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Wijayaratnam A, Kozlowska O, Krayem A, Kaur S, Ayres H, Smith R, Paterson J, Moghabghab R, Henshall C. Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review. Int J Ment Health Nurs 2024; 33:834-858. [PMID: 38519874 DOI: 10.1111/inm.13317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 02/17/2024] [Accepted: 02/26/2024] [Indexed: 03/25/2024]
Abstract
Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.
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Affiliation(s)
| | | | | | - Satinder Kaur
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Helen Ayres
- Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Jane Paterson
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rola Moghabghab
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Cathy Henshall
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Oxford Brookes University, Oxford, UK
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Lawrence D, Bagshaw R, Stubbings D, Watt A. The Maintenance Model of Restrictive Practices: A Trauma-Informed, Integrated Model to Explain Repeated Use of Restrictive Practices in Mental Health Care Settings. Issues Ment Health Nurs 2024:1-16. [PMID: 39023511 DOI: 10.1080/01612840.2024.2369594] [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: 07/20/2024]
Abstract
Nurses are at the forefront of care in mental health services but their role is conflicted; they carry the most responsibility for care and also for restrictive practices. The harmful effects of restrictive practices for mental health patients are well documented, have attracted negative media attention, public concern, and criticism directed specifically at nursing staff. The need to reduce restrictive practices has been highlighted by patients, carer groups, legislators, policy makers, academics, and mental health service providers. Policies and best practice guidelines have resulted, but restrictive practices remain a global problem. This theory paper proposes that inertia is partly due to the absence of a coherent model that explains the initiation and maintenance of restrictive practice in inpatient mental health settings. The conceptual development and synthesis of the model and its practical implications are discussed.
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Affiliation(s)
- Daniel Lawrence
- Priory Group, Priory Healthcare, Monmouthshire, UK
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, UK
| | - Ruth Bagshaw
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, UK
| | - Daniel Stubbings
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, UK
| | - Andrew Watt
- Department of Applied Psychology, Cardiff Metropolitan University, Cardiff, UK
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Rowsell KA, Akinbola A, Hancock M, Nyambayo T, Jackson Z, Hunt DF. Reducing use of seclusion on a male medium secure forensic ward. BMJ Open Qual 2024; 13:e002576. [PMID: 38365432 PMCID: PMC10875490 DOI: 10.1136/bmjoq-2023-002576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
The reduction of restrictive practices is a priority for mental health inpatient services. Often such practices are considered to increase patients' feelings of anger, loneliness, hopelessness and vulnerability. Moreover, such approaches are counterintuitive to both recovery-orientated and trauma-informed practice.Our project, based in a male 15-bed secure forensic ward, aimed to reduce the duration (outcome measure) and frequency (balancing measure) of the use of seclusion by 10% over 6 months. Following the analysis of our local data systems and feedback from both patients and staff, we identified the high levels of use of seclusion, and reluctance to terminate it. These included a lack of awareness of the effective and appropriate use of such a facility, a hesitancy to use de-escalation techniques and an over-reliance on multidisciplinary team and consultant decision making.We subsequently designed and implemented three tests of change which reviewed seclusion processes, enhanced de-escalation skills and improved decision making. Our tests of change were applied over a 6-month period. During this period, we surpassed our original target of a reduction of frequency and duration by 10% and achieved a 33% reduction overall. Patients reported feeling safer on the ward, and the team reported improvements in relationships with patients.Our project highlights the importance of relational security within the secure setting and provides a template for other wards wishing to reduce the frequency and duration of seclusions.
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Affiliation(s)
- Kathryn Amy Rowsell
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ayodele Akinbola
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Mark Hancock
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Tsitsi Nyambayo
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Zoe Jackson
- Forensic Psychology Department, Oxford Health NHS Foundation Trust, Oxford, UK
| | - David Francis Hunt
- School of Psychology, University of Exeter Faculty of Health and Life Sciences, Exeter, UK
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Lyver B, Gorla J, Schulz-Quach C, Anderson M, Singh B, Hanagan T, Haines J, Sethi R. Identifying quality indicators to measure workplace violence in healthcare settings: a rapid review. BMC Emerg Med 2024; 24:29. [PMID: 38360571 PMCID: PMC10870575 DOI: 10.1186/s12873-024-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/29/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Workplace violence (WPV) in healthcare is a growing challenge posing significant risks to patient care and employee well-being. Existing metrics to measure WPV in healthcare settings often fail to provide decision-makers with an adequate reflection of WPV due to the complexity of the issue. This increases the difficulty for decision-makers to evaluate WPV in healthcare settings and implement interventions that can produce sustained improvements. OBJECTIVE This study aims to identify and compile a list of quality indicators that have previously been utilized to measure WPV in healthcare settings. The identified quality indicators serve as tools, providing leadership with the necessary information on the state of WPV within their organization or the impact of WPV prevention interventions. This information provides leadership with a foundation for planning and decision making related to addressing WPV. METHODS Ovid databases were used to identify articles relevant to violence in healthcare settings, from which 43 publications were included for data extraction. Data extraction produced a total of 229 quality indicators that were sorted into three indicator categories using the Donabedian model: structure, process, and outcome. RESULTS A majority of the articles (93%) contained at least 1 quality indicator that possessed the potential to be operationalized at an organizational level. In addition, several articles (40%) contained valuable questionnaires or survey instruments for measuring WPV. In total, the rapid review process identified 84 structural quality indicators, 121 process quality indicators, 24 outcome quality indicators, 57 survey-type questions and 17 survey instruments. CONCLUSIONS This study provides a foundation for healthcare organizations to address WPV through systematic approaches informed by quality indicators. The utilization of indicators showed promise for characterizing WPV and measuring the efficacy of interventions. Caution must be exercised to ensure indicators are not discriminatory and are suited to specific organizational needs. While the findings of this review are promising, further investigation is needed to rigorously evaluate existing literature to expand the list of quality indicators for WPV.
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Affiliation(s)
- Brendan Lyver
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jaswanth Gorla
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christian Schulz-Quach
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.
- Centre of Mental Health, University Health Network, Toronto, ON, Canada.
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada.
| | - Melanie Anderson
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Brendan Singh
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Trevor Hanagan
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Jennifer Haines
- University Health Network, 200 Elizabeth St, M5G 2C4, Toronto, ON, Canada
| | - Rickinder Sethi
- Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre of Mental Health, University Health Network, Toronto, ON, Canada
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5
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Ewen J, Gaeta L, Fitzgerald KA, Ragione BL, Feil DA, Raio CC, Arrillaga A, Klein LR, Eckardt PA. Measuring Emergency Department Staff Perceptions of Causes and Management of Violence. J Trauma Nurs 2023; 30:307-317. [PMID: 37937869 DOI: 10.1097/jtn.0000000000000749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Half of all reported violent incidents in health care settings occur in the emergency department (ED) placing all staff members at risk. However, research typically does not include all ED work groups or validated measures beyond nurses and physicians. OBJECTIVE The aims of this study were to (a) validate an established instrument measuring perceptions of causes of violence and attitudes toward managing violence within an inclusive workforce sample; and (b) explore variation in perceptions, attitudes, and incidence of violence and safety to inform a violence prevention program. METHODS This is an investigator-initiated single-site cross-sectional survey design assessing the psychometric properties of the Management of Aggression and Violence Attitude Scale (MAVAS) within a convenience sample (n = 134). Construct validity was assessed using exploratory factor analysis and reliability was evaluated by the Cronbach's α estimation. Descriptive, correlational, and inferential estimates explored differences in perceptions, attitudes, and incidence of violence and safety. RESULTS Exploratory factor analysis indicated validity of the MAVAS with a seven-factor model. Its internal consistency was satisfactory overall (Cronbach's α= 0.87) and across all subscales (Cronbach's α values = 0.52-0.80). Significant variation in incidence of physical assault, perceptions of safety, and causes of violence was found between work groups. CONCLUSIONS The MAVAS is a valid and reliable tool to measure ED staff members' perceptions of causes of violence and attitudes toward managing violence. In addition, it can inform training according to differences in work group learner needs.
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Affiliation(s)
- Julia Ewen
- Good Samaritan University Hospital, West Islip, New York (Mss Ewen and Fitzgerald and Drs Gaeta, Ragione, Raio, Arrillaga, Klein, and Eckardt); and Molloy University, Rockville Centre, New York (Ms Feil and Dr Eckardt)
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Yap CYL, Daniel C, Knott JC, Myers E, Gerdtz M. Causes and management of aggression and violence: A survey of emergency department nurses and attendees. Int Emerg Nurs 2023; 69:101292. [PMID: 37150146 DOI: 10.1016/j.ienj.2023.101292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 03/12/2023] [Accepted: 03/26/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Celene Y L Yap
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
| | - Catherine Daniel
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
| | - Jonathan C Knott
- Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia; Department of Medical Education, The University of Melbourne, Victoria 3010, Australia.
| | - Erin Myers
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia.
| | - Marie Gerdtz
- Department of Nursing. Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, 161 Barry Street, The University of Melbourne, Victoria 3010, Australia; Melbourne Health, The Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3052, Australia; Department of Critical Care, The University of Melbourne, Victoria 3010, Australia.
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7
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Hansen A, Hazelton M, Rosina R, Inder K. What do we know about the experience of seclusion in a forensic setting? An integrative literature review. Int J Ment Health Nurs 2022; 31:1109-1124. [PMID: 35384224 PMCID: PMC9543699 DOI: 10.1111/inm.13002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2022] [Indexed: 11/30/2022]
Abstract
Seclusion is used in forensic and general mental health settings to protect a person or others from harm. However, seclusion can result in trauma-related harm and re-traumatization with little known about the experience of seclusion for consumers in forensic mental health settings from their perspectives. This article explores consumer experiences of seclusion in forensic mental health settings and explores the differences between female and male experiences of seclusion. Five electronic databases were systematically searched using keywords and variations of experience, attitude, seclusion, coercion, forensic mental health, and forensic psychiatry. Inclusion criteria were original peer-reviewed studies conducted in adult forensic mental health settings reporting data on the experiences of or attitudes towards seclusion. Seven studies met the criteria for inclusion and a quality assessment was undertaken. Results found consumers in forensic mental health settings perceive seclusion to be harmful, a punishment for their behaviour, and largely a negative experience that impacts their emotional health. Some consumers report positive experiences of seclusion. Differences in the experience of seclusion for females and males are unclear. Further research is required to understand the experience of seclusion for women in forensic mental health settings. Identification and consideration of differences in the experience of seclusion for males and females may assist in identifying sex-specific interventions and may inform policy and practices to eliminate or reduce the trauma associated with seclusion use.
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Affiliation(s)
- Alison Hansen
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,School of Nursing & Midwifery, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Michael Hazelton
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Robyn Rosina
- Independent Researcher, Sydney, New South Wales, Australia
| | - Kerry Inder
- School of Nursing & Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New Lambton, New South Wales, Australia
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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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Kuosmanen A, Tiihonen J, Repo-Tiihonen E, Turunen H. Voluntary patient safety incidents reporting in forensic psychiatry-What do the reports tell us? J Psychiatr Ment Health Nurs 2022; 29:36-47. [PMID: 33548085 DOI: 10.1111/jpm.12737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 01/04/2021] [Accepted: 01/27/2021] [Indexed: 11/29/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Patient safety incident reporting has been recognized as a key process for organizational learning and safety culture; however, there is limited knowledge about patient safety in forensic psychiatric care. There are distinct patient safety issues in psychiatric nursing, associated (inter alia) with the self-harm, violence, seclusion/restrain and restrictions. Many adverse events are preventable. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: No harm was caused to patients in less than half (51%) of all reported incidents (in a Finnish forensic psychiatric hospital during a six-year period) considered in this study. The most common location of violent incidents was corridors (31%), followed by day rooms (20%), and patient rooms (15%). The most common patient safety incidence type was violence against another patient (38%), which typically occurred in corridors (36%), dayrooms (25%) and patient rooms (15%), and was usually related to daily activities in the afternoon (1,400-1,600 hr) and evening (1,800-2,000 hr). Typically, recommendations for improving patient safety focus on human behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: There is a need to notify and report all patient safety incidents (following staff training), learn from previous incidents (also learn for success), prevent typical incidents, learn for success, promote patient participation in incident prevention, share development measures outside the ward to enable exploitation by others and strengthen safety culture. In forensic psychiatry, conversation with patients regarding safety measures is strongly recommended to prevent patient safety incidents related to violence. The perspective should be extended from patient-specific factors to general factors such as patient treatment and general comfort and privacy. ABSTRACT INTRODUCTION: Patient safety incident reporting has been recognized as a key process for organizational learning and safety culture, but there is limited knowledge about patient safety in forensic psychiatric care. AIMS To characterize the types and frequencies of incidents in forensic psychiatric care and assess the implications for practice. METHODS Data were collected from a patient safety incident reporting system (PSiRS) database of one forensic psychiatry hospital in Finland and analysed using descriptive statistics. RESULTS No harm was caused in more than half of the 2,521 reported incidents examined (51%, n = 1,260). The most frequently recorded incident type was violence (38%), which typically occurred in corridors (31%) or dayrooms (20%). The most frequently recommended action to prevent violent events was that potential risks should be discussed (77%). DISCUSSION Patient safety incidents related to violence are common in forensic psychiatric hospitals. Although very few adverse events were classified as causing serious harm to patients, many cases of violence could be prevented by identifying potential circumstances that lead to violence. IMPLICATIONS FOR PRACTICE Staff need encouragement and training to detect and report all patient safety incidents. Safety culture is strengthened by learning and sharing development measures to improve patient safety.
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Affiliation(s)
- Anssi Kuosmanen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,Department of Nursing Science, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eila Repo-Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Kuopio, Finland
| | - Hannele Turunen
- Department of Nursing Science, University of Eastern Finland, Kuopio, Finland.,Kuopio University Hospital, Kuopio, Finland
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Lenk-Adusoo M, Hürden L, Tohvre R, Tretjakov I, Evert L, Haring L. Healthcare professionals' and patients' attitudes toward the causes and management of aggression in Estonian psychiatric clinics: a quantitative cross-sectional comparative study. J Ment Health 2022; 31:699-708. [PMID: 35001762 DOI: 10.1080/09638237.2021.2022624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND To enhance patient aggression management efficacy and to reduce the use of coercive interventions in inpatient psychiatric care, it is important to know the attitudes of all involved parties towards the aggression and its management. AIMS This study aimed to explore attitudes of the psychiatrists, nurses and inpatients toward the causes and management of patient aggression in Estonian psychiatric clinics. A frequency of aggressive behaviour experienced by professionals, the relationships between the attitudes, participation in coercion, and a frequency of aggression, were also identified. METHODS To assess attitudes towards the causes and management of patient aggression, the Management of Aggression and Violence Attitude Scale was implemented. RESULTS The survey comprised of 63 psychiatrists, 197 nurses and 199 inpatients. The patients and the professionals had similar as well as different attitudes toward aggression and its management. Patients expected professionals to take a more personal approach when aggression occurs; in some cases, allowing the patients to deal with negative emotions on their own but, if necessary, isolating or restraining the violent people. CONCLUSIONS There is a need of training programs that focus on dealing patient aggression to foster a culture of safe, patient-centred care and to reduce aggression in psychiatric clinics.
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Affiliation(s)
- Margit Lenk-Adusoo
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia.,Department of Nursing and Midwifery, Tartu Health Care College, Tartu, Estonia
| | - Liina Hürden
- Psychiatry Clinic of North Estonia Medical Centre, Tallinn, Estonia
| | - Reet Tohvre
- Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
| | - Ilja Tretjakov
- Psychiatry Clinic of Viljandi Hospital, Viljandi, Estonia
| | - Luule Evert
- Psychiatry Clinic of Pärnu Hospital, Pärnu, Estonia
| | - Liina Haring
- Institute of Clinical Medicine, Faculty of Medicine, University of Tartu, Tartu, Estonia.,Psychiatry Clinic of Tartu University Hospital, Tartu, Estonia
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Weltens I, Bak M, Verhagen S, Vandenberk E, Domen P, van Amelsvoort T, Drukker M. Aggression on the psychiatric ward: Prevalence and risk factors. A systematic review of the literature. PLoS One 2021; 16:e0258346. [PMID: 34624057 PMCID: PMC8500453 DOI: 10.1371/journal.pone.0258346] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 09/26/2021] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION On psychiatric wards, aggressive behaviour displayed by patients is common and problematic. Understanding factors associated with the development of aggression offers possibilities for prevention and targeted interventions. This review discusses factors that contribute to the development of aggression on psychiatric wards. METHOD In Pubmed and Embase, a search was performed aimed at: prevalence data, ward characteristics, patient and staff factors that are associated with aggressive behaviour and from this search 146 studies were included. RESULTS The prevalence of aggressive behaviour on psychiatric wards varied (8-76%). Explanatory factors of aggressive behaviour were subdivided into patient, staff and ward factors. Patient risk factors were diagnosis of psychotic disorder or bipolar disorder, substance abuse, a history of aggression, younger age. Staff risk factors included male gender, unqualified or temporary staff, job strain, dissatisfaction with the job or management, burn-out and quality of the interaction between patients and staff. Staff protective factors were a good functioning team, good leadership and being involved in treatment decisions. Significant ward risk factors were a higher bed occupancy, busy places on the ward, walking rounds, an unsafe environment, a restrictive environment, lack of structure in the day, smoking and lack of privacy. CONCLUSION Despite a lack of prospective quantitative data, results did show that aggression arises from a combination of patient factors, staff factors and ward factors. Patient factors were studied most often, however, besides treatment, offering the least possibilities in prevention of aggression development. Future studies should focus more on the earlier stages of aggression such as agitation and on factors that are better suited for preventing aggression such as ward and staff factors. Management and clinicians could adapt staffing and ward in line with these results.
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Affiliation(s)
- Irene Weltens
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Maarten Bak
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Simone Verhagen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Emma Vandenberk
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Patrick Domen
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands.,Mondriaan Mental Health Institute, Maastricht / Heerlen, The Netherlands
| | - Marjan Drukker
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Conflict management: A qualitative study of mental health staff's perceptions of factors that may influence conflicts with forensic mental health inpatients. Arch Psychiatr Nurs 2021; 35:407-417. [PMID: 34561053 DOI: 10.1016/j.apnu.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/09/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022]
Abstract
Internationally, clinical services are under pressure to reduce their use of restrictive practices. The aim was to explore how mental health nurses and nursing assistants perceive conflict and their use of restrictive practices with mental health inpatients in forensic mental health care. A total of 24 semi-structured interviews with forensic mental health staff were conducted and analysed using thematic analysis. The findings propose a dynamic model that explains how tolerance of potential conflict situations changes depending on individual staff members' perceptions of patients and colleagues, and their relationships.
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13
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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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14
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Lim E, Wynaden D, Heslop K. Using Q-methodology to explore mental health nurses' knowledge and skills to use recovery-focused care to reduce aggression in acute mental health settings. Int J Ment Health Nurs 2021; 30:413-426. [PMID: 33084220 DOI: 10.1111/inm.12802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
When nurses practise recovery-focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery-focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q-methodology that examined the knowledge and skill components of recovery-focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co-production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery-focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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15
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Goodman H, Papastavrou Brooks C, Price O, Barley EA. Barriers and facilitators to the effective de-escalation of conflict behaviours in forensic high-secure settings: a qualitative study. Int J Ment Health Syst 2020; 14:59. [PMID: 32774452 PMCID: PMC7397665 DOI: 10.1186/s13033-020-00392-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/23/2020] [Indexed: 01/02/2023] Open
Abstract
Background Violent and aggressive incidents are common within mental health settings and are often managed using high-risk physical interventions such as restraint and seclusion. De-escalation is a first-line technique to manage conflict behaviours and prevent violence and aggression. There is limited research into the use of de-escalation in high-secure settings. This study investigated staff, patient and carer perspectives on the barriers and facilitators to using de-escalation for conflict behaviours. Methods Semi-structured individual interviews (n = 12) and focus groups (n = 3) were conducted with eight patients, four carers and 25 staff members in a high-secure hospital in England. Interviews and focus groups were informed by the theoretical domains framework and were digitally recorded, transcribed verbatim and analysed using framework analysis and the COM-B behaviour change model. Results Four themes and 15 sub-themes (barriers and facilitators) were identified. Themes related to capabilities (building relationships: knowing the patient and knowing yourself), opportunities (filling the void: challenges within the high-security environment; dynamic relationships) and motivation (keeping everyone safe). Strong staff-patient therapeutic relationships underpinned by trust, fairness, consistency and an awareness of the trauma-aggression link were considered key to successful de-escalation. Specific psychological and interpersonal skills including empathy, respect, reassurance, sincerity, genuine concern and validation of the patient perspective are needed to achieve this. Barriers related to the physical environment; organisational resources, practices and systems; staff traumatisation; hierarchical and punitive attitudes towards patient care, and an insufficient understanding of psychiatric diagnoses, especially personality disorder. It was apparent across themes that fear, which was experienced by both staff and patients, was a driver for many behaviours. Conclusions This work has identified organizational and behaviour change targets for interventions seeking to reduce violence and restrictive practices through the use of de-escalation in high-secure hospitals. The potential for, and occurrence of, violence in such settings is high and leads to fear in patients and staff. The factors which promote fear in each group should be addressed in de-escalation training.
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Affiliation(s)
- Helena Goodman
- Kate Granger Building, University of Surrey, Guildford, GU2 7YH UK
| | | | - Owen Price
- Jean McFarlane Building, University of Manchester, Manchester, M13 9PY UK
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16
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Abstract
The appropriate treatment of mentally unwell, aggressive patients has challenged psychiatry for centuries. Seclusion is practiced worldwide, but concerns remain regarding its appropriateness and lack of alternatives. Patients generally report seclusion as a negative experience, though there is a paucity of literature exploring this in detail. This investigation was a service evaluation appraising inpatients' perspective of processes occurring before (information, communication), during (review, care), and after (debrief, reflection) seclusion in a psychiatric intensive care unit (PICU). In this phenomenological study, qualitative data were gathered using a questionnaire in a structured interview. All patients had been nursed in seclusion during admission to a male PICU at South London and the Maudsley NHS Foundation Trust. Ten patients were interviewed over 4 months. The central theme was perceived lack of communication in the patient-professional relationship, which manifested itself as (i) violence against patients, (ii) lack of psychological support, and (iii) the need for alternatives. Such feedback from patients queries whether national guidelines are appropriate and/or being adhered to. Healthcare practitioners have a responsibility to challenge accepted practice to continually improve the standard of patient-centred care. Utilising patient perspectives can be a powerful driver of change towards more humane treatment of vulnerable patients.
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Affiliation(s)
- Silvia Allikmets
- Department of Life Sciences & Medicine, GKT School of Medical Education, King's College London, London, United Kingdom
| | - Caryl Marshall
- Southwark High Support Rehabilitation, South London and the Maudsley NHS Foundation Trust, London, United Kingdom.,Community Forensic LD/ASD, Oxleas NHS Foundation Trust, South London Partnership, London, United Kingdom
| | - Omar Murad
- Psychiatric Intensive Care, South London and the Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kamal Gupta
- South London and the Maudsley NHS Foundation Trust, London, United Kingdom
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17
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Muir-Cochrane E, Oster C, Grimmer K. International research into 22 years of use of chemical restraint: An evidence overview. J Eval Clin Pract 2020; 26:927-956. [PMID: 31318109 DOI: 10.1111/jep.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 06/25/2019] [Accepted: 06/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chemical restraint (CR) (also known as rapid tranquilisation) is the forced (non-consenting) administration of medications to manage uncontrolled aggression, anxiety, or violence in people who are likely to cause harm to themselves or others. Our population of interest was adults with mental health disorders (with/without substance abuse). There has been a growing international movement over the past 22 years towards reducing/eliminating restrictive practices such as CR. It is appropriate to summarise the research that has been published over this time, identify trends and gaps in knowledge, and highlight areas for new research to inform practice. AIMS To undertake a comprehensive systematic search to identify, and describe, the volume and nature of primary international research into CR published since 1995. METHODS This paper reports the processes and overall findings of a systematic search for all available primary research on CR published between 1 January 1996 and 31 July 2018. It describes the current evidence base by hierarchy of evidence, country (ies) producing the research, CR definitions, study purpose, and outcome measures. RESULTS This review identified 311 relevant primary studies (21 RCTs; 46 non-controlled experimental or prospective observational studies; 77 cross-sectional studies; 69 retrospective studies; 67 opinion pieces, position or policy statements; and 31 qualitative studies). The USA, UK, and Australia contributed over half the research, whilst cross-country collaborations comprised 6% of it. The most common research settings comprised acute psychiatric wards (23.3%), general psychiatric wards (21.6%), and general hospital emergency departments (19.0%). DISCUSSION A key lesson learnt whilst compiling this database of research into CR was to ensure that all papers described non-consenting administration of medications to manage adults with uncontrolled aggression, anxiety, or violence. There were tensions in the literature between using effective CR without producing adverse events, and how to decide when CR was needed (compared with choosing non-chemical intervention for behavioural emergencies), respecting patients' dignity whilst safeguarding their safety, and preserving safe workplaces for staff, and care environments for other patients. The range of outcome measures suggests opportunities to standardise future research.
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Affiliation(s)
- Eimear Muir-Cochrane
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042
| | - Candice Oster
- On-Line Education and Development, Flinders Human Behaviour and Health Research Unit (FHBHRU), College of Medicine and Public Health, Flinders University, South Australia, Australia, 5042
| | - Karen Grimmer
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia, 5042.,Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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18
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Coneo AMC, Thompson AR, Parker K, Harrison G. The outcome of a training programme (RESPECT) on staff's attitudes towards causes and management of aggression in a Regional Referral Hospital of northern Uganda. J Psychiatr Ment Health Nurs 2020; 27:25-40. [PMID: 31349379 DOI: 10.1111/jpm.12549] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 07/02/2019] [Accepted: 07/23/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Health systems in many low- to middle-income countries (LMICs) are heavily underfunded, and staff training opportunities are limited. There is a lack of empirical data on the development and use of sustainable training programmes in aggression management skills in LMICs. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: After RESPECT, participants showed greater agreement with statements about the role of environmental and relational factors as antecedents of aggression and described favouring the use of non-physical techniques to manage aggressive behaviour. Attitudes towards management practices of seclusion, medication and restraint remained unchanged after RESPECT training. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Training programmes like RESPECT may be useful to improve attitudes towards causes of aggression and its management in LMIC hospitals. However, further evidence is required to demonstrate whether these results can be sustained over time and whether these attitudinal changes are associated with reduction of workplace violence. Mental health nurses and other mental health professionals can play a key role in establishing hospital-wide training and sharing skills across geographical boundaries. Abstract Introduction Occupational violence has been demonstrated to impact negatively on the well-being of nurses and patients. Staff attitudes towards causes and management of patients' aggression influence their practice. Training is likely to influence attitudes towards aggression; however, Uganda's health system lacks adequate resources to provide aggression management training for staff. Aim To assess the impact of a training programme (RESPECT) on staff attitudes towards causes and management of patient's aggression in a Ugandan hospital. Methods This study used a mixed-methods convergent design. A convenience sample of nurses and support staff employed in the psychiatric ward and other services across the hospital (N = 90) completed the Management of Aggression and Violence Attitude Scale (MAVAS) pre- and post-training. The views of a smaller sample (n = 35) were captured via interviews and focus groups and analysed using thematic analysis. Results Participants reported greater agreement with patients' physical and social environment (external and situational causative models) as factors influencing patient's aggression. Qualitative findings substantiated the results identified in the survey. Attitudes towards seclusion, restraint and medication remained unchanged. Discussion and implications for practice RESPECT has the potential to change staff attitudes towards aggression in the short term. Further research is needed to investigate long-term effects and impact on incidents of aggression.
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Affiliation(s)
- Ana M C Coneo
- Department of Psychology, University of Sheffield, Sheffield, UK
| | | | - Kim Parker
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
| | - Greg Harrison
- Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK
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19
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Zheng C, Li S, Chen Y, Ye J, Xiao A, Xia Z, Liao Y, Xu Y, Zhang Y, Yu L, Wang C, Lin J. Ethical consideration on use of seclusion in mental health services. Int J Nurs Sci 2019; 7:116-120. [PMID: 32099869 PMCID: PMC7031114 DOI: 10.1016/j.ijnss.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 09/04/2019] [Accepted: 10/11/2019] [Indexed: 02/05/2023] Open
Abstract
Seclusion was widely used in mental health service, which had caused various negative effects on patients and nurses. In China, the clinical use of seclusion was gradually increasing, which had led to ethical dilemma and had gained public concern. This article aimed to synthesize the ethical issue according to the principle of autonomy, justice, beneficence, and non-maleficence. Given that nursing workforce was limited and work burden among psychiatric nurses was heavy, seclusion was one of coercive interventions managing aggressive behavior. In relation to cope with ethical dilemma, it was proposed to improve therapeutic environment, and to apply de-escalation technique. Additionally, reducing clinical use and adverse effects of seclusion was also important, this goal would be achieved by building appropriate patient-nurse relationship, increasing staff engagement, and promoting guideline of seclusion.
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Affiliation(s)
- Chaodun Zheng
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Sijue Li
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yingmei Chen
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Junrong Ye
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Aixiang Xiao
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China.,Department of Traditional Chinese Medicine, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Zhichun Xia
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Yao Liao
- Department of Nursing Administration, Jingzhou Central Hospital, Jingzhou, China
| | - Yu Xu
- Department of Intensive Care Unit, West China Hospital of Sichuan University, Chengdu, China
| | - Yunlei Zhang
- Department of Nursing Administration, Jingzhou Central Hospital, Jingzhou, China
| | - Lin Yu
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Chen Wang
- Department of Early Intervention, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
| | - Jiankui Lin
- Department of Nursing Administration, Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou, China
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20
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Vermeulen JM, Doedens P, Boyette LLNJ, Spek B, Latour CHM, de Haan L. "But I did not touch nobody!"-Patients' and nurses' perspectives and recommendations after aggression on psychiatric wards-A qualitative study. J Adv Nurs 2019; 75:2845-2854. [PMID: 31222795 PMCID: PMC6899923 DOI: 10.1111/jan.14107] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 11/28/2022]
Abstract
AIMS To gain a deeper understanding of the differences in patients and staff perspectives in response to aggression and to explore recommendations on prevention. DESIGN Qualitative, grounded theory study. METHODS We conducted semi-structured interviews with patients and nurses involved in an aggressive incident. Data collection was performed from May 2016 - March 2017. RESULTS Thirty-one interviews were conducted concerning 15 aggressive incidents. Patients and nurses generally showed agreement on the factual course of events, there was variation in agreement on the perceived severity (PS). Patients' recommendations on prevention were mostly personally focussed, while nurses suggested general improvements. CONCLUSION Patients are often capable to evaluate aggression and give recommendations on prevention shortly after the incident. Patients and nurses differ in the PS of aggression. Recommendations on prevention of patients and nurses are complementary. IMPACT What problem did the study address? Perspectives of patients and nurses differ with respect to aggression, but how is unclear. What were the main findings? Patients and nurses generally described a similar factual course of events concerning the incident, patients often perceive the severity less than nurses. Patients are capable to give recommendations on prevention of aggressive incidents, shortly after the incident. Where and on whom will the research have impact? Factual course of events can be a common ground to start evaluating aggressive incidents and post-incident review should address the severity of incidents. Asking recommendations from patients on how to improve safety and de-escalation can lead to innovative and personal de-escalation strategies and supports patients autonomy.
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Affiliation(s)
- Jentien M Vermeulen
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Paul Doedens
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lindy-Lou N J Boyette
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Bea Spek
- Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands
| | - Corine H M Latour
- ACHIEVE Centre for Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Psychiatry, Amsterdam UMC (location Academic Medical Center), University of Amsterdam, Amsterdam, The Netherlands.,Arkin, Amsterdam, The Netherlands
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21
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Cross-cultural adaptation of the Management of Aggression and Violence Attitude Scale for nurse in emergency department. FRONTIERS OF NURSING 2019. [DOI: 10.2478/fon-2019-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
To follow the guidelines of intercultural adaptation provided by the American Academy of Orthopedic Surgeons’ (AAOS) Evidence-Based Medicine Committee, translating the original scale and evaluating the reliability and validity, and then to compile the Chinese version of the Management of Aggression and Violence Attitude Scale (MAVAS) for nurses in emergency room in the mainland of China.
Methods
This study consists of two phases of testing: (1) translation: forward translation, synthesis, back translation, expert committee review, and pretesting; (2) psychometric properties: content and construct validity, internal consistency, and test–retest reliability.
Results
The Chinese version of MAVAS and the original version showed excellent similarities and equivalence. The average Scale-level Content Validity Index was 0.904, and the Item-level Content Validity Index ranged from 0.80 to 1.00. The construct validity was tested using confirmatory factor analysis by LISREL 8.7; χ2/df of the scale was 4.781<5, NFI, NNFI, CFI, IFI>0.90, indicating that the scale’s factor structure model fitted better. The internal consistency was satisfactory (scale, Cronbach’s α=0.94; subscales, Cronbach’s α=0.74–0.90), and the test–retest reliability over 2 weeks was good (scale, Pearson’s coefficient=0.996; subscales, Pearson’s coefficient=0.801–0.963).
Conclusions
The Chinese version of MAVAS had an excellent feasibility. It was found to be a valid and reliable tool to assess nurses’ attitude toward patients’ violence in emergency department.
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Deering K, Pawson C, Summers N, Williams J. Patient perspectives of helpful risk management practices within mental health services. A mixed studies systematic review of primary research. J Psychiatr Ment Health Nurs 2019; 26:185-197. [PMID: 31046161 DOI: 10.1111/jpm.12521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/23/2019] [Accepted: 04/29/2019] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ABOUT THE SUBJECT?: Risk in psychiatry involves harm to self or others owing to mental health difficulties, for example iatrogenic effects of treatment, self-harm, suicide and violence. Risk management is a framework to minimize risks, comprising of risk assessment, generation of risk management plans and evaluation of interventions. Literature has extensively explored risk management and presented a critique that its practices can lead to patient harm. However, there is a paucity of literature about what patients identify as helpful risk management practices, despite the potential for such patient views to ameliorate harm and improve mental health care. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: Interpersonal relationships with clinicians, and communication that keeps patients involved and informed of management processes, were found to be central to beneficial risk management practices, while patients having agency and autonomy to influence their participation was also important. Beneficial interpersonal relationships and connectivity in the form of patients' wider community of support were found to be influential in aiding risk management. Meaningful relationships, and particularly peer support, that maintained personal and collective identities were prevalent in the literature. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Rendering risk management more visible and accessible in practice might cultivate an openness that promotes patient participation. This includes drawing on a wider network of support, for example the patient's friends and family, as well as having advocacy utilizing peer support. Abstract Introduction Minimizing the harm that patients pose to themselves and others, due to mental health difficulties, is a central component of risk management in psychiatry. However, risk management itself can cause patient harm, but despite this and the potentially informative value of lived experience, little is known about what patients want or expect from risk management. Aim To review research and explore what patients consider beneficial in risk management practice. Method A mixed studies systematic review utilizing PRISMA guidelines, alongside a convergent qualitative design to categorize findings. Results Twelve papers were identified, generating two categories of beneficial practices: interpersonal relationships and communication with clinicians; coupled with patient agency in their own risk management. Discussion Connectivity appears important. Particularly patients feeling involved, and their voices being heard in both the identification of risks and then shaping risk management practice. Moreover, this included involvement of friends, family and peers to widen input and supportive networks beyond clinical relationships. Implications for Practice Risk management needs to be an accessible part of care, which is more inclusive of patient views and needs. The latter might also be aided by drawing on the patient's wider community in order to provide more effective support and risk management.
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Affiliation(s)
- Kris Deering
- Mental Health Nursing Department, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Chris Pawson
- Psychological Sciences Research Group, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
| | - Neil Summers
- Faculty of Wellbeing, Education & Language Studies, School of Health, Wellbeing and Social Care, Open University, Milton Keynes, UK
| | - Jo Williams
- Mental Health Nursing Department, Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
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23
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Ireland CA, Ireland JL, Jones NS, Chu S, Lewis M. Predicting security incidents in high secure male psychiatric care. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:40-52. [PMID: 31122639 DOI: 10.1016/j.ijlp.2019.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/20/2018] [Accepted: 01/18/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The contribution of environmental and organisational factors in predicting security incidents within a high secure male psychiatric setting is considered using a series of connected studies; a systematic literature review comprising 41 studies and five inquiries (Study 1) to identify core themes of likely importance; application of these themes to incident data through assessment of the ward culture, as perceived by 73 male psychiatric patients and 157 staff (Study 2); and detailed examination of noted relevant factors in the form of interpersonal style, meaningful activity and physical environmental characteristics in a study comprising 62 patients and 151 staff (Study 3). It was predicted that security incidents would be identified through inclusion of environmental and organisational factors. RESULTS The systematic review demonstrated the importance of accounting for staff characteristics, patient interactions, physical environment and meaningful activity. The subsequent study noted the importance of only specific aspects of the social environment, with the final study demonstrating that incidents were associated with controlling interpersonal styles of staff, lower perceived fairness, and less involvement in off-ward activities. Perception of fair treatment and off-ward activities mediated the staff interpersonal style and security incident relationship. CONCLUSIONS The research proposes a preliminary framework - the McKenna Framework for understanding Incidents in Secure Settings (M-FISS) - to explain the occurrence of security incidents in secure psychiatric care.
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Affiliation(s)
- Carol A Ireland
- School of Psychology, University of Central Lancashire, Darwin Building, Preston PR1 2HE, UK; Ashworth Research Centre, Mersey Care NHS Trust, OER Building, Parkbourn, Maghull L31 1HW, UK.
| | - Jane L Ireland
- School of Psychology, University of Central Lancashire, Darwin Building, Preston PR1 2HE, UK; Ashworth Research Centre, Mersey Care NHS Trust, OER Building, Parkbourn, Maghull L31 1HW, UK
| | - Naomi S Jones
- School of Psychology, University of Central Lancashire, Darwin Building, Preston PR1 2HE, UK; Ashworth Research Centre, Mersey Care NHS Trust, OER Building, Parkbourn, Maghull L31 1HW, UK
| | - Simon Chu
- School of Psychology, University of Central Lancashire, Darwin Building, Preston PR1 2HE, UK; Ashworth Research Centre, Mersey Care NHS Trust, OER Building, Parkbourn, Maghull L31 1HW, UK
| | - Michael Lewis
- School of Psychology, University of Central Lancashire, Darwin Building, Preston PR1 2HE, UK; Ashworth Research Centre, Mersey Care NHS Trust, OER Building, Parkbourn, Maghull L31 1HW, UK
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Tingleff EB, Hounsgaard L, Bradley SK, Gildberg FA. Forensic psychiatric patients' perceptions of situations associated with mechanical restraint: A qualitative interview study. Int J Ment Health Nurs 2019; 28:468-479. [PMID: 30341808 DOI: 10.1111/inm.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 12/14/2022]
Abstract
To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence-based patient care, we need more knowledge about patients' subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients' perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: 'overt protest reactions', 'silent protest reactions', 'illness-related behaviour', and 'genuinely calm', which together characterize patients' perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: 'pattern of protest' and 'pattern of illness'. Further research is needed to illuminate the associations between patients' perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.
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Affiliation(s)
- Ellen B Tingleff
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Department of Nursing, UCL University College, Vejle, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.,Institute of Nursing & Health Science, University of Greenland, Nuuk, Greenland
| | | | - Frederik A Gildberg
- Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
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Hylén U, Engström I, Engström K, Pelto-Piri V, Anderzen-Carlsson A. Providing Good Care in the Shadow of Violence - An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden. Issues Ment Health Nurs 2019; 40:148-157. [PMID: 30376382 DOI: 10.1080/01612840.2018.1496207] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.
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Affiliation(s)
- Ulrika Hylén
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Ingemar Engström
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Karin Engström
- c School of Culture and Education , Södertörn University , Stockholm
| | - Veikko Pelto-Piri
- a School of Medical Sciences , Örebro University , Örebro , Sweden.,b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden
| | - Agneta Anderzen-Carlsson
- b University Health Care Research Center, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.,d School of Health Sciences , Örebro University , Örebro , Sweden
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26
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Lim E, Wynaden D, Heslop K. Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study. Int J Ment Health Nurs 2019; 28:237-246. [PMID: 30027634 DOI: 10.1111/inm.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Abstract
Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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27
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Ezeobele IE, McBride R, Engstrom A, Lane SD. Aggression in Acute Inpatient Psychiatric Care: A Survey of Staff Attitudes. Can J Nurs Res 2019; 51:145-153. [PMID: 30669859 DOI: 10.1177/0844562118823591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction Inpatient aggression poses consistent complications for psychiatric hospitals. It can affect patient and staff safety, morale, and quality of care. Research on staff attitudes toward patient aggression is sparse. Purpose The study explored staff attitudes toward patient aggression by hospital position types and years of experience in a psychiatric hospital. We predicted that staff experiencing patient aggression would be related to working in less trained positions, having less psychiatric work experience, and demonstrating attitudes that were consistent with attributes internal to the patient and not external. Methods Fifty-one percent completed online survey using Management of Aggression and Violence Attitude Scale, along with demographics, years of work experience, and number of times staff experienced aggressive event. Results Management of Aggression and Violence Attitude Scale scores, staff position types, and years of experience were related to the number of aggressive interactions. Nurses and psychiatric technicians reported highest number of exposures to patient aggression, followed by physicians; however, support staff reported less patient aggression. More years worked in a psychiatric hospital was associated with more aggressive experience. Conclusion Nurses, psychiatric technicians, and physicians reported greater exposure to patients’ aggression than support staff. Training programs, developed specifically to individual position types, focusing on recognition of sources of aggression, integrated into staff training, might reduce patient on staff aggression in psychiatric hospitals.
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Affiliation(s)
- Ifeoma E Ezeobele
- 1 Department of Nursing and Research, UTHealth Harris County Psychiatric Center, Houston, TX, USA
| | - Rachel McBride
- 1 Department of Nursing and Research, UTHealth Harris County Psychiatric Center, Houston, TX, USA
| | - Allison Engstrom
- 1 Department of Nursing and Research, UTHealth Harris County Psychiatric Center, Houston, TX, USA
| | - Scott D Lane
- 1 Department of Nursing and Research, UTHealth Harris County Psychiatric Center, Houston, TX, USA.,2 Department of Psychiatry and Behavioral Sciences, UTHealth, Houston, TX, USA
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Stepanow C, Stepanow J, Walter M, Borgwardt S, Lang UE, Huber CG. Narrative Case Notes Have the Potential to Predict Seclusion 3 Days in Advance: A Mixed-Method Analysis. Front Psychiatry 2019; 10:96. [PMID: 30873054 PMCID: PMC6403491 DOI: 10.3389/fpsyt.2019.00096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 02/11/2019] [Indexed: 02/03/2023] Open
Abstract
Objectives: Current risk assessment tools can predict problematic behavior and the need for coercive measures, but only with a moderate level of accuracy. The aim of this study was to assess antecedents and triggers of seclusion. Methods: Narrative notes of health care professionals on psychiatric inpatients were analyzed daily starting 3 days prior to seclusion in the case group (n = 26) and compared to a matched control group without seclusion (n = 26) by use of quantitative and qualitative research methods, based on qualitative content analysis. Results: Quantitative measures showed more aggression in the case group with highly significant differences between the groups (p < 0.001) at all measurement times. Seclusion was significantly associated with the total word count of the narrative notes. Subjective emotional expressions by staff were more apparent before seclusion (p = 0.003). Most frequently, subjective expressions regarding "arduous/provocative" (p < 0.001) and "anxious" (p = 0.010) sentiments could be identified in the case group. Description of patients' behavior in the case group included more negatively assessed terms (p = 0.001). Moreover, sleep loss, refusing medication, high contact frequency, demanding behavior and denied requests were present in a significantly higher frequency before seclusion. Expressions like "threatening" (p = 0.001) were found only before seclusion and appeared to have the function of personal risk assessment. The expression "manageable" (p = 0.035) appeared often in difficult situations that could still be handled. Conclusion: Several factors preceding seclusion could be identified. Narrative notes of staff already showed differences 3 days before the escalation. Particularly the word count, the analysis of terms describing patients' behavior, subjective expressions of staff, and terms used as a function of personal risk assessment could help to provide better predictions of aggressive incidents and to prevent coercive measures.
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Affiliation(s)
- Clara Stepanow
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Jefim Stepanow
- Department of Urology, Kantonsspital Baselland, Liestal, Switzerland
| | - Marc Walter
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Stefan Borgwardt
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Undine E Lang
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
| | - Christian G Huber
- Universitäre Psychiatrische Kliniken Basel, Universität Basel, Basel, Switzerland
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Salzmann-Erikson M. Moral mindfulness: The ethical concerns of healthcare professionals working in a psychiatric intensive care unit. Int J Ment Health Nurs 2018; 27:1851-1860. [PMID: 29934965 DOI: 10.1111/inm.12494] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 11/30/2022]
Abstract
Healthcare professionals working on inpatient wards face the externalizing or challenging behaviour of the patients who are admitted. Ethical values and principles in psychiatric nursing have been reported to be important when approaching patients during the most acute phase of deterioration in their mental health. Hence, the aim of this study was to discover and describe staff members' ethical and moral concerns about their work as healthcare professionals in a psychiatric intensive care unit. The study has a qualitative descriptive design and makes use of Framework Analysis. Registered nurses and psychiatric aides in a psychiatric intensive care unit in Sweden were observed during ethical reflection meetings. Four to six staff attended the 90-min meetings. The data comprise observations from six meetings, which provided 94 pages of text. The results demonstrate that the work was described as being both motivating and exhausting. The staff faced ethical concerns in their daily work, as patients often demonstrated challenging behaviours. Three themes were identified as follows: (i) concerns about the staff impacting on patients' experience of care, (ii) concerns about establishing a safe working environment, and (iii) concerns about becoming unprofessional due to expectations and a high workload. Ethical concerns included simultaneously taking into account both the patients' dignity and safety aspects, while also being exposed to high workloads. These elements of work are theorized as influencing complex psychiatric nursing. If we are to bring these influential factors to light in the workplace, advanced nursing practice must be grounded in moral mindfulness.
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Affiliation(s)
- Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, University of Gävle, Gävle, Sweden
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30
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Dias MGPF, de Vargas D. Psychiatric Nurses' Attitudes Towards Violent Behaviour: A Brazilian Study. Issues Ment Health Nurs 2018; 39:687-692. [PMID: 29436881 DOI: 10.1080/01612840.2017.1422198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examines nurses' attitudes towards violent behaviour and the management of aggressiveness. A convenience sample of 185 nurses working in psychiatric urgent care and emergency services in Brazil responded to the MAVAS-BR. The results show that nurses' attitudes are more reflective of the external and situational models of violent behaviour and the use of control methods to manage aggressiveness. The mapping of this phenomenon using the same tools in a different context from those traditionally studied while observing similar results suggests a pattern of attitudes towards violent behaviour and the management of aggressiveness among nurses around the world.
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Affiliation(s)
| | - Divane de Vargas
- a São Paulo University , Department of Maternal-Child and Psychiatric Nursing, School of Nursing , São Paulo , SP , Brazil
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31
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Gustafsson N, Salzmann-Erikson M. Effect of Complex Working Conditions on Nurses Who Exert Coercive Measures in Forensic Psychiatric Care. J Psychosoc Nurs Ment Health Serv 2018; 54:37-43. [PMID: 27576227 DOI: 10.3928/02793695-20160817-06] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Accepted: 07/08/2016] [Indexed: 11/20/2022]
Abstract
Nurses who exert coercive measures on patients within psychiatric care are emotionally affected. However, research on their working conditions and environment is limited. The purpose of the current study was to describe nurses' experiences and thoughts concerning the exertion of coercive measures in forensic psychiatric care. The investigation was a qualitative interview study using unstructured interviews; data were analyzed with inductive content analysis. Results described participants' thoughts and experiences of coercive measures from four main categories: (a) acting against the patients' will, (b) reasoning about ethical justifications, (c) feelings of compassion, and (d) the need for debriefing. The current study illuminates the working conditions of nurses who exert coercive measures in clinical practice with patients who have a long-term relationship with severe symptomatology. The findings are important to further discuss how nurses and leaders can promote a healthier working environment. [Journal of Psychosocial Nursing and Mental Health Services, 54(9), 37-43.].
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Tingleff EB, Bradley SK, Gildberg FA, Munksgaard G, Hounsgaard L. "Treat me with respect". A systematic review and thematic analysis of psychiatric patients' reported perceptions of the situations associated with the process of coercion. J Psychiatr Ment Health Nurs 2017; 24:681-698. [PMID: 28665512 DOI: 10.1111/jpm.12410] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Psychiatric patients have generally negative experiences of being exposed to coercive measures. Existing research has generally not investigated coercion as a process; that is, it does not address issues that arise before, during and after exposure to coercion. A part of existing research within the area does not clarify and define the type of coercive measure(s) investigated. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Patients place great significance on the link between the positive and negative perceived impact of a coercive situation and the professionals' ability and willingness to interact and communicate respectfully. Psychiatric patients associate the use of seclusion, physical restraint/holding, mechanical restraint and forced medication with strong negative perceptions and wish to be treated with respect by professionals, rather than being subjected to the professionals' control. What patients perceive as moderating factors in regard to the use of coercive measures is currently under-researched. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Increased sensitivity to the patient's views of the situation at each point in the coercive process would help professionals to respond to the patients' individual needs. Professionals need to articulate concern and empathy towards patients and to improve communication skills before, during and after a coercive incident. Greater emphasis should be placed on de-escalation and the use of non-coercive strategies or coping skills before the initiation of coercive measures. ABSTRACT Introduction There is a lack of research into psychiatric patients' perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients' perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical practice. Aims To review existing research literature in order to investigate adult psychiatric patients' reported perceptions of situations before, during and after specific and defined types of coercive measures, and to investigate what patients perceive as moderating factors, in regard to the use of these coercive measures. Method A systematic review and thematic analysis of 26 peer-reviewed studies was undertaken. Results The analysis identified six themes and additional subthemes, where "interactions with professionals" and "communication" were predominant themes across the timeline of coercion. Altogether, themes were associated with either "positive or negative patient-perceived impact." Implications for practice Increased sensitivity to patients' views of the situation at each point in the process is desirable in order to respond to the patients' individual needs. Professionals also need to articulate concern and empathy towards the patient and to improve communication skills before, during and after a coercive incident. Use of de-escalation and noncoercive strategies is required. Relevance statement Coercion within psychiatric/mental health care remains controversial, and repeated international calls have recommended a reduction of their use. This review indicates that greater attention to how patients perceive the use of coercive measures (before, during, and after incidents) needs to be considered in order to improve the evidence-based and clinical practice.
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Affiliation(s)
- E B Tingleff
- Department of Clinical Research, Odense Patient data Explorative Network (OPEN), Odense University Hospital/University of Southern Denmark, Odense, Denmark.,Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,The Department of Nursing, University College Lillebaelt, Vejle, Denmark.,Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark.,Center for Psychiatric Nursing and Health Research, Faculty of Health Science, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - S K Bradley
- Catherine McAuley School of Nursing and Midwifery, Brookfield Health Sciences Complex, University College Cork, Cork, UK
| | - F A Gildberg
- Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Center for Psychiatric Nursing and Health Research, Faculty of Health Science, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - G Munksgaard
- Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Center for Psychiatric Nursing and Health Research, Faculty of Health Science, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - L Hounsgaard
- Department of Clinical Research, Odense Patient data Explorative Network (OPEN), Odense University Hospital/University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark.,Center for Psychiatric Nursing and Health Research, Faculty of Health Science, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Institute of Nursing & Health Science, University of Greenland, Nuuk, Greenland
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Lim E, Wynaden D, Heslop K. Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. Int J Ment Health Nurs 2017; 26:445-460. [PMID: 28960737 DOI: 10.1111/inm.12378] [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: 04/07/2017] [Indexed: 12/19/2022]
Abstract
Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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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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Lantta T, Anttila M, Kontio R, Adams CE, Välimäki M. Violent events, ward climate and ideas for violence prevention among nurses in psychiatric wards: a focus group study. Int J Ment Health Syst 2016; 10:27. [PMID: 27051463 PMCID: PMC4820948 DOI: 10.1186/s13033-016-0059-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/22/2016] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Patient violence against nurses in their work environments is a widespread global concern, particularly in the field of mental health care. A high prevalence of violent events impacts the well-being of nurses and may also impair overall ward climate. However, it has been proposed that nurses' use limited techniques to prevent patient violence, and, therefore, more comprehensive methods for dealing with patient violence are needed. There is still restricted understanding of the ward climate during the occurrence of a violent event as well as how these incidents could be more effectively prevented. This study aimed to explore nurses' experiences of violent events in psychiatric wards, give insight into ward climates and examine suggestions for violence prevention. METHODS This study employed a descriptive, exploratory design including focus groups (n = 5) and open-ended questions. The participants were registered and enrolled nurses (n = 22) working on three closed psychiatric in-patient wards in one Finnish hospital district. Focus groups were tape-recorded, transcribed and analyzed with inductive content analysis. RESULTS Nurses' experiences of violent events included a variety of warning signs and high-risk situations which helped them to predict forthcoming violence. Patient-instigated violent events were described as complicated situations involving both nurses and patients. When the wards were overloaded with work or emotions, or if nurses had become cynical from dealing with such events, well-being of nurses was impaired and nursing care was complicated. Suggestions for violence prevention were identified, and included, for example, more skilled interaction between nurses and patients and an increase in contact between nurses and patients on the ward. CONCLUSIONS This study revealed the complexity of violent events on psychiatric wards as well as the implications of these events on clinical practice development and training, administration and policy. A routine process is needed through which nurses' experiences and ideas concerning prevention of violent events are acknowledged.
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Affiliation(s)
- Tella Lantta
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
| | - Minna Anttila
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
| | - Raija Kontio
- />Helsinki University and Hospital District of Helsinki and Uusimaa, Helsinki University Central Hospital, Helsinki, Finland
| | - Clive E. Adams
- />Division of Psychiatry, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Maritta Välimäki
- />Department of Nursing Science, University of Turku, Hoitotieteen laitos, TURUN YLIOPISTO, 20014 Turku, Finland
- />School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- />Turku University Hospital, Turku, Finland
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Engaging with Families Is a Challenge: Beliefs among Healthcare Professionals in Forensic Psychiatric Care. Nurs Res Pract 2015; 2015:843717. [PMID: 26448874 PMCID: PMC4581559 DOI: 10.1155/2015/843717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/17/2022] Open
Abstract
Being healthcare professionals in the complex field of forensic psychiatry care (FPC) seems particularly challenging. Historically, families have almost been invisible in FPC. The aim of this study was to uncover beliefs among healthcare professionals concerning families of patients admitted for FPC. Using a hermeneutical approach inspired by Gadamer's philosophy, group interviews with healthcare professionals in four Swedish forensic psychiatric clinics were analyzed. Analysis resulted in seven key beliefs. There were three beliefs about families: family belongingness is a resource for the patient; most families are broken and not possible to trust; and most families get in the way of the patient's care. Four beliefs concerned encounters with families: it is important to achieve a balance and control over the family; it is essential to set aside one's own values and morals; family-oriented work is an impossible mission; and family oriented work requires welcoming the families. Despite ethical dilemmas of working with families in FPC, healthcare professionals showed a willingness and desire to work in a more family-oriented manner. More knowledge, understanding, and caring tools are needed in order to meet the needs of the family as well as support the family's resources.
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Abstract
Physical violence is a frequent occurrence in acute community psychiatry units worldwide. Violent acts by patients cause many direct injuries and significantly degrade quality of care. The most accurate tools for predicting near-term violence on acute units rely on current clinical features rather than demographic risk factors. The efficacy of risk assessment strategies to lower incidence of violence on acute units is unknown. A range of behavioral and psychopharmacologic treatments have been shown to reduce violence among psychiatric inpatients.
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Lepiešová M, Tomagová M. Analysis of the MAVAS instrument to assess the management of patient aggression. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2014. [DOI: 10.15452/cejnm.2014.05.0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McCann TV, Baird J, Muir-Cochrane E. Factors influencing clinicians' attitudes about aggression in Australian acute old age psychiatry inpatient units: a cross sectional survey design. Issues Ment Health Nurs 2014; 35:542-50. [PMID: 24963855 DOI: 10.3109/01612840.2014.883559] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patient aggression occurs in old age psychiatry and is problematic. The aim of this study is to identify the factors that influence clinicians' attitudes toward aggression in old age psychiatry. Eighty-five individuals, comprising nurses (n = 75) and medical and allied health staff (n = 10), completed the questionnaire. The results show that gender, profession, and work experience do not affect attitudes toward aggression. A low score indicated agreement with an attitudinal statement. However, younger age, better higher level of completed education, and place of work increased the likelihood of participants endorsing the questionnaire's attitudinal statements about aggression. The findings suggest clinicians' attitudes may affect the way they attempt to prevent and manage aggression.
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Affiliation(s)
- Terence V McCann
- Victoria University, Discipline of Mental Health Nursing, College of Health and Biomedicine, Centre for Chronic Disease Prevention and Management, Melbourne, Australia
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McCann TV, Baird J, Muir-Cochrane E. Attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient units. BMC Psychiatry 2014; 14:80. [PMID: 24642026 PMCID: PMC3974596 DOI: 10.1186/1471-244x-14-80] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Accepted: 03/12/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND In psychiatry, most of the focus on patient aggression has been in adolescent and adult inpatient settings. This behaviour is also common in elderly people with mental illness, but little research has been conducted into this problem in old age psychiatry settings. The attitudes of clinical staff toward aggression may affect the way they manage this behaviour. The purpose of this study was to examine the attitudes of clinical staff toward the causes and management of aggression in acute old age psychiatry inpatient settings. METHODS A convenience sample of clinical staff were recruited from three locked acute old age psychiatry inpatient units in Melbourne, Australia. They completed the Management of Aggression and Violence Scale, which assessed the causes and managment of aggression in psychiatric settings. RESULTS Eighty-five staff completed the questionnaire, comprising registered nurses (61.1%, n = 52), enrolled nurses (27.1%, n = 23) and medical and allied health staff (11.8%, n = 10). A range of causative factors contributed to aggression. The respondents had a tendency to disagree that factors directly related to the patient contributed to this behaviour. They agreed patients were aggressive because of the environment they were in, other people contributed to them becoming aggressive, and patients from certain cultural groups were prone to these behaviours. However, there were mixed views about whether patient aggression could be prevented, and this type of behaviour took place because staff did not listen to patients. There was agreement medication was a valuable approach for the management of aggression, negotiation could be used more effectively in such challenging behaviour, and seclusion and physical restraint were sometimes used more than necessary. However, there was disagreement about whether the practice of secluding patients should be discontinued. CONCLUSIONS Aggression in acute old age psychiatry inpatient units occurs occasionally and is problematic. A range of causative factors contribute to the onset of this behaviour. Attitudes toward the management of aggression are complex and somewhat contradictory and can affect the way staff manage this behaviour; therefore, wide-ranging initiatives are needed to prevent and deal with this type of challenging behaviour.
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Affiliation(s)
- Terence V McCann
- Discipline of Mental Health Nursing and Aged Care, College of Health and Biomedicine, Victoria University, PO Box 1428, Melbourne 8001, Victoria, Australia.
| | - John Baird
- NorthWestern Mental Health Old Aged Persons’ Mental Health Program, Harvester Building, 4C Devonshire Road, Sunshine 3020, Victoria, Australia
| | - Eimear Muir-Cochrane
- School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide, South Australia 5001, Australia
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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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