Understanding inpatient violence in a New Zealand child and adolescent psychiatric setting

Nurses' responses to adolescent distress in an acute child and adolescent mental health inpatient unit: A qualitative interpretive descriptive study

PURPOSE

To describe observed nursing responses and interventions to adolescent inpatients experiencing distress.

METHODS

Thorne's interpretive descriptive approach guided data collection and analysis of nonparticipant observations of a purposive sample of adolescents, and nurses.

FINDINGS

Three major themes are presented: engagement: responses and interventions for working with distress; adolescent reactions and nurses' clinical decision making to manage distress; and outcomes: escalation or resolution of distress.

CONCLUSIONS

The TAR3 conceptual model developed from this study can guide nurses' responses to distressed adolescents and promote safety, enhance positive outcomes, and reduce the use of coercive interventions.

Factors Associated With Involuntary Psychiatric Hospitalization of Youths in China Based on a Nationally Representative Sample

Objective: This nationally representative sample investigates demographic, diagnostic and clinical features associated with both voluntary and involuntary psychiatric hospitalization among children and adolescents psychiatrically hospitalized in China. Method: As part of an official national survey, 41 provincial tertiary psychiatric hospitals in China were selected. Data from 196 children and adolescents who were discharged from these psychiatric hospitals from March 19 to 31, 2019 were retrieved and analyzed. Results: 1. Psychotic symptoms, depressive symptoms and self-injury/suicide were the most common reasons of admission. Girls were significantly likely to be admitted due to depressive symptoms, whereas boys were more likely to be admitted due to aggressive behaviors. 2. The overall rate of involuntary admission was 32.1% (N = 63). Compared to patients who were admitted voluntarily, those who were admitted involuntarily had lower GAF scores on admission, were older, were more likely to present with psychotic symptoms, manic symptoms or aggressive behavior as primary reason for admission, were less likely to present with depressive symptoms, had a significantly longer length of stay, were more likely to be diagnosed with schizophrenia and were less likely to be diagnosed as depressive disorder. 3. A logistic regression showed that depressive symptom as primary reason for admission was significantly associated with voluntary admission (OR = 0.159, p < 0.001), along with two other factors: age (p < 0.01) and a lower GAF score at admission (p < 0.001) were significantly associated with involuntary admission. Conclusion: The rate of involuntary psychiatric hospitalization among children and adolescents is higher in China than in other regions. Developing more specific and more operational criteria to guide involuntary psychiatric admission for child and adolescent patients is of urgency and great importance to ensure appropriate treatment of these patients and protect their rights.

Modifiable factors affecting inpatient violence in an acute child and adolescent psychiatric unit: A 16-year retrospective study

Violent incidents in acute inpatient units for children and adolescents are a major and persistent problem. The demographic, clinical, and modifiable (environmental-organizational) risk factors that affect inpatient violence in an Acute Child and Adolescent Psychiatric Unit were investigated via a retrospective study. Data were collected from nursing and medical reports and the unit's census and included 100 days per year for 16 years. Incidents of violence and assault types were recorded, and variables such as the diagnostic category of assailants, total number of patients, and staffing factors during the incident were examined. Of the 2390 violent incidents recorded, 50% were attributed to cases of physical violence towards another patient, 17% to physical violence towards nursing staff, 19% to physical violence towards self and 14% to destruction of property. According to the final multivariable model, for each additional patient in the unit, the risk of a violent event increased by 9.51%; for each additional offender patient, the risk increased by 14.06%; the number of assistant nurses was associated with a 25.03% increased risk; and, after 2006, the risk increased by 68.99%. The most significant factor associated with a 59.98% decreased risk was the total number of nursing staff. All variables significantly and independently contributed to the model. Acute inpatient psychiatric units with a small number of hospitalized patients, adequate, well-trained and specialized nursing staff, and the hospitalization of different types of patients in separate wards or units are expected to facilitate a reduction in the frequency of violent incidents.

Psychiatric Patients' and Nurses' Opinions About Limit Setting Technique in Port-said City

BACKGROUND

Limit setting facilitates the development of a therapeutic, caring and supportive relationships, it can also decrease patients' feelings of anxiety and uncertainty. It is a two-way process that should be delivered professionally by the nurse and perceived therapeutically by the patient, so patient considered a vital participant of the technique.

AIM

The present study aimed at exploring psychiatric patients' and nurses' opinions as well as their information about limit setting.

METHOD

All nurses working at the hospital and working along the day (the three day shifts) were included in the study (N=88), as well as all convenient patients that were willing to participate in the study (N=104).In order to collect data for the present study, three open-ended structured questionnaires were developed by the researcher.

RESULTS

Psychiatric nurses working at Port-Said psychiatric hospital have insufficient information concerning limit setting in which use of threats and authoritarian communication is nurses' style of application. Regrettably, nurses of the present study disagreed with essential and indispensible principles that should be followed when setting limits. Concerning psychiatric patients, the study revealed that patients had negative experiences with limit settings that contributed to enforcement of misconceptions and negative opinions about limit setting. Also, psychiatric patients viewed limit setting technique as nurses' way of punishment as well as humiliation.

RECOMMENDATIONS

Providing nurses with sufficient information about different psychiatric nursing skills such as communication skills and use of restraint; through holding educational workshops and seminars. Secondly, nurses need specific and professional training course accompanied with clinical application or simulation. As regard psychiatric patients, providing courses by professional and competent nursing staff regarding limit setting emphasizing its therapeutic uses and outcomes is a must; in order to correct misconceptions they acquired.

Workplace Violence toward Physicians and Nurses: Prevalence and Correlates in Macau

This paper sets out to estimate the prevalence of workplace violence in relation to socio-demographic characteristics of physicians and nurses working in healthcare settings in Macau. Background: Concerted efforts worldwide to reduce workplace violence (WPV) have not yet removed medical-related professionals from the threat of patients’, family members’, and colleagues’ physical and other assaults in Southeast Asia. Methods: The study employs a cross-sectional design to estimate the prevalence and examines the socio-economic and psychological correlates of WPV among medical doctors and nurses in Macau. The data collection period spanned from August to December 2014. Multiple logistic regression examines the prevalence rates of WPV and its associated factors in doctors and nurses. Results: A total of 107 doctors (14.9%) and 613 nurses (85.1%) participated in the study; 57.2% had suffered WPV in the preceding year. The most common forms of workplace violence were verbal abuse (53.4%), physical assault (16.1%), bullying/harassment (14.2%), sexual harassment (4.6%), and racial harassment (2.6%). Most violence was perpetrated by patients and their relatives, colleagues, and supervisors. Conclusions: WPV remains a significant concern in healthcare settings in Macau. Macau’s local health authority should consider putting in place a raft of zero-tolerance policies designed to prevent it.

Warning Signs prior to Aggressive Behavior in Child Psychiatric Units

This study aims at detecting and categorizing early warning signs of aggressive behavior in child psychiatric units. We analyzed 575 violent incident report forms and developed a coding scheme consisting of 16 warning signs. From the 575 incident report forms, a total of 1087 signs were coded. Most common warning signs were 'restlessness' (21.2%), 'not listening' (15.2%) and 'anger' (9.8%). These were also the most prevalent warning signs for the severe incidents. Although warning signs differ for each individual child, this study indicates that there are common warning signs for imminent aggressive incidents in child psychiatric facilities.