eley R, Snoswell C, Johnston A. Introducing a Digital Occupational Violence Risk Assessment Tool Into an Emergency Department: A Pilot Implementation Study. J Emerg Nurs 2023; 49:360-370. [PMID: 36872199 DOI: 10.1016/j.jen.2023.01.007] [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: 01/05/2023] [Revised: 01/23/2023] [Accepted: 01/25/2023] [Indexed: 03/06/2023]
Abstract
INTRODUCTION Occupational violence in emergency departments is prevalent and detrimental to staff and health services. There is an urgent call for solutions; accordingly, this study describes the implementation and early impacts of the digital Queensland Occupational Violence Patient Risk Assessment Tool (kwov-pro). METHODS Since December 7, 2021, emergency nurses have been using the Queensland Occupational Violence Patient Risk Assessment Tool to assess 3 occupational violence risk factors in patients: aggression history, behaviors, and clinical presentation. Violence risk then is categorized as low (0 risk factors), moderate (1 risk factor), or high (2-3 risk factors). An important feature of this digital innovation is the alert and flagging system for high-risk patients. Underpinned by the Implementation Strategies for Evidence-Based Practice Guide, from November 2021 to March 2022 we progressively mobilized a range of strategies, including e-learning, implementation drivers, and regular communications. Early impacts measured were the percentage of nurses who completed their e-learning, the proportion of patients assessed using the Queensland Occupational Violence Patient Risk Assessment Tool, and the number of reported violent incidents in the emergency department. RESULTS Overall, 149 of 195 (76%) of emergency nurses completed their e-learning. Further, adherence to Queensland Occupational Violence Patient Risk Assessment Tool was good, with 65% of patients assessed for risk of violence at least once. Since implementing the Queensland Occupational Violence Patient Risk Assessment Tool, there has been a progressive decrease in violent incidents reported in the emergency department. DISCUSSION Using a combination of strategies, the Queensland Occupational Violence Patient Risk Assessment Tool was successfully implemented in the emergency department with the indication that it could reduce the number of incidents of occupational violence. The work herein provides a foundation for future translation and robust evaluation of the Queensland Occupational Violence Patient Risk Assessment Tool in emergency departments.
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Quinn JM, Koopman JM. Violence Risk Assessment in the Emergency Department. J Emerg Nurs 2023; 49:352-359.e1. [PMID: 37150561 DOI: 10.1016/j.jen.2023.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/12/2023] [Accepted: 02/15/2023] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Workplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency. METHODS Following staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared. RESULTS Incidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints. DISCUSSION The Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.
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Cabilan CJ, Eley R, Snoswell C, Jones AT, Johnston ANB. Inter-rater reliability of the occupational violence risk assessment tool for emergency departments. Australas Emerg Care 2023; 26:54-58. [PMID: 35906121 DOI: 10.1016/j.auec.2022.07.007] [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: 04/20/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The three-item occupational violence (OV) risk assessment tool was developed and validated for use in emergency departments (EDs). It prompts review of each patient's aggression history, behaviours, and clinical presentation. However, confidence around representativeness and generalisability are needed before widescale adoption; hence we measured the inter-rater reliability of the tool among a large group of emergency nurses. METHODS A cross-sectional study was conducted between Sep 2021 and Jan 2022. Nurses were directed to a website that hosted an e-learning module about the tool. They were asked to apply the tool to two video scenarios of typical patient presentations. Demographic data, including years of emergency experience, were collected to contextualise their responses. Gwet's Agreement Coefficients (AC1) were calculated to determine inter-rater reliability. RESULTS There were 135 participants: typically female, under the age of 40 years, with more than 3 years of emergency nursing experience. Overall, there was excellent inter-rater agreement (AC1 =0.752, p = 0.001). This was consistent when years of ED experience was stratified: 0-2 years, AC1 = 0.764, p = 0.002; 3-5 years, AC1 = 0.826, p = 0.001; 6-10 years, AC1 = 0.751, p < 0.001; 11-15 years, AC1 = 0.659, p = 0.004; ≥ 16 years, AC1 = 0.799, p < 0.001. CONCLUSION The three-item OV risk assessment tool has excellent inter-rater reliability across a large sample of emergency nurses.
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Affiliation(s)
- C J Cabilan
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia.
| | - Robert Eley
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; Faculty of Medicine, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Centaine Snoswell
- Centre for Online Health, Centre for Health Services Research, The University of Queensland, Brisbane, Queensland 4102, Australia
| | - Andrew T Jones
- QCIF Facility for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Australia
| | - Amy N B Johnston
- Emergency Department, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, Queensland 4102, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland 4072, Australia
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Croland J, Overton S, Nimtz-Rusch K, Emmerling S, Wiegand L. Implementation of a Violence Risk Assessment and Interventions Aimed at the Prevention of Patient-Perpetrated Violent Events Across Care Settings. J Nurs Adm 2023; 53:168-174. [PMID: 36821501 DOI: 10.1097/nna.0000000000001263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Healthcare worker violence at the hands of patients is the leading cause of workplace injury with reports demonstrating yearly increases. Literature suggests organizational strategies to reduce workplace injury are necessary to create safe environments for patients to receive care and for healthcare workers to practice, but tactics lack a care continuum focus and largely focus on deescalation and management of violent events. One healthcare system identified that the use of an assessment widely used in Canada, identifying patients at risk for violent behaviors, would supplement already existing efforts at protecting patients. The implementation of this tool across care settings is presented in this article.
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Affiliation(s)
- Jennifer Croland
- Author Affiliations: Chief Nursing Officer (Dr Croland), OSF Healthcare Saint Francis Medical Center; Chief Nursing Officer (Overton), OSF Healthcare Ambulatory/Clinical Services; Executive Director (Dr Nimtz-Rusch), The Autism Collective; and Director of Clinical Practice and Research (Dr Emmerling) and Chief Nurse Executive (Dr Wiegand), OSF Healthcare, Peoria, Illinois
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Efficacy of the Crisis Risk Triage Scale in Inpatient Units Within the United States. J Healthc Qual 2023; 45:51-58. [PMID: 36584116 DOI: 10.1097/jhq.0000000000000349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
ABSTRACT Patient violence toward others, including doctors and nurses, is a serious concern worldwide. A wealth of literature supports the assertion that violent behavior can be prevented with proper screening and management policies. This project aimed to evaluate the Crisis Triage Rating Scale (CTRS) within a 12-hospital integrated healthcare delivery system located in the southeastern United States. An initial sample of 112,708 unique patient visits between January 2019 and December 2020 was included in this retrospective review of electronic health records. We found that the CTRS harm triage question and risk levels were significant predictors of harm to others. Consistent with previous literature, positive predictive values ranged between 0.025 and 0.070 and negative predictive values ranged between 0.991 and 0.995. Our results support the assertion that clinicians should make balanced judgments about using a positive risk score to allocate safety measures. Variations in practice were evident across our healthcare systems. Improving appropriate assessment procedures may improve the diagnostic tools and risk stratification. When documented correctly, the CTRS performed as expected in an environment where harm to others occurred infrequently.
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Effectiveness of Artificial Intelligence Methods in Personalized Aggression Risk Prediction within Inpatient Psychiatric Treatment Settings—A Systematic Review. J Pers Med 2022; 12:jpm12091470. [PMID: 36143255 PMCID: PMC9501805 DOI: 10.3390/jpm12091470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/12/2022] [Accepted: 08/27/2022] [Indexed: 11/17/2022] Open
Abstract
Aggression risk assessments are vital to prevent injuries and morbidities amongst patients and staff in psychiatric settings. More recent studies have harnessed artificial intelligence (AI) methods such as machine learning algorithms to determine factors associated with aggression in psychiatric treatment settings. In this review, using Cooper’s five-stage review framework, we aimed to evaluate the: (1) predictive accuracy, and (2) clinical variables associated with AI-based aggression risk prediction amongst psychiatric inpatients. Databases including PubMed, Cochrane, Scopus, PsycINFO, CINAHL were searched for relevant articles until April 2022. The eight included studies were independently evaluated using critical appraisal tools for systematic review developed by Joanna Briggs Institute. Most of the studies (87.5%) examined health records in predicting aggression and reported acceptable to excellent accuracy with specific machine learning algorithms employed (area under curve range 0.75–0.87). No particular machine learning algorithm outperformed the others consistently across studies (area under curve range 0.61–0.87). Relevant factors identified with aggression related to demographic and social profile, past aggression, forensic history, other psychiatric history, psychopathology, challenging behaviors and management domains. The limited extant studies have highlighted a potential role for the use of AI methods to clarify factors associated with aggression in psychiatric inpatient treatment settings.
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Hou Y, Corbally M, Timmins F. Violence against nurses by patients and visitors in the emergency department: A concept analysis. J Nurs Manag 2022; 30:1688-1699. [PMID: 35700325 PMCID: PMC9795924 DOI: 10.1111/jonm.13721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 06/10/2022] [Accepted: 06/13/2022] [Indexed: 12/30/2022]
Abstract
AIM This analysis investigates the concept of violence against nurses by patients and visitors in the emergency department. It aims to differentiate, clarify, and clearly identify this specific concept, which will facilitate more apt measurement and reporting, ultimately to contribute violence reduction measures. BACKGROUND Due to contextual factors, occupational risk and patient characteristics, violence against nurses by patients and visitors in the emergency department varies from other types of violence against other health care staff. METHODS This study employed Walker and Avant's concept analysis technique. RESULTS The analysis found that violence against nurses by patients and visitors in the emergency department is primarily an occurrence of interpersonal violence based on the working relationship, whereby the patient and/or visitor becomes an assailant, and a nurse becomes a target in the absence of capable guardianship. There is also an intentional use of physical force or power, which results in or has a high chance of causing harm. CONCLUSION A clearer understanding of the antecedents, attributes, and consequences of violence against nurses by patients and visitors arising from this concept analysis provides a framework that will assist in the understanding, measurement, reporting, and prevention of violence and inform future research. IMPLICATIONS FOR NURSING MANAGEMENT Nursing managers are encouraged to adopt strategies that act on the factors related to attributes and antecedents that will serve to reduce the occurrence of intentional violent acts.
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Affiliation(s)
- Yongchao Hou
- Emergency DepartmentShanXi Provincial People's HospitalTaiyuanShanXiChina
| | - Melissa Corbally
- School of Nursing and MidwiferyTrinity College DublinDublinIreland
| | - Fiona Timmins
- School of Nursing, Midwifery & Health SystemsUniversity College DublinDublinIreland
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Gregory SD, Park JS. Mass School Shootings: Review of Mental Health Recommendations. SCHOOL MENTAL HEALTH 2022. [DOI: 10.1007/s12310-021-09489-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yao X, Shao J, Wang L, Zhang J, Zhang C, Lin Y. Does workplace violence, empathy, and communication influence occupational stress among mental health nurses? Int J Ment Health Nurs 2021; 30:177-188. [PMID: 32808483 DOI: 10.1111/inm.12770] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 06/28/2020] [Accepted: 07/16/2020] [Indexed: 12/30/2022]
Abstract
Workplace violence is a major cause of occupational stress among mental health nurses, particularly those working in acute care. This study investigated the occurrence of occupational stress among mental health nurses in psychiatric hospitals and explored whether workplace violence, empathy, and communication skills influenced occupational stress levels in this population. A socio-demographic questionnaire and the Chinese Nursing Work Stress Scale, Workplace Violence Scale, Jefferson Scale of Empathy - Health Professions version, and Nurses' Clinic Communication Competence Scale were administered to 539 mental health nurses from three top-grade tertiary research hospitals in the Beijing-Tianjin-Hebei region. The analysis revealed a high level of job stress (3.06 ± 0.69) and a moderate prevalence of workplace violence (6.21 ± 2.94) existed among participants when compared with among other nurses. Meanwhile, participants' empathy (114.78 ± 15.99) and communication (4.31 ± 0.60) abilities were similar to or higher than those of other nursing populations. Mental health nurses with varying years of practice experience distinct levels of job stress. A linear regression analysis revealed that, while practice years (β = 0.104; P < 0.05) and workplace violence (β = 0.264; P < 0.01) aggravated occupational stress levels, empathy (β = -0.147; P < 0.01) facilitated reductions in stress. Results suggest that reducing workplace violence and improving empathy in therapeutic relationships can limit the pervasiveness of occupational stress among mental health nurses. Having both psychological support and organizational support after a violent incident is essential, and the importance of professional education should be stressed.
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Affiliation(s)
- Xiuyu Yao
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Jing Shao
- Department of Nursing, Beijing Huilongguan Hospital, Beijing, China
| | - Lina Wang
- Department of Nursing, Hebei sixth people's Hospital, Baoding, China
| | - Jing Zhang
- Department of Nursing, Tianjin Anding Hospital, Tianjin, China
| | - Chang Zhang
- School of Nursing, Peking Union Medical College, Beijing, China
| | - Yujie Lin
- School of Nursing, Peking Union Medical College, Beijing, China
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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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17
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Roaldset JO, Bjørkly S. Response to Ghosh et al. Int J Ment Health Nurs 2020; 29:544-545. [PMID: 32198813 DOI: 10.1111/inm.12717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 11/29/2022]
Affiliation(s)
- John Olav Roaldset
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Stål Bjørkly
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway.,Molde University College, Molde, Norway
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