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Küçük Öztürk G, Başer E, Engin E. 'On the slope of an erupting volcano': A qualitative study on the workplace violence experiences of psychiatric nurses. J Psychiatr Ment Health Nurs 2024; 31:515-524. [PMID: 38084835 DOI: 10.1111/jpm.13003] [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: 03/31/2023] [Revised: 10/13/2023] [Accepted: 11/17/2023] [Indexed: 07/03/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Workplace violence is common in healthcare. Workplace violence remains a complex and serious occupational hazard in healthcare. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Since there is no study examining detailed explanations of experiences and perspectives of workplace violence among psychiatric nurses, this study will act as a guide for psychiatric nurses. This study provides information about how psychiatric nurses evaluate the concept of workplace violence from their perspective, what it means to them and the effects of workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Considering the effects of workplace violence, a preventive, systematic and holistic approach should be used in psychiatry and community mental health centres. Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. ABSTRACT INTRODUCTION: Workplace violence is common in healthcare and remains a complex and serious occupational hazard. AIM This research was conducted to assess the workplace violence experiences and perspectives of psychiatric nurses. METHOD This study was a qualitative study conducted using a grounded theory approach method. The study was conducted between November 2022 and January 2023. The purposeful sampling method was used, and 11 psychiatric nurses were interviewed. Data were collected with an information form and a semi-structured interview form. The data were analysed using content analysis, and themes were created. FINDINGS The ages of the psychiatric nurses ranged from 38 to 57 years. Themes and sub-themes related to the workplace violence experiences and perspectives of psychiatric nurses included the way of violence (rising tension, eruption of the volcano, unintentional violence and turning to ash) and empowerment (ash cloud and ring of fire). CONCLUSION Psychiatric nurses stated that they were exposed to verbal and physical violence for many reasons, that this situation seriously affected their physical, mental and social health and that in addition to the devastating effects of violence, they became stronger by developing various skills to protect against violence. IMPLICATIONS FOR PRACTICE Supportive interventions should be used to improve the health and safety of psychiatric nurses and patients. Strategies can be developed to include psychiatric nurses in occupational health nursing courses.
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Affiliation(s)
- Gülhan Küçük Öztürk
- Department of Psychiatric Nursing, Vefa Küçük Faculty of Health Sciences, Nevşehir Hacı Bektaş Veli University Semra, Nevşehir, Turkey
| | - Eylül Başer
- Home Patient Care Program, Muş Alparslan University, Health Services Vocational School, Muş, Turkey
| | - Esra Engin
- Department of Psychiatric Nursing, Faculty of Nursing, Ege University, İzmir, Turkey
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Wijayaratnam A, Kozlowska O, Krayem A, Kaur S, Ayres H, Smith R, Paterson J, Moghabghab R, Henshall C. Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review. Int J Ment Health Nurs 2024; 33:834-858. [PMID: 38519874 DOI: 10.1111/inm.13317] [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: 05/23/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.
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Affiliation(s)
| | | | | | - Satinder Kaur
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Helen Ayres
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Jane Paterson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rola Moghabghab
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Cathy Henshall
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Oxford Brookes University, Oxford, UK
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Zhou H, Shen L, Tan H, Zhou J, Zheng Q, Jiang D. Sleep quality and related factors among healthcare workers in designated quarantine hospital site in post-pandemic based on the health ecological model: a cross-sectional study in Nanjing, China. Front Public Health 2024; 12:1419665. [PMID: 39026590 PMCID: PMC11254795 DOI: 10.3389/fpubh.2024.1419665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 06/20/2024] [Indexed: 07/20/2024] Open
Abstract
Aims This study aims to assess the status and related factors among healthcare workers (HCWs) in designated quarantine-hospital-site (DQHS) based on the model of health ecology. Methods The cross-sectional study was conducted from April to May, 2022, which included 351 valid samples. We measured sleep quality using the Pittsburgh Sleep Quality Index, which encompasses seven dimensions: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleep medication, and daytime dysfunction. Each dimension is scored individually, contributing to an overall sleep quality score. Factors associated with the sleep quality of HCWs in DQHS were divided into individual, behavioral, interpersonal and social dimensions. Hierarchical linear regressions were conducted to identify the potential factors associated with sleep quality among HCWs in DQHS. Results HCWs in DQHS had a statistically higher sleep quality than the Chinese national norm. HCWs who were female, afraid of Coronavirus disease, had more negative emotions, frequently worked overtime, were married, and had a higher income were more likely to experience worse sleep quality (p < 0.05), while those who worked between 51 and 70 h weekly, treated over 10 patients daily, and engaged in more health behaviors may have better sleep quality (p < 0.05). Conclusion This study revealed a worrying level of sleep quality among HCWs in DQHS. The government, hospital managers, and families should collaborate to ensure the sleep quality of HCWs in DQHS.
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Affiliation(s)
- Han Zhou
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Lei Shen
- Zhenjiang Mental Health Center, Zhenjiang, Jiangsu, China
| | - Huafeng Tan
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Jiefang Zhou
- Nanjing Lishui District Hospital of Traditional Chinese Medicine, Nanjing, China
| | - Qiyi Zheng
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Dongdong Jiang
- School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
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Xie P, Li HQ, Tao L, Yang H. Eliciting psychiatric nurses' preferences for workplace violence prevention: a protocol for discrete choice experiment. Front Public Health 2024; 12:1296525. [PMID: 39022405 PMCID: PMC11251884 DOI: 10.3389/fpubh.2024.1296525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Introduction Workplace violence against healthcare workers has become a serious global public health problem. The incidence of workplace violence towards Psychiatric nurses is higher than in all other medical institutions, up to 84.2% per year. It not only negatively affects many aspects of healthcare workers' lives, but also destroys the harmony of the nurse-patient relationship and reduces the quality of nursing care. The number of psychiatric nurses in China was approximately 96,000, far lower than most other countries and unable to meet the growing demand for mental health. However, the increase in workplace violence has future exacerbates the current shortage of nurses. Therefore, it is necessary to develop effective strategies to prevent psychiatric nurses from suffering from workplace violence, thereby to reduce nurse turnover and improve the quality of nursing care. A comprehensive understanding of psychiatric nurses' preferences and priorities for preventing workplace violence is an important prerequisite before formulating strategies and taking measures. Unfortunately, to date, no research has investigated the psychiatric nurses' preferences. Therefore, a discrete choice experiment (DCE) is conducting to explore the psychiatric nurses' preferences for workplace violence prevention. This article reports on methodological details of the DCE. Methods and analysis Six attributes were developed through a literature review, one-on-one interviews and focus group discussions. D-efficient design in NGENE was used to generate choice sets. SPSS 24.0 will be used for descriptive analysis of social Demography, and Stata 16.0 will be used for analysis of DCE data. A multinomial logit model will be used to preliminarily explore trade-offs between workplace violence prevention characteristics included in the choice tasks. Then, in a mixed logit model, we plan to choose some arbitrarily defined base violence prevention program and will use the nlcom command to evaluate the probability of an alternative violence prevention program. Ethics and dissemination The study was approved by the relevant ethics committees. Our findings will emphasize priority intervention areas based on the preferences of psychiatric nurses and provide references for hospitals to develop and improve workplace violence prevention strategies. The results will be shared through seminars, policy briefs, peer-reviewed journal articles and online blogs.
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Affiliation(s)
- Peng Xie
- People's Hospital of Deyang City, Deyang, China
| | - Hui-qin Li
- People's Hospital of Deyang City, Deyang, China
| | - Li Tao
- People's Hospital of Deyang City, Deyang, China
| | - Hao Yang
- West China Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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Lin E, Malhas M, Bratsalis E, Thomson K, Hargreaves F, Donner K, Baig H, Boateng R, Swain R, Benadict MB, Busch L. Behavioral skills training for teaching safety skills to mental health service providers compared to training-as-usual: a pragmatic randomized control trial. BMC Health Serv Res 2024; 24:639. [PMID: 38760754 PMCID: PMC11102142 DOI: 10.1186/s12913-024-10994-1] [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: 09/06/2023] [Accepted: 04/16/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Violence in the healthcare workplace has been a global concern for over two decades, with a high prevalence of violence towards healthcare workers reported. Workplace violence has become a healthcare quality indicator and embedded in quality improvement initiatives of many healthcare organizations. The Centre for Addiction and Mental Health (CAMH), Canada's largest mental health hospital, provides all clinical staff with mandated staff safety training for self-protection and team-control skills. These skills are to be used as a last resort when a patient is at imminent risk of harm to self or others. The purpose of this study is to compare the effectiveness of two training methods of this mandated staff safety training for workplace violence in a large psychiatric hospital setting. METHODS Using a pragmatic randomized control trial design, this study compares two approaches to teaching safety skills CAMH's training-as-usual (TAU) using the 3D approach (description, demonstration and doing) and behavioural skills training (BST), from the field of applied behaviour analysis, using instruction, modeling, practice and feedback loop. Staff were assessed on three outcome measures (competency, mastery and confidence), across three time points: before training (baseline), immediately after training (post-training) and one month later (follow-up). This study was registered with the ISRCTN registry on 06/09/2023 (ISRCTN18133140). RESULTS With a sample size of 99 new staff, results indicate that BST was significantly better than TAU in improving observed performance of self-protection and team-control skills. Both methods were associated with improved skills and confidence. However, there was a decrease in skill performance levels at the one-month follow-up for both methods, with BST remaining higher than TAU scores across all three time points. The impact of training improved staff confidence in both training methods and remained high across all three time points. CONCLUSIONS The study findings suggest that BST is more effective than TAU in improving safety skills among healthcare workers. However, the retention of skills over time remains a concern, and therefore a single training session without on-the-job-feedback or booster sessions based on objective assessments of skill may not be sufficient. Further research is needed to confirm and expand upon these findings in different settings.
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Affiliation(s)
- Elizabeth Lin
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Mais Malhas
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Emmanuel Bratsalis
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kendra Thomson
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Applied Disability Studies, Brock University, St. Catharines, ON, Canada
| | - Fabienne Hargreaves
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Kayle Donner
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Heba Baig
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rhonda Boateng
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rajlaxmi Swain
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Mary Benisha Benadict
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Louis Busch
- Department of Education, Centre for Addiction and Mental Health, Toronto, ON, Canada
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Sanz-Osorio MT, González-Diez L, Sánchez-Rueda G, Vallès V, Escobar-Bravo MA, Monistrol O. Humanised care in acute psychiatric hospitalisation units: Definition, values and strategic initiatives from the perspective of persons with mental health problems, primary carers and professionals. J Psychiatr Ment Health Nurs 2024; 31:228-239. [PMID: 37705365 DOI: 10.1111/jpm.12974] [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: 03/06/2023] [Revised: 08/04/2023] [Accepted: 08/25/2023] [Indexed: 09/15/2023]
Abstract
INTRODUCTION Humanised care refers to the holistic approach to the person, considering their bio-psycho-social and behavioural dimensions. It becomes more complex when the person has mental health problems that may affect his or her will, cognition and relationship to the world. The literature on the humanisation of mental health is scarce and only offers the view of professionals. AIM To analyse the concept, values and strategic initiatives of humanised care in acute psychiatric units from the perspective of persons with mental health problems, carers and professionals. METHOD Qualitative grounded-theory approach. Data were collected through focus groups and in-depth interviews among persons with mental health problems, carers and professionals. RESULTS Thirteen focus groups and three in-depth staff interviews were performed, with a total of 61 participants. Humanised care is defined as quality care of an individualised, ethical and safe nature, empowering persons/carers to involve them in their health process, helping them resist the stigma of mental illness through a therapeutic relationship, bond and communication. Formal training, teamwork and effective communication are required. Six values and strategic initiatives were identified. DISCUSSION Each value and strategic initiatives acquires full meaning when connected with the rest. Without this interconnection, humanised care would be impossible.
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Affiliation(s)
- Maria Teresa Sanz-Osorio
- Department of Nursing and Physiotherapy, Mental Health Nurse Specialist, University of Lleida, Lleida, Spain
- Research group on Complex Health Diagnoses and Interventions from Occupation and Care (OCCARE), Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
| | | | - Guadalupe Sánchez-Rueda
- Escola Universitària d'Infermeria i Teràpia Ocupacional de Terrassa (EUIT), Universitat Autònoma de Barcelona, Terrassa, Spain
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Jovanovic Z, Opankovic A, Milovanovic S, Barisic J, Nikolic Turnic T, Djuric D. Assessment of the Frequency, Causes, Degree and Consequences of Violence against Health Workers in Psychiatric Institutions. Healthcare (Basel) 2023; 12:84. [PMID: 38200991 PMCID: PMC10778887 DOI: 10.3390/healthcare12010084] [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: 10/01/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: The prevalence of workplace violence within the health sector varies between 50 and 88%. Depending on the health care environment, the percentages mentioned can be much higher. (2) The aim of this study was to determine the prevalence, characteristics, factors, and consequences of violence against healthcare workers (physicians, nurses, and technicians) in psychiatric institutions in the Republic of Serbia. Additionally, this study should validate the Serbian version of the aggression questionnaire, which could be a significant tool in recognizing and assessing any type of violence against health care workers in psychiatric institutions. (3) Methods: This study was designed as an observational questionnaire study that included 191 health workers (physicians, medical technicians, workers in kitchens or maintenance, and others) from three psychiatric institutions. As an instrument, this study validated and used the Serbian version of the aggression standardized questionnaire. We observed the primary and secondary outcomes of potential violence in psychiatric institutions against healthcare workers using different parameters. (4) Results: The internal consistency of each item as well as the instrument was very good (the mean Cronbach alfa = 0.91). A total of 104 of the participants never experienced physical violence, while more than five times that had 20 health workers (10.5%). We observed the statistical significance of gender, age, working status (permanent/limited) and professional status (physician/medical technician/worker etc.) on physical attack incidence. (5) Conclusions: The incidence of violence against healthcare workers is very high, especially in terms of physical assault and threats in the workplace. The majority of the victims were women who work as medical technicians, attacked by male patients with unknown motivation. A number of changes in the structure and organizational culture of the hospital are required. All hospital employees, employers, patients, and their families share responsibility for the creation of a safe workplace.
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Affiliation(s)
- Zoran Jovanovic
- Department of Psychiatry, General Hospital Sabac, 15000 Šabac, Serbia;
| | - Ana Opankovic
- Clinical Centre of Serbia, Clinic for Psychiatry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.O.); or (S.M.)
| | - Srdjan Milovanovic
- Clinical Centre of Serbia, Clinic for Psychiatry, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (A.O.); or (S.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Jasmina Barisic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia;
| | - Tamara Nikolic Turnic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- N.A. Semashko Public Health and Healthcare Department, F.F. Erismann Institute of Public Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119435 Moscow, Russia
| | - Dusan Djuric
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, 34000 Kragujevac, Serbia;
- Institute for Rehabilitation, 11000 Belgrade, Serbia
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Anastasi G, Bambi S. Utilization and effects of security technologies in mental health: A scoping review. Int J Ment Health Nurs 2023; 32:1561-1582. [PMID: 37449535 DOI: 10.1111/inm.13193] [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: 10/20/2022] [Revised: 06/15/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Violence in healthcare is an urgent and increasing issue. Mental health settings are particularly affected, with severe negative impacts on staff, patients, and organizations. Security technologies could help maintain and improve safety in this field. However, knowledge of their utilization and effectiveness in mental health is lacking. A scoping review was conducted using the methodology recommended by the Joanna Briggs Institute to map research on the utilization and effects of security technologies in mental health, identify how research is currently performed, and highlight gaps in the existing knowledge. Literature search for peer-reviewed publications was performed on PubMed, CINAHL, PsycInfo, Embase, and Scopus. Following the screening process and the eligibility criteria, 22 articles were included in this review. The publication range was 2002-2020, many studies were surveys, and European countries were the most investigated, especially the United Kingdom. Overall, the use of 10 different technologies was reported 46 times. The most represented category was alarms, followed by video cameras, other technologies (such as wearable sensors), and metal detectors. More than half of the included papers reported positive effects of these measures on safety. This review indicates that several security technologies are available in mental health settings, with encouraging positive safety outcomes for both patients and healthcare professionals, especially nurses. However, research on the topic is still emerging, with a limited number of sources and a few high-quality designed studies. Therefore, future research should focus on producing evidence on the availability and effectiveness of these measures in mental health settings across countries.
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Affiliation(s)
- Giuliano Anastasi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Bambi
- Department of Health Sciences, University of Florence, Florence, Italy
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Liu SJ, Wang QN, She J, Zhang YH, Xu H. Relationship between emotional intelligence and job stressors of psychiatric nurses: A multi-centre cross-sectional study. J Clin Nurs 2023; 32:7730-7739. [PMID: 37661580 DOI: 10.1111/jocn.16865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 08/12/2023] [Accepted: 08/21/2023] [Indexed: 09/05/2023]
Abstract
AIM To investigate the impact of socio-demographic factors and job stressors on the emotional intelligence of psychiatric nurses. BACKGROUND Emotional intelligence plays a crucial role in enabling nurses to effectively manage their own emotions, comprehend the emotions of others and assist individuals in dealing with diverse stressors. Nevertheless, a comprehensive conceptualization of the relationship between job stressors and emotional intelligence remains lacking. DESIGN This study employs a multi-centre cross-sectional design. METHODS A multi-centre cross-sectional survey involving 1083 registered nurses from 11 psychiatric hospitals across four provinces in China was conducted. Non-probability sampling was utilised. The survey encompassed assessments of nurse job stressors, emotional intelligence using a scale and socio-demographic characteristics using a questionnaire. A multiple linear regression model was applied to identify significant variables associated with emotional intelligence based on demographic attributes and various nurse job stressors. The study adhered to the STROBE checklist. RESULTS The findings revealed a noteworthy negative correlation between nurse job stressors and emotional intelligence. Socio-demographic factors and job stressors of certain nurses were able to predict emotional intelligence and its dimensions among psychiatric nurses, with percentages of 44.50%, 40.10%, 36.40%, 36.60% and 34.60%. CONCLUSION Providing emotional intelligence training for psychiatric nurses could enhance their capacity to cope effectively with workplace stress, particularly among younger nurses who engage in limited physical activities. RELEVANCE TO CLINICAL PRACTICE The analysis of the relationship between emotional intelligence and nurse job stressors could facilitate early detection and intervention by managers based on pertinent factors. This, in turn, could elevate the emotional intelligence level of psychiatric nurses. NO PATIENT OR PUBLIC CONTRIBUTION This study did not recruit participants, so details of participants were not be involved.
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Affiliation(s)
- Shou-Juan Liu
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qiong-Nan Wang
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Juan She
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Yan-Hong Zhang
- Department of Nursing, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hua Xu
- Department of Adult Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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Abbiati M, Golay P, De Maria LF, Palix J. Measuring the Severity of Objective and Subjective Patient-to-Staff Violence in Psychogeriatric and Adult Psychiatric Wards: A Retrospective Study of Four Swiss Hospitals. Issues Ment Health Nurs 2023; 44:1142-1149. [PMID: 37699065 DOI: 10.1080/01612840.2023.2246560] [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: 09/14/2023]
Abstract
Measurement of patient-to-staff violence (PSV) is essential for the institution to prevent negative outcomes and provide effective interventions. Although there are several approaches to doing this in psychiatry, little is known about how well they adapt to different types of wards. The role of gender and age also needs further investigation. The present study aimed to examine and compare characteristics that contribute to the objective and subjective measurement of the severity of PSV in adult (AP) and geriatric (PG) psychiatric wards. Results show that 70% of the reported violence over 30 months (N = 589) was PSV, mostly perpetrated by male patients against nurses. Objective severity ratings were higher in PG than in AP wards, and conversely, subjective ratings were higher in AP than in PG wards. The findings support the systematic measurement of PSV in psychiatric wards and highlight the need for targeted interventions to address the risks associated with minimizing violence.
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Affiliation(s)
- Milena Abbiati
- Legal Psychiatry and Psychology Research Unit, Institute of Legal Psychiatry, Lausanne University Hospital, Switzerland
| | - Philippe Golay
- Community Psychiatry Unit, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland
- General Psychiatry Unit, Treatment and Early Intervention in Psychosis Program (TIPP-Lausanne), Lausanne University Hospital and University of Lausanne, Switzerland
- Institute of Psychology, University of Lausanne, Switzerland
| | - Lora Flor De Maria
- Legal Psychiatry and Psychology Research Unit, Institute of Legal Psychiatry, Lausanne University Hospital, Switzerland
| | - Julie Palix
- Legal Psychiatry and Psychology Research Unit, Institute of Legal Psychiatry, Lausanne University Hospital, Switzerland
- Institute of Psychology, University of Lausanne, Switzerland
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Choi H, Shin S, Jeon J, Lee H, Lee J, Seo C, Kim S, Park S, Woo S. Workplace Violence Experienced by Community Mental Health Workers. Issues Ment Health Nurs 2023; 44:726-734. [PMID: 37364259 DOI: 10.1080/01612840.2023.2219753] [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: 06/28/2023]
Abstract
A cross-sectional online survey was conducted to 1) investigate the prevalence of workplace violence and workers' emotional distress, 2) explore factors associated with workplace violence, and 3) assess workers' needs for preventive measures. A total of 763 community mental health workers participated in Korea. Among them, 85.85% of workers experienced workplace violence, including verbal (74.31%), emotional (66.45%), infectious (47.44%), informational (42.60%), sexual (32.50%), and physical (23.72%) abuse. Binary logistic regression analysis indicated that sex, occupation, certification, and working institution were significantly associated with workplace violence. Workplace violence affects workers' depression, anger, and anxiety negatively. The most-needed preventive measure is a two-person home visit.
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Affiliation(s)
- Heeseung Choi
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Soyoun Shin
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Junhee Jeon
- Hwaseong Community Mental Health Welfare Center, Gyeonggi-do, Republic of Korea
| | - Heewoo Lee
- Department of Psychiatry, Seoul Medical Center, Seoul, Republic of Korea
| | - Jongeun Lee
- Department of Nursing, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - ChongHee Seo
- Hwaseong Youth Mental Health Welfare Center, Gyeonggi-do, Republic of Korea
| | - Sumi Kim
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
| | - Sanghoon Park
- Ulsan Donggu Community Mental Health Center, Ulsan, Republic of Korea
| | - SoHyun Woo
- College of Nursing and Research Institute of Nursing Science, Seoul National University, Seoul, Republic of Korea
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Jones N, Decker VB, Houston A. De-Escalation Training for Managing Patient Aggression in High-Incidence Care Areas. J Psychosoc Nurs Ment Health Serv 2023; 61:17-24. [PMID: 36853038 DOI: 10.3928/02793695-20230221-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Health care personnel who have close, face-to-face patient contact experience more workplace violence (WPV) than employees in other fields. Certain health care departments (i.e., high-incidence care areas) have elevated rates of WPV that can have adverse emotional, physical, and financial consequences for patients, employees, and institutions. Health care workers need de-escalation training to efficiently manage patient aggression while also safeguarding patients' dignity and patient-provider trust. The current Plan, Do, Study, Act quality improvement project used insights from an in-depth literature review to create a 1-hour, evidence-based, in-service de-escalation training for personnel from high-incidence care areas. A pre/post design was used to evaluate participants' responses to the Confidence Coping with Patient Aggression Instrument. Post-training, participants reported significantly increased feelings of safety regarding potential patient aggression (p = 0.001) and more efficacy regarding their aggression management techniques (p = 0.039). Based on the training's results, recommendations were made for future institutional de-escalation initiatives. [Journal of Psychosocial Nursing and Mental Health Services, 61(8), 17-24.].
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Bekelepi N, Martin P. Self-reported incidents of violence towards nurses working in acute psychiatric units. Curationis 2023; 46:e1-e8. [PMID: 37403668 PMCID: PMC10319927 DOI: 10.4102/curationis.v46i1.2350] [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: 06/03/2022] [Revised: 05/15/2023] [Accepted: 05/18/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Acute psychiatric units are found to be stressful working environments because of the nature of illness patients present with. OBJECTIVES This study aimed to determine self-reported incidents of physical and verbal violence towards nurses working in acute psychiatric units in Western Cape, South Africa. METHOD A questionnaire was used to collect data. Chi-square test was performed to determine association between gender, category and experience of violence. Mann-Whitney U test was carried out to determine associations between years of employment and the likelihood of experiencing physical violence and verbal abuse. RESULTS Overall physical violence 35 (34.3%) and verbal abuse 83 (83%) incidents. Most female respondents reported both physical violence (74.2%, n = 26) and verbal abuse (72.2%, n = 60), with (56.2%, n = 18) professional nurses reporting physical violence. Years of employment was statistically significantly associated with the likelihood of nurses experiencing physical violence (p = 0.007). CONCLUSION Most respondents (74.2%, n = 26) were females and they mostly experienced physical violence and verbal abuse while 28.2% (n = 29) were males. Years of service were associated with the likelihood of experiencing physical violence.Contribution: The knowledge gained will add on existing knowledge about the challenge of violence experienced by nurses in the workplace and might have an influence on policymakers.
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Affiliation(s)
- Ntombiyakhe Bekelepi
- School of Nursing, Faculty of Community Health Science, University of the Western Cape, Cape Town.
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14
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Biswas J, Lee SE, Muñoz CG, Armstrong NE. Delays in commitment and treatment court proceedings worsen psychiatric and other medical conditions. Schizophr Res 2023; 255:189-194. [PMID: 37003238 DOI: 10.1016/j.schres.2023.03.022] [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: 09/11/2022] [Revised: 03/07/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023]
Abstract
OBJECTIVE Adversarial hearings in hospital commitment and de novo treatment proceedings, or court hearings, delay psychiatric treatment in many jurisdictions. In Massachusetts, the "treatment over objection" process requires a court petition. For state hospital patients, the delay to treatment is an initial 34 day waiting period in addition to continuances of court hearings that extend treatment delays. This study examined the frequency of adverse medical events due to delayed court hearings within a forensic state hospital in the US. METHODS The study reviewed all (n = 355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems. RESULTS 82.6 % of treatment petitions led to involuntary treatment, 16.6 % were withdrawn by the medical petition filer, and only 0.8 % petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41 days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced. CONCLUSIONS Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.
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Affiliation(s)
- Jhilam Biswas
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA and Harvard Medical School, Boston, MA, United States of America.
| | - Sarah E Lee
- Department of Psychiatry, University of Maryland Medical School, Baltimore, MD, United States of America
| | - Carla G Muñoz
- Department of Forensic eServices, Solomon Carter Fuller Mental Health Center, Boston, MA, United States of America
| | - Natalie E Armstrong
- Forensic Evaluation Team, Central State Hospital, Petersburg, VA, United States of America
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15
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Flannery RB, Flannery GJ. Characteristics of International Staff Victims of Psychiatric Patient Assaults: Review of Published Findings, 2017-2022. Psychiatr Q 2023; 94:79-88. [PMID: 36705881 PMCID: PMC9880918 DOI: 10.1007/s11126-022-10008-5] [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: 10/13/2022] [Revised: 10/13/2022] [Accepted: 11/16/2022] [Indexed: 01/28/2023]
Abstract
Psychiatric patient assaults on staff are a worldwide occupational hazard for health care staff that results in medical injury, human suffering, and dollar cost expense. International research through 2000-2017 documented the continued frequency of these assaults and a continuing high risk for nursing personnel. This present paper reviewed the international published literature on staff victims of patient assaults during the next five-year period of 2017-2022. There were 39,034 assaults on 34,679 employee victims. The findings indicate that assaults on staff remain a serious worldwide issue as it has been since the 1990s and that nursing personnel continued to be at greater risk. Aggression management approaches, post-incident interventions, and an updated methodological inquiry are presented.
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Affiliation(s)
- Raymond B Flannery
- University of MA Chan School of Medicine, 7 Westchester Road, 02458, Newton, MA, USA.
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16
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Appelbaum PS. Regulating Workplace Safety in Psychiatric Facilities. Psychiatr Serv 2023; 74:441-443. [PMID: 36820524 DOI: 10.1176/appi.ps.20230036] [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] [Indexed: 02/24/2023]
Abstract
Violence by patients is common in psychiatric facilities. Under federal law, however, employers are charged with taking steps to protect worker safety. A recent case from a psychiatric hospital in Colorado illustrates how the Occupational Safety and Health Act can be invoked to remedy deficiencies in workplace safety. Following an anonymous complaint by an employee, an onsite investigation revealed multiple lapses, ranging from inadequate staffing to an antiquated emergency system, which had led to frequent injuries among staff as a result of patient assault. After a court hearing, the hospital's challenge to a remediation plan was rejected, creating a precedent for improving safety at other facilities.
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17
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Hvidhjelm J, Berring LL, Whittington R, Woods P, Bak J, Almvik R. Short-term risk assessment in the long term: A scoping review and meta-analysis of the Brøset Violence Checklist. J Psychiatr Ment Health Nurs 2023. [PMID: 36718598 DOI: 10.1111/jpm.12905] [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: 04/27/2022] [Revised: 12/17/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Existing literature on the Brøset Violence Checklist (BVC) is examined in the context of usability, implementation and validity to provide evidence-based recommendations on its application and identify opportunities for future development. AIM/QUESTION To identify current knowledge on the BVC and guide clinicians and researchers toward the next steps in using this tool in clinical practice to prevent violence in healthcare settings. METHOD A scoping review approach with a meta-analysis supplement was adopted to broadly identify and map available evidence on the BVC and provide specific estimates of predictive validity in different contexts. RESULTS Sixty-two studies conducted in 23 countries addressed the implementation of the BVC across various settings. Many studies adapted the original BVC, and the clinical utility was noted as an important feature. A meta-analysis of the original BVC format estimated a pooled area under the curve at 0.83 (95% CI 0.78-0.87) in a subset of 15 studies. DISCUSSION The BVC combines high predictive validity and good clinical utility across a wide range of settings and cultures. It should continue to be incorporated into routine practice in mental health services focused on preventing violence and coercion. IMPLICATIONS FOR PRACTICE Development of collaborative approaches with service users involved in assessing their own risk of future violence.
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Affiliation(s)
- Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center, Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Centre for Relation & De-escalation, Mental Health Services, Region Zealand, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Richard Whittington
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Phil Woods
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesper Bak
- Clinical Mental Health and Nursing Research Unit, Mental Health Center, Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Roger Almvik
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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18
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Sun L, Zhang W, Cao A. Associations between work-related variables and workplace violence among Chinese medical staff: A comparison between physical and verbal violence. Front Public Health 2023; 10:1043023. [PMID: 36703849 PMCID: PMC9871913 DOI: 10.3389/fpubh.2022.1043023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Background Workplace violence (WPV) against medical staff has been an important public health and societal problem worldwide. Although numerous studies have implied the differences between physical violence (PV) and verbal violence (VV) against medical staff, few studies were conducted to analyze the different associations between work-related variables, PV, and VV, especially in China. Methods A cross-sectional study was conducted among Chinese medical staff in public hospitals, and 3,426 medical staff were interviewed and analyzed. WPV, including PV and VV, were evaluated by the self-report of the medical staff. Work-related variables, physical disease, depression, and social-demographic variables were also measured. The work-related variables included types of medical staff, professional titles, hospital levels, managers, working years, job changing, working hours/week, night duty times/week, monthly income, self-reported working environment, and social position. Logistic regressions were conducted to examine the factors associated with PV and VV. Results A total of 489 medical staff (23.0%) reported the experience of PV and 1,744 (50.9%) reported the experience of VV. Several work-related variables were associated with PV and VV, including nurse (OR = 0.56 for PV, p < 0.01; OR = 0.76 for VV, p < 0.05), manager (OR = 1.86 for PV, p < 0.01; OR = 1.56 for VV, p < 0.001), night duty frequency/week (OR = 1.06 for PV, p < 0.01; OR = 1.03 for VV, p < 0.01), bad working environment (OR = 2.73 for PV, p < 0.001; OR = 3.52 for VV, p < 0.001), averaged working environment (OR = 1.51 for PV, p < 0.05; OR = 1.55 for VV, p < 0.001), and bad social position (OR = 4.21 for PV, p < 0.001; OR = 3.32 for VV, p < 0.001). Working years (OR = 1.02, p < 0.05), job changing (OR = 1.33, p < 0.05), and L2 income level (OR = 1.33, p < 0.01) were positively associated with VV, but the associations were not supported for PV (all p>0.05). The other associated factors were male gender (OR = 1.97 for PV, p < 0.001; OR = 1.28 for VV, p < 0.05) and depression (OR = 1.05 for PV, p < 0.001; OR = 1.04 for VV, p < 0.001). Conclusion Both PV and VV were positively associated with work-related variables, such as doctor, manager, more night duty frequency, perceived bad working environment, or social position. Some variables were only associated with VV, such as working years, job changing, and monthly income. Some special strategies for the work-related variables should be applied for controlling PV and VV.
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Affiliation(s)
- Long Sun
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, Shandong, China
| | - Wen Zhang
- Department of Psychiatry, Binzhou People Hospital, Binzhou, Shandong, China
| | - Aihua Cao
- Department of Pediatrics, Qilu Hospital of Shandong University, Jinan, Shandong, China
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19
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Chang PY, Chen JH, Cheng HW, Wang YC. Effects of Psychiatric Disease Severity and Clinical Characteristics on Duration of High Violence Risk: A Perspective on Violence Prevention in the Psychiatric Ward. Neuropsychiatr Dis Treat 2023; 19:663-671. [PMID: 37007613 PMCID: PMC10065427 DOI: 10.2147/ndt.s403388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/16/2023] [Indexed: 04/04/2023] Open
Abstract
Objective Prevention, de-escalation, and management of violence in the acute psychiatric ward is essential. Few studies have focused on differences in the duration of high-violence risk between different profiles of high-violence risk. This study aimed to analyze the data of high-violence patients and duration of high-violence risk to provide a new perspective on violence prevention, de-escalation and management. Methods This retrospective observational cohort study included 171 patients who were treated in the acute psychiatric ward of Keelung Chang Gung Memorial Hospital between January 2016 and June 2020, and who were assessed daily as having high violence risk. All patient data were collected from electronic hospital records (eg, age, gender, diagnosis, violence history, self-harm history, and admission condition (involuntary admission, discharged against medical advice). Between-group differences in disease severity, use of antipsychotics and benzodiazepine, and duration of high violence risk were analyzed using regression analysis. Results Only patients' age was significantly associated with duration of high-violence risk (P = 0.028), making it predictive of longer duration of high-violence risk. In patients with schizophrenia spectrum disorder or bipolar disorder, higher severity was significantly associated with longer duration of high-violence risk (P = 0.007, P = 0.001, respectively). Conclusion Only age is a predictor of longer duration of violence risk in psychiatric patients, although higher severity is associated with higher violence risk. Study results may help management and healthcare staff better understand how quickly or slowly violence risk will decrease and may improve efficient use of healthcare resources and individualized patient-centered care.
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Affiliation(s)
- Ping-Ying Chang
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
| | - Jian-Hong Chen
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
- School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China
- Doctoral Program for Transnational Sport Management and Innovation, National Taiwan Sport University, Taoyuan, Taiwan, Republic of China
- Correspondence: Jian-Hong Chen, Email
| | - Hui-Wen Cheng
- Department of Psychiatry, Chang-Gung Medical Foundation Keelung Chang-Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Yen-Chin Wang
- Department of Psychiatry, National Taiwan University Hospital, Hsin-Chu Branch, Hsinchu, Taiwan, Republic of China
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20
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Doedens P, Vermeulen J, Ter Riet G, Boyette LL, Latour C, de Haan L. Association between characteristics of nursing teams and patients' aggressive behavior in closed psychiatric wards. Perspect Psychiatr Care 2022; 58:2592-2600. [PMID: 35505593 PMCID: PMC9790403 DOI: 10.1111/ppc.13099] [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: 01/25/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Estimate the effect of nursing, shift, and patient characteristics on patients' aggression. DESIGN AND METHODS Follow-up study on a closed psychiatric ward was performed to estimate the effect of nursing team characteristics and patient characteristics on the incidence of aggression. FINDINGS The incidence of aggression (n = 802 in sample) was lower in teams with >75% male nurses. Teams scoring high on extraversion experienced more verbal aggression and teams scoring high on neuroticism experienced more physical aggression. Younger patients and/or involuntarily admitted patients were more frequently aggressive. PRACTICE IMPLICATIONS These findings could stimulate support for nurses to prevent aggression.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Gerben Ter Riet
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands.,Department of Cardiology, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Corine Latour
- Urban Vitality - Centre of Expertise, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, location Academic Medical Center, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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21
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Nurses’, patients’, and informal caregivers’ attitudes toward aggression in psychiatric hospitals: A comparative survey study. PLoS One 2022; 17:e0274536. [PMID: 36174064 PMCID: PMC9522285 DOI: 10.1371/journal.pone.0274536] [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: 09/07/2021] [Accepted: 08/30/2022] [Indexed: 12/02/2022] Open
Abstract
Attitudes toward aggression is a controversial phenomenon in psychiatry. This study examined and compared attitudes toward patient aggression in psychiatric hospitals from the perspectives of nurses, patients and informal caregivers and identified factors associated to these attitudes. A total of 2,424 participants completed a self-reported instrument regarding attitudes toward aggression (12-items Perception of Aggression Scale; POAS-S). We analysed data from nurses (n = 782), patients (n = 886), and informal caregivers (n = 765). Pearson’s r correlations were used to examine associations between variables. Differences between group scores were analysed using ANOVA/MANOVA with post-hoc Sheffe tests. Multivariate logistic regression models and logistic regression analysis were used to examine the effects of respondents’ characteristics on their attitudes toward aggression. Nurses had significantly more negative and less tolerant perceptions toward aggression (mean [SD] 47.1 [7.5], p<0.001) than the patients (mean [SD] 44.4 [8.2]) and the informal caregivers (mean [SD] 45.0 [6.9), according to the POAS-S total scores. The same trend was found with the dysfunction and function sub-scores (mean [SD] 25.3 [4.1] and 15.0 [3.6], respectively); the differences between the groups were statistically significant (p <0.001) when nurses’ scores were compared to those of both the patients (mean [SD] 23.7 [5.3] and 14.0 [4.1], respectively) and the informal caregivers (mean [SD] 24.4 [4.2] and 13.9 [3.5], respectively). The study offers new understanding of aggressive behavior in different treatment settings where attitudes toward patient behavior raises ethical and practical dilemmas. These results indicate a need for more targeted on-the-job training for nursing staff, aggression management rehabilitation programs for patients, and peer-support programs for informal caregivers focused on patient aggression.
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22
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Mistler LA, Friedman MJ. Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review and Recommendations. Psychiatr Serv 2022; 73:650-657. [PMID: 34521209 DOI: 10.1176/appi.ps.202000297] [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] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Violence by patients against inpatient psychiatric unit staff is common, causing considerable suffering. Despite the Joint Commission's 2018 requirement for behavioral health organizations to use standardized instruments, no identified gold standard measures of violence and aggression exist. Therefore, accurate data are lacking on the frequency of patient-to-staff violence to guide development of safer institutional clinical policies or to assess the impact of targeted interventions to reduce violence. To inform recommendations for developing standardized scales, the authors reviewed the scoring instruments most commonly used to measure violence in recent studies. METHODS A comprehensive literature search for violence measurement instruments in articles published in English from June 2008 to June 2018 was performed. Review criteria included use of instruments measuring patient-to-staff violence or aggression in acute, nonforensic, nongeriatric populations. Exclusion criteria included child or adolescent populations, staff-to-staff violence, and staff- or visitor-to-patient violence. RESULTS Overall, 74 studies were identified, of which 74% used structured instruments to measure aggression and violence on inpatient psychiatric units during the past 10 years. The instruments were primarily variants of the Observed Aggression Scale (OAS); 26% of the studies used unstructured clinical notes and researcher questionnaires. Major obstacles to implementing measurement instruments included time and workflow constraints and difficulties with use. CONCLUSIONS In the past 10 years, OAS variants with evidence of validity and reliability that define aggression and violence have been consistently used. The authors propose that adapting the Modified OAS to collect real-time clinical data could help overcome barriers to implementing standardized instruments to quantify violence against psychiatric staff.
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Affiliation(s)
- Lisa A Mistler
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Mistler, Friedman); New Hampshire Hospital, Concord (Mistler); National Center for PTSD, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont (Friedman)
| | - Matthew J Friedman
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Mistler, Friedman); New Hampshire Hospital, Concord (Mistler); National Center for PTSD, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont (Friedman)
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Jang SJ, Son YJ, Lee H. Prevalence, associated factors and adverse outcomes of workplace violence towards nurses in psychiatric settings: A systematic review. Int J Ment Health Nurs 2022; 31:450-468. [PMID: 34773361 DOI: 10.1111/inm.12951] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 01/24/2023]
Abstract
Workplace violence towards psychiatric nurses by psychiatric patients is common, which can potentially affect care quality as well as nurses' health. This study aimed to synthesize the literature on workplace violence towards psychiatric nurses and identify the prevalence and factors influencing workplace violence and related outcomes. PubMed, Cochrane Library, CINAHL, EMBASE and PsychINFO were searched for English articles on workplace violence against psychiatric nurses published from January 2011 to December 2020. Sixteen articles were selected for the systematic review. This was followed by quality assessment and data extraction. The workplace violence prevalence ranged 11.4-97.6%. Diagnosis of the patient; nurse-related factors such as age, sex, marital status, education, emotional intelligence level and personality; and work shift were associated with the occurrence of workplace violence. Psychiatric nurses who experienced workplace violence had primarily poor mental health such as depressive symptoms and negative work-related outcomes such as turnover intention. The results revealed that there were relatively few patient-related factors associated with workplace violence and few reports on workplace violence-related to nurses' physical health, suggesting the need for a multi-dimensional approach. Future studies are needed to develop standardized instruments for workplace violence investigation considering inpatients psychiatric settings. Effective workplace violence prevention strategies should consider comprehensive patient-, nurse- and occupation-related factors.
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Affiliation(s)
- Sun Joo Jang
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Youn-Jung Son
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
| | - Haeyoung Lee
- Red Cross College of Nursing, Chung-Ang University, Seoul, Korea
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