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Kiymaz D, Koç Z. Workplace violence, occupational commitment and intention among emergency room nurses: A mixed-methods study. J Clin Nurs 2023; 32:764-779. [PMID: 35429057 DOI: 10.1111/jocn.16331] [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: 01/21/2022] [Revised: 03/21/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This study aimed to determine the correlations between the violence experienced by emergency nurses in the work environment, their occupational commitment and their intention to resign. BACKGROUND The emergency service, when compared with other hospital departments, is the unit where violence against healthcare workers is most common. DESIGN A multi-method design was used. METHODS The research was carried out between 15 January 2020 and 15 May 2021. The sample of the study consisted of 202 emergency service nurses. The first stage of the research was reserved for the validity and reliability study of the Turkish version of the Perceptions of the Prevalence of Aggression Scale (POPAS). Quantitative data were collected using the POPAS, the Three-Component Model of Commitment Scale. A qualitative method was used to determine in-depth the causes and effects of the violence the nurses were exposed to and what they thought and felt about the factors affecting their commitment to the occupation and their intention to resign. The Consolidated criteria for Reporting Qualitative Research (COREQ) were used for this paper. RESULTS The fit index values of the POPAS, which were confirmed with 15 items and four subdimensions, were determined to be acceptable and highly reliable. It was determined that 96.5% of the nurses were exposed to verbal violence. Qualitative interviews with nurses revealed that the violence they were subjected to in the working environment affected the nurses physically, psychologically, socially and caused them to consider leaving their jobs. CONCLUSIONS The increasing incidence of exposure to violent behaviours and verbal violence was found to decrease nurses' emotional commitment to their occupation. RELEVANCE TO CLINICAL PRACTICE Nurses' working conditions and work environments should be improved and their workload should be reduced in order to maximise their level of occupational commitment and prevent them from thinking about resigning.
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Affiliation(s)
- Dilek Kiymaz
- Sağlık Bilimleri University Samsun Education and Research Hospital, Samsun, Turkey
| | - Zeliha Koç
- Health Science Faculty, Ondokuz Mayıs University, Samsun, Turkey
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Soenen C, Van Overmeire R, Six S, Bilsen J, De Backer L, Glazemakers I. Aggression in mental health care: Opportunities for the future-A qualitative study on the challenges when defining and managing aggression across inpatient disciplines. J Psychiatr Ment Health Nurs 2023. [PMID: 36708052 DOI: 10.1111/jpm.12904] [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: 03/08/2022] [Revised: 12/31/2022] [Accepted: 01/11/2023] [Indexed: 01/29/2023]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Aggression towards caregivers is a global phenomenon in mental health care. Although attempts have been made to define aggression, there is no globally accepted definition. Discrepancies in defining aggression can lead to differences in judgement and a sub-par management of aggression. The fact that different disciplines work together in mental health care makes it an even more pressing matter as no research was found regarding a multidisciplinary definition of aggression. Currently, coercive measures, such as isolation, sedation or restraints, are the most common ways of managing aggression. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Mental healthcare nurses and psychologists defined aggression by previous experiences, and they also agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Several opportunities and examples of best practice were given by the participants, but the consensus was that caregivers are in need of alternatives when they are face to face with acute aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is vital for residential units to agree on a definition of aggression and acute aggression. It is our belief that this can aid them in preventing and de-escalating aggression as well as diminishing the use of coercive measures. Further primary research exploring the opportunities of non-coercive techniques, a multidisciplinary approach and the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers is also needed. ABSTRACT INTRODUCTION: Aggression by patients against healthcare workers is a global recurring phenomenon in mental health care. Discrepancies in defining aggression can lead to differences in judgement, which in turn causes difficulties in managing aggression. The multidisciplinary nature of mental healthcare makes a standardized definition an even more pressing matter. No studies, however, were found exploring the way different disciplines approach the definition of aggression. Although traditional methods of managing aggression rely on coercive methods, current research favours the use of non-coercive measures. AIM The aim of this study was to explore the different ways mental healthcare nurses and psychologists define and manage aggression in a residential unit. METHOD A qualitative research design was used, consisting of interviews and focus groups. Transcripts were analysed using a reflexive thematic approach. RESULTS Three major themes were found: (1) approaches towards defining aggression, (2) experiencing aggression and (3) managing aggression: the need for alternatives. DISCUSSION In this study, aggression is defined by how aggression has been experienced, both mental health nurses and psychologists agree that there are no alternatives in managing aggression when non-coercive techniques do not work. Aggression is considered an integral part of the job indicating an "aggression-tolerating" workplace. IMPLICATIONS FOR PRACTICE Three implications for practice were identified: (1) It is vital for residential units to agree on a broad-based definition of aggression, (2) further primary research exploring the opportunities of non-coercive techniques and a multidisciplinary approach is crucial and (3) the relationship between a workplace culture normalizing aggression and the mental well-being of healthcare workers also needs further study.
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Affiliation(s)
- Clemens Soenen
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp and Odisee University of Applied Sciences, Antwerp, Belgium
| | - Roel Van Overmeire
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Stefaan Six
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Johan Bilsen
- Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Lieve De Backer
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Inge Glazemakers
- The Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
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Geoffrion S, Lamothe J, Giguère CÉ, Collin-Vézina D. The effects of adherence to professional identity, workplace aggression, and felt accountability on child protection workers' professional quality of life. CHILD ABUSE & NEGLECT 2023; 135:105950. [PMID: 36410288 DOI: 10.1016/j.chiabu.2022.105950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 10/21/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Child protection workers (CPWs) are exposed to physical and psychological violence initiated by clients. The consequences associated with exposure to this type of trauma and others are compounded by the anxiety generated by the feelings of being accountable and the constant scrutiny and monitoring CPWs are under. Previous research suggests that acting according to one's professional values can help protect against the effects of trauma exposure and the anxiety associated with being held accountable when situations devolve into crises. METHODS AND OBJECTIVES Using path analysis, this study sought to investigate how this complex intersection between client aggression, felt accountability, and professional identity among 310 CPWs is related to their professional quality of life (ProQol). RESULTS Results show that adherence to professional identity was strongly and positively associated with ProQoL scores (β = -0.42, p < .001). Felt accountability and exposure to psychological violence (but no other forms of violence) were consistently and negatively related to ProQoL scores (β = -0.42, p < .001/β = -0.20, p < .001). The impact of felt accountability on ProQoL scores can be partially explained by lowered adherence to professional identity. This suggests that the current way CPWs are held accountable and evaluated comes at odds with their professional values. CONCLUSION The article ends with a discussion on how organizational changes surrounding accountability can be anxiety-inducing for some CPWs who increasingly feel overwhelmed by the complexity of their cases. Organizations must therefore reflect on how they can better embody the values of their clinicians.
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Affiliation(s)
- Steve Geoffrion
- School of Social Work, Université de Sherbrooke, 2500, boul. de l'Université, Sherbrooke, QC, J1K 2R1; Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montréal, QC H1N 3M5, Canada.
| | - Josianne Lamothe
- School of Social Work, McGill University, 3506 University St., Montreal, QC H3A 2A7, Canada
| | - Charles-Édouard Giguère
- Institut universitaire en santé mentale de Montréal, 7401, rue Hochelaga, Montréal, QC H1N 3M5, Canada
| | - Delphine Collin-Vézina
- School of Social Work, McGill University, 3506 University St., Montreal, QC H3A 2A7, Canada
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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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Nam S, Hong S, Kim H, Wong JYH, Fong DYT. Reliability and validity of the Korean 12-item Perception of Aggression Scale. J Psychiatr Ment Health Nurs 2022; 29:442-450. [PMID: 33780587 DOI: 10.1111/jpm.12759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The importance of and interest in nurses' attitudes towards and subjective experience with workplace violence in clinical settings is increasing. The prevalence of patient-perpetrated violence against Korean nurses in hospital settings is highly prevalent. Only few instruments are available to measure the nurses' perception of patient aggression in Korea. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to assess the linguistic and psychometric reliability and validity of an instrument that evaluates the attitude of Korean nursing staff towards patient-perpetrated workplace violence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: This valid and reliable instrument could be used to assess and monitor the nurses' attitudes towards aggressive tendencies in the workplace. The results could contribute to the development of relevant interventions for coping with violence by patients towards nursing staff and the implementation of practical training to cultivate healthy perceptions towards patients to foster therapeutic nurse-patient relationships. ABSTRACT: Introduction Despite the high prevalence of patient-perpetrated violence against Korean nurses globally, reliable and valid measures of patient aggression are lacking in Korean. Aim We translated the 12-item Perception of Aggression Scale (POAS) into Korean and psychometrically assessed its utility in measuring nurses' attitudes towards aggression. Methods The 12-item Korean POAS was obtained through forward-backward translation and cognitive debriefing. It was administered online to 319 nurses (mean age = 32.64 years; females = 96.2%), of which 206 completed it again after two weeks. Confirmatory factor analysis validated the 3-factor structure as hypothesized in the original version. The intra-class correlation coefficient was used to assess the test-retest reliability. Results The originally hypothesized 3-factor structure showed a good fit. The 3 dimensions: aggression as a dysfunctional or undesirable phenomenon, aggression as a functional or comprehensible phenomenon, and aggression as a protective measure had internal consistencies of 0.74, 0.86 and 0.90 and corresponding ICCs of 0.70, 0.86 and 0.90, respectively. Discussion The 12-item Korean POAS is a valid and reliable scale that might aid investigating nurses' attitudes towards patient aggression. Implications for practice The 12-item Korean POAS can help Korean nurses adopt protective behaviours and develop interventions to cope with aggression.
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Affiliation(s)
- Sujin Nam
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Soyun Hong
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
| | - Heejung Kim
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Republic of Korea
| | - Janet Yuen Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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Schlup N, Gehri B, Simon M. Prevalence and severity of verbal, physical, and sexual inpatient violence against nurses in Swiss psychiatric hospitals and associated nurse-related characteristics: Cross-sectional multicentre study. Int J Ment Health Nurs 2021; 30:1550-1563. [PMID: 34196092 PMCID: PMC8596810 DOI: 10.1111/inm.12905] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022]
Abstract
This analysis (1) describes the prevalence and severity of psychiatric inpatient violence against nurses in Switzerland's German-speaking region and (2) investigates the associations between nurse-related characteristics (socio-demographics; previous exposure to severe forms of psychiatric inpatient violence; attitude towards psychiatric inpatient violence) and nurses' exposure to various types of psychiatric inpatient violence. We used cross-sectional survey data from the MatchRN Psychiatry study sample of 1128 nurses working on 115 units across 13 psychiatric hospitals. In addition to lifetime severe assaults, nurses' exposure to violence against property, verbal violence, verbal sexual violence, physical violence, and physical sexual violence was assessed for the 30 days prior to the survey. Descriptive statistics (frequency and percentage) were calculated for each class of violence as also for items under study. With generalized linear mixed models, odds ratios and 95% confidence intervals were calculated. Of nurse respondents, 73% reported facing verbal violence, 63% violence against property, 40% verbal sexual violence, 28% physical violence, and 14% physical sexual violence. Almost 30% had been subjected to a serious assault in their professional lifetimes. All nurse characteristics were associated with psychiatric inpatient violence against nurses, especially a history of sexual assault (OR 4.53, 95%-CI 2.19-9.34; P = 0.00) and ≤3 years' professional experience (OR 3.70, 95%-CI 1.95-7.02; P = 0.00). Prevalence data suggest that widely used strategies such as aggression management courses or alarm devices cannot fully reduce patient violence against nurses in psychiatry. This situation demands proactive strategies in safety and violence prevention.
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Affiliation(s)
- Nanja Schlup
- Solothurn Hospital Group, Solothurn, Switzerland
| | - Beatrice Gehri
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,University Psychiatric Clinics, Basel, Switzerland
| | - Michael Simon
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland.,Nursing Research Unit, Department of Nursing, Inselspital Bern University Hospital, Bern, Switzerland
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Fletcher A, Crowe M, Manuel J, Foulds J. Comparison of patients' and staff's perspectives on the causes of violence and aggression in psychiatric inpatient settings: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:924-939. [PMID: 33837640 DOI: 10.1111/jpm.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.
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Affiliation(s)
- Alice Fletcher
- Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, Vic., Australia
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Lim E, Wynaden D, Baughman F, Heslop K. Realising the potential of Q methodology in nursing research. Collegian 2021. [DOI: 10.1016/j.colegn.2020.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Doedens P, Vermeulen J, Boyette LL, Latour C, de Haan L. Influence of nursing staff attitudes and characteristics on the use of coercive measures in acute mental health services-A systematic review. J Psychiatr Ment Health Nurs 2020; 27:446-459. [PMID: 31876970 PMCID: PMC7508163 DOI: 10.1111/jpm.12586] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggressive behaviour is a major problem in clinical practice of mental health care and can result in the use of coercive measures. Coercive measures are dangerous for psychiatric patients and international mental healthcare works on the elimination of these interventions. There is no previous review that summarizes the attitude of nursing staff towards coercive measures and the influence of nursing staff characteristics on attitude towards and the use of coercive measures. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The attitude of nurses shifted from a therapeutic paradigm (coercive measures have positive effects on patients) to a safety paradigm (coercive measures are undesirable, but necessary for the wards' safety). Nurses express the need for less coercive interventions to prevent seclusion and restraint, but their perception of intrusiveness is influenced by how often they use specific coercive measures. The knowledge from scientific literature on the influence of nursing staff on coercive measures is highly inconclusive, although the feeling of safety of nurses might prove to be promising for further research. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is need for increased attention specifically for the feeling of safety of nurses, to better equip nurses for their difficult work on acute mental health wards. ABSTRACT: Introduction The use of coercive measures generally has negative effects on patients. To help prevent its use, professionals need insight into what nurses believe about coercion and which staff determinants may influence its application. There is need for an integrated review on both attitude and influence of nurses on the use of coercion. Aim To summarize literature concerning attitude of nurses towards coercive measures and the influence of staff characteristics on the use of coercive measures. Method Systematic review. Results The attitude of nurses changed during the last two decades from a therapeutic to a safety paradigm. Nurses currently view coercive measures as undesirable, but necessary to deal with aggression. Nurses express the need for less intrusive interventions, although familiarity probably influences its perceived intrusiveness. Literature on the relation between staff characteristics and coercive measures is inconclusive. Discussion Nurses perceive coercive measures as unwanted but still necessary to maintain safety on psychiatric wards. Focussing on the determinants of perception of safety might be a promising direction for future research. Implications for practice Mental health care could improve the focus on the constructs of perceived safety and familiarity with alternative interventions to protect patients from unnecessary use of coercive interventions.
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Affiliation(s)
- Paul Doedens
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands.,ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands
| | - Lindy-Lou Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
| | - Corine Latour
- ACHIEVE Centre of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Netherlands
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Husum TL, Thorvarsdottir V, Aasland O, Pedersen R. 'It comes with the territory' - Staff experience with violation and humiliation in mental health care - A mixed method study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2020; 71:101610. [PMID: 32768105 DOI: 10.1016/j.ijlp.2020.101610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The aim of this study was to investigate staff's experiences with violation and humiliation during work in mental health care (MHC). A total of 1160 multi-professional MHC staff in Norway responded to an online questionnaire about their experiences with different kinds of violation and humiliation in the MHC setting. In addition, a sample of professionals (eight MHC nurses) were recruited for in-depth individual interviews. METHOD The study used an explorative mixed method with a convergent parallel design; this included a web-based questionnaire to MHC staff in combination with individual interviews. The sample is considered to be equivalent to staff groups in MHC in Norway. RESULTS Between 70 and 80% of the staff reported experiencing rejection, being treated with disrespect, condescending behaviour or verbal harassment. Male workers were significantly more often victims of serious physical violence, and women were significantly more often targets for sexual harassment. In interviews, participants said they considered being exposed to violence and humiliation to be part of the job when working in MHC, and that experience, as well as social support from colleagues, helped MHC practitioners to cope better with violent situations and feel less humiliated at work. DISCUSSION A high amount of MHC staff report experiences of being violated and humiliated during work. The participants' perceptions of the users and their behaviour seem to influence their experience of feeling violated and humiliated. Knowledge about the dynamics of aggression between staff and users in MHC may be used in safeguarding staff and users, prevent coercion and heighten the quality of care.
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Affiliation(s)
| | | | - Olaf Aasland
- Centre for Medical Ethics, University of Oslo, Norway
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Harrison I, Trevethan CT, Pasciak F, Irwin A. Part and Parcel: A Qualitative Interview Study Examining the Experience of Client Rudeness by Mental Health Workers. Issues Ment Health Nurs 2020; 41:122-131. [PMID: 31603711 DOI: 10.1080/01612840.2019.1644567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Considerable research has demonstrated that workplace rudeness can have a variety of negative consequences. However, although research has examined the impact of patient aggression, no research has examined patient or client rudeness towards those who work in mental health roles. The present study investigated the nature of client rudeness, how mental health workers respond and the coping strategies used. Eighteen participants from a range of mental health roles and experience levels participated in semi-structured interviews based on their experience of client rudeness. Thematic analysis revealed that participants experienced a variety of client behaviours they classified as rude, the majority of which were verbal. Reasons for rudeness included the client's personal history, mood, and mental health, and as such rudeness was conceptualised as simply a part of the job. Client rudeness was found to have both negative and positive outcomes on a range of areas including work and client relationships. Participants identified supervisors and colleagues as key sources of support for coping with rudeness. These findings suggest that rudeness is "part and parcel" of a mental health practitioner's role. Supervisor support and further training are recommended to help practitioners deal with rudeness in practice.
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Affiliation(s)
- Isabelle Harrison
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
| | - Ceri T Trevethan
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK.,Department of Clinical Neuropsychology, NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, UK.,Aberdeenshire Clinical Psychology, Crichiebank Business Centre, Inverurie, UK
| | - Flawia Pasciak
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
| | - Amy Irwin
- School of Psychology, Applied Psychology and Human Factors group, University of Aberdeen, Aberdeen, UK
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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15
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Lovell A, Skellern J. Understanding violence when the perpetrator has an intellectual disability: The perceptions of professionals. JOURNAL OF INTELLECTUAL DISABILITIES : JOID 2019; 23:552-566. [PMID: 29254412 DOI: 10.1177/1744629517747161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM The research sought to enhance professional understanding of the violence perpetrated by some people with an intellectual disability. BACKGROUND The violent behaviour exhibited by some people with intellectual disabilities remains poorly understood, particularly with regard to a clear and informative definition. DESIGN A qualitative study investigated the views and perceptions of professionals working directly with people with an intellectual disability in different settings. METHODS Twenty-two semi-structured interviews were undertaken with professionals from a variety of backgrounds, and four themes were generated through data analysis. FINDINGS Themes produced comprised the degree of intellectual disability, impulsivity, intentionality and unpredictability. Findings indicated tension between understanding violence as purposeful and explaining it in relation to the intellectual disability and/or additional conditions. CONCLUSION Intellectual disability is central to understanding the impact of the other three themes, though there is a professional reluctance to use such knowledge as evidence to inform practice.
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Panagiotou A, Mafreda C, Moustikiadis A, Prezerakos P. Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study. Int J Ment Health Nurs 2019; 28:1078-1089. [PMID: 31169358 DOI: 10.1111/inm.12619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Abstract
Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.
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Affiliation(s)
- Aspasia Panagiotou
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
| | | | | | - Panagiotis Prezerakos
- Laboratory of Integrated Health Care, Department of Nursing, University of Peloponnese, Sparta, Greece
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17
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Motamed M, Yahyavi ST, Sharifi V, Alaghband-Rad J, Aghajannashtaei F. Emergency psychiatric services in Roozbeh Hospital: A qualitative study of the staff's experiences. Perspect Psychiatr Care 2019; 55:249-254. [PMID: 30637760 DOI: 10.1111/ppc.12348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 11/26/2018] [Accepted: 12/09/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study aims to explore how psychiatric residents and nurses experience the conditions of psychiatric emergency services. DESIGN AND METHODS This qualitative study was carried out using content analysis. Data were collected through unstructured interviews conducted during three focus groups. FINDINGS The results of the focus groups were classified into the following five categories of issues influencing the staff's experiences: repetitive problems, long wait times, ambiguity, insecurity, and stability. PRACTICE IMPLICATIONS Improving the staff's communication skills and educating them on how to manage violence, establishing a well-functional system of triage, and optimizing bed management and discharge planning are among several potential strategies that might be considered to improve the quality of care in psychiatric emergency services.
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Affiliation(s)
- Mahtab Motamed
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyyed Taha Yahyavi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Vandad Sharifi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Alaghband-Rad
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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18
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Spencer S, Johnson P, Smith IC. De-escalation techniques for managing non-psychosis induced aggression in adults. Cochrane Database Syst Rev 2018; 7:CD012034. [PMID: 30019748 PMCID: PMC6513023 DOI: 10.1002/14651858.cd012034.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Aggression occurs frequently within health and social care settings. It can result in injury to patients and staff and can adversely affect staff performance and well-being. De-escalation is a widely used and recommended intervention for managing aggression, but the efficacy of the intervention as a whole and the specific techniques that comprise it are unclear. OBJECTIVES To assess the effects of de-escalation techniques for managing non-psychosis-induced aggression in adults in care settings, in both staff and service users. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL and 14 other databases in September 2017, plus three trials registers in October 2017. We also checked references, and contacted study authors and authorities in the field to identify additional published and unpublished studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and quasi-RCTs comparing de-escalation techniques with standard practice or alternative techniques for managing aggressive behaviour in adult care settings. We excluded studies in which participants had psychosis. DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS This review includes just one cluster-randomised study of 306 older people with dementia and an average age of 86 years, conducted across 16 nursing homes in France. The study did not measure any of our primary or secondary outcomes but did measure behavioural change using three measurement scales: the Cohen-Mansfield Agitation Inventory (CMAI; 29-item scale), the Neuropsychiatric Inventory (NPI; 12-item scale), and the Observation Scale (OS; 25-item scale). For the CMAI, the study reports a Global score (29 items rated on a seven-point scale (1 = never occurs to 7 = occurs several times an hour) and summed to give a total score ranging from 29 to 203) and mean scores (evaluable items (rated on the same 7-point scale) divided by the theoretical total number of items) for the following four domains: Physically Non-Aggressive Behaviour, such as pacing (13 items); Verbally Non-Aggressive Behaviour, such as repetition (four items); Physically Aggressive Behaviour, such as hitting (nine items); and Verbally Aggressive Behaviour, such as swearing (three items). Four of the five CMAI scales improved in the intervention group (Global: change mean difference (MD) -5.69 points, 95% confidence interval (CI) -9.59 to -1.79; Physically Non-Aggressive: change MD -0.32 points, 95% CI -0.49 to -0.15; Verbally Non-Aggressive: change MD -0.44 points, 95% CI -0.69 to -0.19; and Verbally Aggressive: change MD -0.16 points, 95% CI -0.31 to -0.01). There was no difference in change scores on the Physically Aggressive scale (MD -0.08 points, 95% CI -0.37 to 0.21). Using GRADE guidelines, we rated the quality of this evidence as very low due to high risk of bias and indirectness of the outcome measures. There were no differences in NPI or OS change scores between groups by the end of the study.We also identified one ongoing study. AUTHORS' CONCLUSIONS The limited evidence means that uncertainty remains around the effectiveness of de-escalation and the relative efficacy of different techniques. High-quality research on the effectiveness of this intervention is therefore urgently needed.
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Affiliation(s)
- Sally Spencer
- Edge Hill UniversityPostgraduate Medical InstituteSt Helens RoadOrmskirkLancashireUKL39 4QP
| | - Paula Johnson
- Mersey Care NHS Foundation TrustDepartment of Research and DevelopmentMitton Road, WhalleyLancashireClitheroeLancashireUKBB7 9PE
| | - Ian C Smith
- Lancaster UniversityDivision of Health ResearchBailriggLancasterLancasterUK
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Vandewalle J, Malfait S, Eeckloo K, Colman R, Beeckman D, Verhaeghe S, Van Hecke A. Patient safety on psychiatric wards: A cross-sectional, multilevel study of factors influencing nurses' willingness to share power and responsibility with patients. Int J Ment Health Nurs 2018; 27:877-890. [PMID: 28795468 DOI: 10.1111/inm.12376] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/26/2017] [Indexed: 11/27/2022]
Abstract
The World Health Organization highlights the need for more patient participation in patient safety. In mental health care, psychiatric nurses are in a frontline position to support this evolution. The aim of the present study was to investigate the demographic and contextual factors that influence the willingness of psychiatric nurses to share power and responsibility with patients concerning patient safety. The patient participation culture tool for inpatient psychiatric wards was completed by 705 nurses employed in 173 psychiatric wards within 37 hospitals. Multilevel modelling was used to analyse the self-reported data. The acceptance of a role wherein nurses share power and responsibility with patients concerning patient safety is influenced by the nurses' sex, age, perceived competence, perceived support, and type of ward. To support nurses in fulfilling their role in patient participation, patient participation-specific basic and continuing education should be provided. Managers and supervisors should recognize and fulfil their facilitating role in patient participation by offering support to nurses. Special attention is needed for young nurses and nurses on closed psychiatric wards, because these particular groups report being less willing to accept a new role. Ward characteristics that restrict patient participation should be challenged so that these become more patient participation stimulating. More research is needed to explore the willingness and ability of psychiatric nurses to engage in collaborative safety management with patients who have specific conditions, such as suicidal ideation and emotional harm.
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Affiliation(s)
- Joeri Vandewalle
- Department of Public Health, Ghent University, Ghent, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Simon Malfait
- Department of Public Health, Ghent University, Ghent, Belgium.,Ghent University Hospital, Ghent, Belgium
| | - Kristof Eeckloo
- Department of Public Health, Ghent University, Ghent, Belgium.,Ghent University Hospital, Ghent, Belgium
| | - Roos Colman
- Department of Public Health, Ghent University, Ghent, Belgium
| | | | - Sofie Verhaeghe
- Department of Public Health, Ghent University, Ghent, Belgium.,Department of Health Care, VIVES University College, Roeselare, Belgium
| | - Ann Van Hecke
- Department of Public Health, Ghent University, Ghent, Belgium.,Ghent University Hospital, Ghent, Belgium
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20
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Well-Being and Safety Among Inpatient Psychiatric Staff: The Impact of Conflict, Assault, and Stress Reactivity. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2018; 43:703-716. [PMID: 26377816 DOI: 10.1007/s10488-015-0683-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Psychiatric staff are faced with multiple forms of hostility, aggression, and assault at work, collectively referred to as workplace violence, which typically is activated by patients but can also come from coworkers and supervisors. Whether workplace violence adversely affects staff well-being may be related not only to its presence, but also to an individual's stress reactivity. At a large public psychiatric hospital, an online survey was completed by 323 clinical care staff, of whom 69.5 % had experienced physical assault in the previous 12 months. Staff well-being (depression, anger, and physical health) and staff safety concerns were adversely affected by conflicts with other staff members and by individual reactivity to social conflict and to assault. To improve staff well-being, in addition to safety protocols, interventions should target staff relationships, personal health maintenance practices, and individual coping skills for dealing with adverse workplace experiences.
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21
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Maguire T, Daffern M, Bowe SJ, McKenna B. Predicting aggressive behaviour in acute forensic mental health units: A re-examination of the dynamic appraisal of situational aggression's predictive validity. Int J Ment Health Nurs 2017; 26:472-481. [PMID: 28960740 DOI: 10.1111/inm.12377] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/16/2017] [Indexed: 11/29/2022]
Abstract
In the present study, we explored the predictive validity of the Dynamic Appraisal of Situational Aggression (DASA) assessment tool in male (n = 30) and female (n = 30) patients admitted to the acute units of a forensic mental health hospital. We also tested the psychometric properties of the original DASA bands and novel risk bands. The first 60 days of each patient's file was reviewed to identify daily DASA scores and subsequent risk-related nursing interventions and aggressive behaviour within the following 24 hours. Risk assessments, followed by documented nursing interventions, were removed to preserve the integrity of the risk-assessment analysis. Receiver-operator characteristics were used to test the predictive accuracy of the DASA, and generalized estimating equations (GEE) were used to account for repeated risk assessments, which occurs when analysing short-term risk-assessment data. The results revealed modest predictive validity for males and females. GEE analyses suggested the need to adjust the DASA risk bands to the following (with associated odds ratios (OR) for aggressive behaviour): 0 = low risk; 1, 2, 3 = moderate-risk OR, 4.70 (95% confidence interval (CI): 2.84-7.80); and 4, 5, 6, 7 = high-risk OR, 16.13 (95% CI: 9.71-26.78). The adjusted DASA risk bands could assist nurses by prompting violence-prevention interventions when the level of risk is elevated.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Deakin Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
| | - Brian McKenna
- Department of Health Sciences, Auckland University of Technology, Auckland, New Zealand.,Auckland Regional Forensic Psychiatry Services, Auckland, New Zealand
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22
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Geoffrion S, Goncalves J, Sader J, Boyer R, Marchand A, Guay S. Workplace aggression against health care workers, law enforcement officials, and bus drivers: Differences in prevalence, perceptions, and psychological consequences. JOURNAL OF WORKPLACE BEHAVIORAL HEALTH 2017. [DOI: 10.1080/15555240.2017.1349611] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Steve Geoffrion
- School of Psychoeducation of Université de Montréal, Montreal, Canada
- Trauma Studies Center, Université de Montréal, Montreal, Canada
| | - Jane Goncalves
- Trauma Studies Center, Université de Montréal, Montreal, Canada
| | - Josette Sader
- Trauma Studies Center, Université de Montréal, Montreal, Canada
| | - Richard Boyer
- Trauma Studies Center, Université de Montréal, Montreal, Canada
| | - André Marchand
- Trauma Studies Center, Université de Montréal, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Stéphane Guay
- Trauma Studies Center, Université de Montréal, Montreal, Canada
- School of Criminology, Université de Montréal, Montreal, Canada
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23
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Khalil AI, Al Ghamdi MAM, Al Malki S. Nurses’ knowledge, attitudes, and practices toward physical restraint and seclusion in an inpatients’ psychiatric ward. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/17542863.2017.1329330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Amal Ibrahim Khalil
- Faculty of Nursing, Menoufyia University, Egypt
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
| | | | - Sarah Al Malki
- College of Nursing, King Saud Bin Abdul-Aziz University for Health Sciences, Jeddah, Saudi Arabia
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24
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Geoffrion S, Giguère CÉ, Fortin M, Fortin C, Guay S. Validation de la version française canadienne du Perception of Prevalence of Aggression Scale auprès d’un échantillon d’intervenants en protection de la jeunesse1. ACTA ACUST UNITED AC 2017. [DOI: 10.7202/1039685ar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectif. L’objectif de cette étude est d’évaluer la validité de construit de la version française de l’échellePerception Of Prevalence of Aggression Scale (POPAS), un questionnaire auto-rapporté mesurant l’exposition à la violence au travail commise par la clientèle du milieu de la santé et des services sociaux.Méthode. Un échantillon de 310 intervenants en protection de la jeunesse est utilisé afin de confirmer la structure interne à quatre facteurs de l’instrument. À défaut de confirmer cette structure, un modèle d’équation structurelle exploratoire est utilisé. Les facteurs retenus sont soumis aux tests d’alpha de Cronbach qui permettent d’évaluer leur cohérence interne. Ils sont corrélés avec la version française duPosttraumatic Stress Disorder Checklist Scale(PCLS) et du nombre de jours d’absence du travail causé par la violence afin d’évaluer la validité convergente. Il sont également corrélées avec leFelt Accountability(FA) afin d’évaluer la validité divergente. Des analyses de comparaison en fonction du lieu de travail permettent d’explorer la validité de critère.Résultats. L’analyse factorielle confirmatoire ne confirme pas la structure à quatre facteurs du POPAS. L’équation structurelle exploratoire valide une structure à trois facteurs : « violence verbale », « violence physique » et « violence envers soi-même ». Les deux premiers possèdent une bonne cohérence interne. Les corrélations positives entre ces deux facteurs et le PCLS, ainsi qu’entre ces deux facteurs et le nombre de jours d’absence appuient la validité convergente du POPAS. Toutefois, l’absence de corrélation significative entre le dernier facteur et le PCLS, et entre ce facteur et le nombre de jour d’absence n’appuient pas cette convergence. L’absence de corrélation des facteurs avec le FA appuie la validité divergente du POPAS. Les différences observées selon les environnements de travail attestent aussi de la validité de critère.Discussion. La validité de construit de la version française canadienne du POPAS suggère que l’outil permet d’évaluer la fréquence subjective de différentes formes de violence au travail vécues par les intervenants en protection de la jeunesse. Il offre ainsi une alternative aux données officielles (c.-à-d. déclaration d’incidents à l’employeur) qui reflètent peu la réalité de ces travailleurs compte tenu de la sous-déclaration des incidents de violence dans ce milieu.
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Affiliation(s)
- Steve Geoffrion
- École de psychoéducation, Université de Montréal. Correspondance : École de psychoéducation, Université de Montréal, C.P. 6128 succursale Centre-Ville, Montréal (Québec) H3C 3J7
| | | | | | - Christophe Fortin
- Centre de recherche de l’Institut Universitaire en santé mentale de Montréal
| | - Stéphane Guay
- Centre de recherche de l’Institut Universitaire en santé mentale de Montréal
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25
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Wong WK, Chien WT. Testing psychometric properties of a Chinese version of perception of aggression scale. Asian J Psychiatr 2017; 25:213-217. [PMID: 28262153 DOI: 10.1016/j.ajp.2016.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 10/14/2016] [Accepted: 10/29/2016] [Indexed: 10/20/2022]
Abstract
AIM This study was to evaluate the psychometric properties of the Chinese version of the 12-item Perception of Aggression Scale (POAS). METHOD It consists of three phases of testing, including (1) translation and back-translation and content validity; (2) semantic equivalence between translated Chinese and original English version; and (3) construct validity, internal consistency and test-retest reliability. RESULTS The translated Chinese and back-translated English version showed excellent similarities and agreements between two independent translators. The Chinese version indicated high item- and scale-level content validity indexes (0.86-1.00) and satisfactory semantic equivalence with the original English language version (weighted kappa=0.48-0.90; intraclass correlation coefficient=0.91). Exploratory factor analysis in 249 nursing students resulted in three components (dysfunctional, functional and protective dimensions), explaining 64% of the total variance, with satisfactory internal consistency (Cronbach's alpha=0.76-0.83) and good 2-week test-retest reliability (Pearson's r=0.87). The Chinese version of POAS was found to be a valid and reliable tool to examine nurses' attitudes towards patient aggression. DISCUSSION Chinese nurses in this study viewed patient aggression to be an undesirable negative behaviour suggestive of uncontrollability behaviour presented by the patient under their care.
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Affiliation(s)
- Wai Kit Wong
- School of Nursing, The Hong Kong Polytechnic University, A102, Hung Hom, Hong Kong.
| | - Wai Tong Chien
- School of Nursing, The Hong Kong Polytechnic University, A102, Hung Hom, Hong Kong
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26
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Drori T, Guetta H, Ben Natan M, Polakevich Y. Patient Violence Toward Psychiatric Health Care Workers in Israel as Viewed Through Incident Reports. J Am Psychiatr Nurses Assoc 2017; 23:143-148. [PMID: 28060602 DOI: 10.1177/1078390316687372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Rates of violence perpetrated by patients toward health care workers are known to be higher in psychiatry than in other fields. Objective standardized reports of violent incidents may clarify this phenomenon. OBJECTIVE The purpose of this study was to assess the characteristics of patient violence, as evident from objective reports. STUDY DESIGN In this retrospective chart review study, conducted at a large mental health hospital in Israel between 2013 and 2015, reports of violent incidents perpetrated by people diagnosed with mental health problems against health care workers of the hospital were reviewed. RESULTS A total of 80 violent incidents were recorded. The findings outline the characteristics of a typical assailant, a typical victim, and a typical incident, and demonstrate associations between some of these characteristics. CONCLUSIONS This information may be beneficial for planning interventions for efficient coping with and prevention of violence at psychiatric inpatient facilities.
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Affiliation(s)
- Tal Drori
- 1 Tal Drori, MD, Tirat Carmel Mental Health Center, Tirat Carmel, Israel
| | - Hava Guetta
- 2 Hava Guetta, MA, RN, Tirat Carmel Mental Health Center, Tirat Carmel, Israel
| | - Merav Ben Natan
- 3 Merav Ben Natan, PhD, RN, Hillel Yaffe Medical Center, Hadera, Israel
| | - Yaakov Polakevich
- 4 Yaakov Polakevich, MD, Tirat Carmel Mental Health Center, Tirat Carmel, Israel
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Tomagová M, Bóriková I, Lepiešová M, Čáp J. Nurses' experience and attitudes towards inpatient aggression on psychiatric wards. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2016. [DOI: 10.15452/cejnm.2016.07.0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Verhaeghe S, Duprez V, Beeckman D, Leys J, Van Meijel B, Van Hecke A. Mental Health Nurses' Attitudes and Perceived Self-Efficacy Toward Inpatient Aggression: A Cross-Sectional Study of Associations With Nurse-Related Characteristics. Perspect Psychiatr Care 2016; 52:12-24. [PMID: 25495430 DOI: 10.1111/ppc.12097] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 10/25/2014] [Accepted: 11/13/2014] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To explore mental health nurses' attitude and self-efficacy to adult inpatient aggression, and to explore the association with nurse-related characteristics. DESIGN AND METHOD Cross-sectional study in a sample of 219 mental health nurses in nine psychiatric hospitals, with stepwise linear regression analysis to detect predictive models. FINDINGS Female and less experienced nurses were less likely to blame patients for their behavior. Gender, burnout, secondary traumatic stress, and compassion satisfaction accounted for 26.2% of the variability in mental health nurses' self-efficacy toward aggression. PRACTICE IMPLICATIONS There needs to be attention to professional quality of life for mental health nurses, to provide them with of self-efficacy and a positive attitude toward coping with aggression.
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Affiliation(s)
- Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Nursing, Vives University College Leuven, Roeselare, Belgium
| | - Veerle Duprez
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Dimitri Beeckman
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Joris Leys
- Department of Bachelor in Nursing, Artevelde University College Ghent, Ghent, Belgium
| | - Berno Van Meijel
- Research Group Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Nursing Science, University Hospital Ghent, Ghent, Belgium
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Holmes D, Murray SJ, Knack N. Experiencing Seclusion in a Forensic Psychiatric Setting: A Phenomenological Study. JOURNAL OF FORENSIC NURSING 2015; 11:200-213. [PMID: 26457901 DOI: 10.1097/jfn.0000000000000088] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In hospital settings, and especially in forensic psychiatric ones, restlessness, aggression, and even violence are familiar issues to healthcare workers. Under these circumstances, the need for restrictive measures (seclusion, mechanical/chemical restraints) is sometimes needed. Although such measures should be considered as exceptional interventions, they continue to be widespread in general, psychiatric, and forensic psychiatric settings. Although there is a great deal of literature on a myriad of issues associated with the use of seclusion, very little research has focused on the lived experience of the seclusion room in forensic psychiatric settings, whether from the patient's perspective or from the perspective of nursing staff responsible for these patients. Such an examination could help ameliorate the experience of secluded forensic psychiatric patients while informing nursing staff about the impacts of seclusion. This article reports the results of a federally funded qualitative, phenomenological research study conducted in a Canadian forensic psychiatric environment. Our results show that the "structure of place" matters for both patients who experience seclusion and nursing staff who work therapeutically in these settings. "Place" is irreducible to the physical "space" in which bodies find themselves; this study of place took into consideration the ways the lived body experiences seclusion and interrelates with others. Although there can be no doubt that many patients who experience seclusion are oftentimes objectively at risk, with a heightened potential to self-harm and to harm other inpatients and nursing staff as well, as our study participants attested, the bodies secluded in this space are not "objects."
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Affiliation(s)
- Dave Holmes
- Author Affiliations: 1Faculty of Health Sciences, School of Nursing, University of Ottawa; 2Department of English Language and Literature, Carleton University; and 3Institute of Mental Health Research/The Royal, University of Ottawa
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Stevenson KN, Jack SM, O'Mara L, LeGris J. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study. BMC Nurs 2015. [PMID: 25999795 DOI: 10.1186-/s12912-015-0079-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022] Open
Abstract
BACKGROUND Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses' experiences of patient violence in acute care inpatient psychiatric settings. METHODS An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. RESULTS Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered "part of the job." Nurses often struggled with role conflict between one's duty to care and one's duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. CONCLUSIONS Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.
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Affiliation(s)
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, ON Canada
| | - Linda O'Mara
- School of Nursing, McMaster University, Hamilton, ON Canada
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Stevenson KN, Jack SM, O'Mara L, LeGris J. Registered nurses' experiences of patient violence on acute care psychiatric inpatient units: an interpretive descriptive study. BMC Nurs 2015; 14:35. [PMID: 25999795 PMCID: PMC4440495 DOI: 10.1186/s12912-015-0079-5] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/30/2015] [Indexed: 11/10/2022] Open
Abstract
Background Nurses working in acute care psychiatry settings experience high rates of patient violence which influences outcomes for nurses and the organization. This qualitative study explored psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings. Methods An interpretive descriptive design guided this study that included 17 semi-structured interviews with a purposeful sample of 12 Canadian registered nurses who self-reported experiencing patient violence within acute care inpatient psychiatry. Thematic analysis and constant comparison techniques were used for analysis. A problem, needs and practice analysis was also used to structure overall data interpretation. Results Thirty three unique exposures to patient violence among the sample of nurses were analysed. Nurses reported experiencing physical, emotional and verbal violence. For many, patient violence was considered “part of the job.” Nurses often struggled with role conflict between one’s duty to care and one’s duty to self when providing care following a critical incident involving violence. Issues of power, control and stigma also influenced nurse participant perceptions and their responses to patient violence. Nurses used a variety of strategies to maintain their personal safety and to prevent, and manage patient violence. Nurses endorsed the need for improved education, debriefing following an incident, and a supportive work environment to further prevent patient violence. Present findings have implications for reducing the barriers to reporting violent experiences and the creation of best practice guidelines to reduce patient violence in the workplace. Conclusions Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater understanding of the phenomenon of patient violence and may inform the development of interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting.
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Affiliation(s)
| | - Susan M Jack
- School of Nursing, McMaster University, Hamilton, ON Canada
| | - Linda O'Mara
- School of Nursing, McMaster University, Hamilton, ON Canada
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Kontio R, Anttila M, Lantta T, Kauppi K, Joffe G, Välimäki M. Toward a safer working environment on psychiatric wards: service users' delayed perspectives of aggression and violence-related situations and development ideas. Perspect Psychiatr Care 2014; 50:271-9. [PMID: 24405057 DOI: 10.1111/ppc.12054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Revised: 10/20/2013] [Accepted: 11/04/2013] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To explore service users' (n = 9) delayed perceptions of and suggestions for improvement of management of aggression/violence in psychiatry. DESIGN AND METHOD Focus group interviews, inductive content analysis. FINDINGS Participants reported aggression/violence-related negative perceptions (including loneliness, boredom, excessive control, and fear) but also memories of humane and caring personnel. The suggestions included meaningful activities and humane, interactive nursing. PRACTICE IMPLICATIONS Delayed perceptions and proposals resembled the proximate ones. Perceptions may persist for years. Such perceptions and proposals, if taken into account from the beginning of treatment, may prevent negative long-term consequences of witnessed or experienced aggression/violence. Humane, interactive nursing models should be studied and disseminated.
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Affiliation(s)
- Raija Kontio
- Department of Psychiatry, Hospital District of Helsinki and Uusimaa, Kellokoski, Tuusula, Finland
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Laiho T, Lindberg N, Joffe G, Putkonen H, Hottinen A, Kontio R, Sailas E. Psychiatric staff on the wards does not share attitudes on aggression. Int J Ment Health Syst 2014; 8:14. [PMID: 24778708 PMCID: PMC4002577 DOI: 10.1186/1752-4458-8-14] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 04/10/2014] [Indexed: 11/19/2022] Open
Abstract
Background The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent’s gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.
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Affiliation(s)
- Tero Laiho
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Nina Lindberg
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Faculty of Medicine, Forensic Psychiatry, University of Helsinki, Helsinki, Finland
| | - Grigori Joffe
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Hanna Putkonen
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland ; Vanha Vaasa Hospital, Vaasa, Finland
| | - Anja Hottinen
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Raija Kontio
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
| | - Eila Sailas
- Hospital District of Helsinki and Uusimaa, Hyvinkää Hospital Area, Tuusula, Finland
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Dickens G, Piccirillo M, Alderman N. Causes and management of aggression and violence in a forensic mental health service: perspectives of nurses and patients. Int J Ment Health Nurs 2013; 22:532-44. [PMID: 23167989 DOI: 10.1111/j.1447-0349.2012.00888.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.
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Moghadam MF, Pazargadi M, Khoshknab MF. Iranian nurses' experiences of aggression in psychiatric wards: a qualitative study. Issues Ment Health Nurs 2013; 34:765-71. [PMID: 24066653 DOI: 10.3109/01612840.2012.737893] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Aggression from psychiatric patients is a constant problem for care providers that causes major problems in the therapeutic environment, and may have negative effects on the quality of care. Since recognition of aggression with regard to cultural background leads to better control of aggression in the psychiatric wards, this study has been done to clarify Iranian nurses' experiences of aggression in psychiatric wards. A qualitative content analysis study was conducted to explore experiences of nurses. Data analysis revealed four themes: (1) Damage resulting from aggression, (2) Aggression catalysts, (3) Contagious nature of aggression, and (4) Various control strategies. There are various causes for in-patients' aggression, and nurses use various approaches to control it. These approaches are influenced by personnel, facilities, and ward environment. Identifying these factors and strategies can contribute to better management of aggression and, thus, better quality of care in psychiatric wards.
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Affiliation(s)
- Malek Fereidooni Moghadam
- Ahvaz Jundishapur University of Medical Sciences, Faculty of Nursing and Midwifery, Ahvaz, Islamic Republic of Iran
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Kennedy M, Julie H. Nurses’ experiences and understanding of workplace violence in a trauma and emergency department in South Africa. Health SA 2013. [DOI: 10.4102/hsag.v18i1.663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Violence in South African society has reached epidemic levels and has permeated the walls of the workplace. The aim of the study was to gain a deeper understanding of how nurses experience and understand workplace violence perpetrated by patients, and to make recommendations to reduce this type of violence. A qualitative, exploratory and descriptive study was conducted to explore the experiences and coping mechanisms of nurses regarding workplace violence. The purposive sample comprised eight nurses working in the Trauma and Emergency Department in the Western Cape, South Africa. Thematic analysis was done of the semi-structured interviews. Four main themes and 10 categories were identified. Nurses are experiencing physical threats, verbal abuse and psychological and imminent violence on a regular basis. They tend to ‘normalise’ abusive patient behaviour because of the perception that workplace abuse ‘comes with the territory’, which resulted in under-reporting. However, perpetrators received compromised care by being avoided, ignored or given only minimal nursing care. Coping mechanisms ranged from using colleagues as sounding boards, helping out with duties, taking a smoke break and using friends and family to get it ‘off their chest’. The tolerance of non-physical violence and the absence of policies to deal with the violence, contribute to under-reporting.Geweld in die Suid-Afrikaanse samelewing het epidemiese vlakke bereik en selfs werksplekke binnegedring. Die doel van die studie was om ‘n dieper begrip te verkry van hoe verpleegsters geweld deur pasiënte by die werksplek ervaar en verstaan, en aanbevelings te maak om hierdie tipe van geweld te verminder. ‘n Kwalititatiewe, eksploratiewe en beskrywende ontwerp is gebruik om die ervaringe en hanteringsmeganismes te verken van verpleegkundiges wat aan werkpleksgeweld blootgestel was. ‘n Doelgerigte steekproef is gedoen bestaande uit agt verpleegkundiges werksaam in die Trauma en Nooddienste Departement in die Weskaap, Suid Afrika. Die semi-gestruktureerde onderhoude is kwalitatief ontleed vir temas. Vier hooftemas en 10 kategorieë is geïdentifiseer. Verpleegkundiges ervaar dreigemente van fisiese geweld, verbale misbruik en psigiese en dreigende geweld gereeld. Hulle is geneig om pasiënte se misbruikende gedrag te ‘normaliseer’ omdat hulle die persepsie het dat geweld of misbruik ‘deel van die werksomgewing’ is. Hierdie persepsie gee aanleiding tot onder-rapportering van nie-fisiese geweld en gekompromitteerde sorg deurdat skuldige pasiënte of vermy, geïgnoreer of minimale sorg gegee word. Hanterings meganismes sluit in reflektering teenoor kollegas, uithelp met take, die gebruikmaking van ’n rook breek, en ontlaaing teenoor familielede en vriende. Die toleransie van nie-fisiese geweld en die gebrek van beleidsriglyne dra by tot die onder-rapportering van werksplek geweld.
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Pulsford D, Crumpton A, Baker A, Wilkins T, Wright K, Duxbury J. Aggression in a high secure hospital: staff and patient attitudes. J Psychiatr Ment Health Nurs 2013; 20:296-304. [PMID: 22486938 DOI: 10.1111/j.1365-2850.2012.01908.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Responding to aggressive behaviour is a key activity for nurses and other care staff in high secure hospitals. The attitudes and beliefs of staff regarding patient aggression will influence the management strategies they adopt. Patients will also hold attitudes regarding the causes of and best ways to respond to aggressive behaviour. This study measured the attitudes towards aggression of staff (n= 109) and patients (n= 27) in a high secure hospital in the UK using the Management of Aggression and Violence Attitude Scale (MAVAS). There was considerable concordance of views, staff and patients disagreeing on only two items on the MAVAS. Aggression was felt to have a range of causes, embracing factors internal to the person, factors in the external environment and situational or interactional factors. Interpersonal means of managing aggression were supported, but both staff and patients also advocated the use of controlling management strategies such as medication, seclusion and restraint. The implications of these findings for aggression management in high secure settings are discussed in the light of best practice guidelines that promote interpersonal approaches over controlling strategies.
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Affiliation(s)
- D Pulsford
- Divisional Lead for Mental Health Reader in Mental Health Nursing, School of Health, University of Central Lancashire, Preston Management of Violence & Aggression Lead, MersyCare NHS Trust Practice Development Team Senior Nurse Therapist/Research Lead, Ashworth Hospital, Maghull, Merseyside, UK.
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Melnikov S, Shor R, Kigli-Shemesh R, Gun Usishkin M, Kagan I. Closing an open psychiatric ward: organizational change and its effect on staff uncertainty, self-efficacy, and professional functioning. Perspect Psychiatr Care 2013; 49:103-9. [PMID: 23557453 DOI: 10.1111/ppc.12001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2012] [Revised: 09/12/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Converting an open psychiatric ward to a closed one can be threatening and stressful for the medical and nursing staff involved. This study describes the effects of this change, in particular the before-after correlation among self-efficacy, professional functioning, and uncertainty. DESIGN AND METHODS Forty-four staff participated, completing pre-/poststructured questionnaires. FINDINGS Uncertainty was higher before the conversion than after the conversion. Professional functioning declined after the conversion. Self-efficacy was positively correlated with pre- and postconversion functioning, but negatively correlated with postconversion uncertainty. PRACTICE IMPLICATIONS It is important to prepare staff for this significant organizational change. Suggestions for prechange interventions are offered.
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Zuzelo PR, Curran SS, Zeserman MA. Registered nurses' and behavior health associates' responses to violent inpatient interactions on behavioral health units. J Am Psychiatr Nurses Assoc 2012; 18:112-26. [PMID: 22412084 DOI: 10.1177/1078390312438553] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Violence carried out by patients against nursing staff unsettles and threatens coworkers as they care for individuals admitted to inpatient psychiatric units. OBJECTIVE This study explored nursing staff's individual and group responses to violent incidents performed by patients against caregivers. DESIGN This qualitative study used focus groups to collect data from professional nurses and behavioral health associations (N = 19) recruited from urban, inpatient psychiatric unit. Data were analyzed thematically. RESULTS Sharing information about violence, intervening therapeutically, intervening nontherapeutically, recognizing team influences, experiencing emotions following violence, and understanding the work environment comprised the major themes of the experience. CONCLUSIONS Findings may stimulate discussions and education sessions that address strategies helpful to nursing staff so that incidents are prevented and staff is supported following such disturbing events. Events of workplace violence, including those occurring on behavioral mental health in inpatient units, require accurate individual and aggregate reporting to develop interventions and evaluate effectiveness of violence reduction strategies.
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Pazvantoğlu O, Gümüş K, Böke Ö, Yıldız İ, Şahin AR. Perception of patient aggression among nurses working in a university hospital in Turkey. Int J Nurs Pract 2011; 17:495-501. [DOI: 10.1111/j.1440-172x.2011.01967.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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TEMA T, POGGENPOEL M, MYBURGH C. Experiences of psychiatric nurses exposed to hostility from patients in a forensic ward. J Nurs Manag 2011; 19:915-24. [DOI: 10.1111/j.1365-2834.2011.01304.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Cornaggia CM, Beghi M, Pavone F, Barale F. Aggression in psychiatry wards: a systematic review. Psychiatry Res 2011; 189:10-20. [PMID: 21236497 DOI: 10.1016/j.psychres.2010.12.024] [Citation(s) in RCA: 205] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 12/04/2010] [Accepted: 12/08/2010] [Indexed: 01/13/2023]
Abstract
Although fairly frequent in psychiatric in-patient, episodes of aggression/violence are mainly limited to verbal aggression, but the level of general health is significantly lower in nurses who report 'frequent' exposure to violent incidents, and there is disagreement between patients and staff concerning predictors of these episodes. We searched the Pubmed, Embase and PsychInfo databases for English, Italian, French or German language papers published between 1 January 1990 and 31 March 2010 using the key words "aggress*" (aggression or aggressive) "violen*" (violence or violent) and "in-patient" or "psychiatric wards", and the inclusion criterion of an adult population (excluding all studies of selected samples such as a specific psychiatric diagnosis other than psychosis, adolescents or the elderly, men/women only, personality disorders and mental retardation). The variables that were most frequently associated with aggression or violence in the 66 identified studies of unselected psychiatric populations were the existence of previous episodes, the presence of impulsiveness/hostility, a longer period of hospitalisation, non-voluntary admission, and aggressor and victim of the same gender; weaker evidence indicated alcohol/drug misuse, a diagnosis of psychosis, a younger age and the risk of suicide. Alcohol/drug misuse, hostility, paranoid thoughts and acute psychosis were the factors most frequently involved in 12 studies of psychotic patients. Harmony among staff (a good working climate) seems to be more useful in preventing aggression than some of the other strategies used in psychiatric wards, such as the presence of male nurses.
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Affiliation(s)
- Cesare Maria Cornaggia
- Department of Clinical Psychiatry, University of Milano-Bicocca, Monza, Italy; Organic Psychiatry Unit, Zucchi Clinical Institute, Carate Brianza, Italy
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Fluttert FAJ, Van Meijel B, Van Leeuwen M, Bjørkly S, Nijman H, Grypdonck M. The development of the Forensic Early Warning Signs of Aggression Inventory: preliminary findings toward a better management of inpatient aggression. Arch Psychiatr Nurs 2011; 25:129-37. [PMID: 21421164 DOI: 10.1016/j.apnu.2010.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2010] [Revised: 06/29/2010] [Accepted: 07/01/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVE "Early warning signs of aggression" refers to recurring changes in behaviors, thoughts, perceptions, and feelings of the patient that are considered to be precursors of aggressive behavior. The early recognition of these signs offers possibilities for early intervention and prevention of aggressive behaviors in forensic patients. The Forensic Early warning Signs of Aggression Inventory (FESAI) was developed to assist nurses and patients in identifying and monitoring these early warning signs of aggression. METHODS The FESAI was developed by means of qualitative and quantitative strategies. One hundred seventy six early detection plans were studied to construct a list of early warning signs of aggression. Inventory drafting was done by merging and categorizing early warning signs. Forensic nursing professionals assessed face validity, and interrater agreement was tested. RESULTS The investigation of early detection plans resulted in the FESAI, which contains 44 early warning signs of aggression subdivided into 15 main categories. The face validity of the form was very good, and the interrater agreement was satisfactory. CONCLUSIONS Preliminary findings indicate that the FESAI provides a useful listing of early warning signs of aggression in forensic patients. It may facilitate the construction of early detection plans for the prevention of aggressive behaviors in forensic psychiatry.
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Ng KC, Lovell R. Survey on Victorian driver assessors’ experience of critical incidents. Aust Occup Ther J 2011; 59:47-55. [DOI: 10.1111/j.1440-1630.2010.00895.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Krystle C Ng
- School of Occupational Therapy, Faculty of Health Sciences, La Trobe University, Bundoora, Victoria, Australia
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Fluttert F, van Meijel B, Nijman H, Bjørkly S, Grypdonck M. Detached concern of forensic mental health nurses in therapeutic relationships with patients the application of the early recognition method related to detached concern. Arch Psychiatr Nurs 2010; 24:266-74. [PMID: 20650372 DOI: 10.1016/j.apnu.2009.09.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Revised: 09/18/2009] [Accepted: 09/30/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Improvement of the interaction between forensic mental health nurses and patients may lead to a reduction of inpatient violence. The concept under study is detached concern, which refers to nurses' skills to neutralize the emotional appeal of patients by a balanced attitude between objectivity and emotional involvement. The Patient Contact Questionnaire (PCQ) aims at measuring the degree of concern of nurses for their patients. METHODS The PCQ was applied in a pretest-posttest design, evaluating the effects of the Early Recognition Method (ERM). This method aims at the prevention of inpatient violence in forensic psychiatry. Subjects were 116 forensic mental heath nurses working on 16 wards of a large Dutch forensic hospital. First, the baseline scores were compared to scores reported in an earlier study conducted in general psychiatry. Second, pretest-posttest comparisons were carried out for all nurses, and for subgroups of nurses with regard to gender, educational level, years of working experience, and patient population. Third, pretest-posttest comparisons were made on the PCQ item level. RESULTS The baseline scores of male nurses indicated significantly higher levels of concern than those of female nurses. In addition, more experienced nurses scored significantly higher with regard to concern than less experienced nurses. When comparing the scores before and after applying ERM, no significant differences were found. However, the sores of female nurses showed a tendency toward more concern after implementation of ERM. CONCLUSIONS Detached concern may be a meaningful concept in forensic mental health nursing in measuring nurses' concern for their patients. Levels of detached concern did not change significantly after application of ERM. However, the application of the PCQ could contribute to a better understanding of the interaction between nurses and their patients.
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Affiliation(s)
- Frans Fluttert
- Department of Nursing Science, Utrecht University, The Netherlands.
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Gale C, Hannah A, Swain N, Gray A, Coverdale J, Oud N. Patient aggression perceived by community support workers. Australas Psychiatry 2009; 17:497-501. [PMID: 20001375 DOI: 10.1080/10398560903287516] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Aggression by patients is a known risk factor for hospital workers. Within New Zealand, the bulk of ongoing care for physical and mental disabilities and health issues is not hospital based, but contracted to various non-governmental agencies. The rate of client aggression towards care workers from these organizations, to our knowledge, has not been assessed. Method: Two hundred and forty-two support workers in non-governmental agencies caring for people with disabilities responded to an anonymous mailed survey on client aggression, personal distress, and communication style. Results: Most support workers did experience verbal forms of aggression or destructive behaviour, fewer experienced physical aggression, and a minority were injured, sexually harassed, stalked or harassed by means of formal complaint. The median total violence score was five (interquartile range 12.25). A higher total violence score (using the POPAS-NZ) was associated with age and gender, the primary disability of clients, and the numbers of hours worked. The length of time worked was not associated with total violence risk. Communication style, after correcting for other factors, was a predictor of aggression. Almost 6% of care workers reported distress symptoms at a level associated with clinically significant stress reactions. Conclusions: Patient aggression is common among care workers, and can cause distress in the minority. We suggest that further research to clarify risk factors and develop interventions for care workers is needed.
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Affiliation(s)
- Christopher Gale
- Senior Lecturer, Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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