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Scheirich L, Maguire T, Daffern M. Testing a recovery-oriented nursing communication framework to encourage collaboration and discussion about aggression prevention: A mixed methods study. Int J Ment Health Nurs 2024. [PMID: 38532536 DOI: 10.1111/inm.13325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/21/2024] [Accepted: 03/15/2024] [Indexed: 03/28/2024]
Abstract
Recovery-oriented practice is essential in healthcare, yet research exploring methods for integrating recovery-oriented principles in forensic mental health settings is limited. This study involved the co-development, with mental health care nurses and a lived experience expert, and testing of a recovery-oriented script for forensic mental health nurses to use when communicating with consumers at high-risk of imminent aggression. The aim was to examine whether nurses perceived the script as more empathic when the script included specific references to empathy, compared to an equivalent script that did not include empathic statements, and to explore nurses' perspectives on whether the script could help prevent aggression. Nurses (n = 54) working in a secure forensic mental health hospital were randomly allocated to read a script containing statements representing nine recovery-oriented principles that also included empathic statements, or an equivalent script that did not include empathic statements. After reading the script, the participants completed a questionnaire involving a recovery-oriented practice scale developed by the authors, measuring the extent to which the scripts reflected recovery-oriented principles, and open-ended questions about the script's potential to prevent aggression. Results revealed no significant difference in nurse perceptions of empathy between the two scripts. Content analysis indicated that nurses perceived the scripts could help prevent aggression.
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Affiliation(s)
- Laura Scheirich
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
| | - Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
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Simmons ML, Maguire T, Ogloff JRP, Gabriel J, Daffern M. Using the Dynamic Appraisal of Situational Aggression (DASA) to assess the impact of unit atmosphere on violence risk assessment. J Psychiatr Ment Health Nurs 2023; 30:942-951. [PMID: 36825355 DOI: 10.1111/jpm.12913] [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: 11/10/2021] [Revised: 12/16/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT Research suggests that the Dynamic Appraisal of Situational Aggression (DASA) is a useful risk assessment instrument to identify individuals who might be at risk of aggression in mental health inpatient units. Although, risk assessment research has typically focused on an individual's risk of aggression, recent research has begun exploring whether the DASA could be used to assess the likelihood that a group of patients would be aggressive. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE While the DASA was useful for assessing whether an individual was likely to be aggressive, the group average score was not a useful indicator for the likelihood of aggression once the individual DASA score was taken into consideration. Unexpectedly, patients who were assessed as high risk on the DASA were more likely to be aggressive on settled units compared to unsettled units, which included other individuals whose risk was elevated. WHAT ARE THE IMPLICATIONS FOR PRACTICE There is not enough evidence to suggest that the group DASA average improves the identification of aggression above the individual DASA score. ABSTRACT INTRODUCTION: The Dynamic Appraisal of Situational Aggression (DASA) is an inpatient aggression risk assessment instrument. Recently, research explored whether the unit atmosphere, as indicated by a unit's average DASA score, was related to inpatient aggression risk, but failed to control for individual risk. AIM Investigate whether the DASA unit average score or an interaction between the unit average and an individual patient's DASA score was related to the likelihood that an individual would act aggressively. METHOD Cox regression with repeated assessments and recurrent events was used to analyse 11,243 DASA risk assessments of 113 inpatients collected via retrospective file review. RESULTS The unit DASA average score was not related to aggression towards staff. There was a negative interaction between the individual and the unit DASA average scores when identifying patient-to-patient aggression; high-risk patients engaged in less aggression when the unit average was heightened relative to units with lower DASA average scores. DISCUSSION It is possible that there were more nursing interventions and/or patients engaged in greater self-regulation on unsettled units, thus reducing aggression. IMPLICATIONS FOR PRACTICE Currently, there is insufficient evidence to suggest that the unit average score should be used to supplement individual DASA scores to identify aggression risk.
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Affiliation(s)
- Melanie L Simmons
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
| | - Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
| | - James R P Ogloff
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
| | - Jessica Gabriel
- The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Victoria, Australia
- Victorian Institute of Forensic Mental Health (Forensicare), Fairfield, Victoria, Australia
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Hamrick B, Van Hassel T, Snyder D, Stephens C. Screening for Behavioral Health Patient Aggression in Emergency Departments to Reduce Workplace Violence. J Emerg Nurs 2023; 49:403-414. [PMID: 36272824 DOI: 10.1016/j.jen.2022.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 05/09/2023]
Abstract
INTRODUCTION Patient violence in health care facilities occurs daily. Structured risk assessments, when regularly completed, have been effective in prompting interventions to reduce aggression in Behavioral Health (BH) settings. METHODS This quasi-experimental study evaluated the effectiveness of the Dynamic Appraisal of Situational Aggression - Inpatient Version (DASA) validated screening tool to reduce aggressive outbursts in an emergency department (ED) setting with BH patients awaiting transfer to a psychiatric facility. The tool was used in 4 non-psychiatric EDs from a large health care system. Chart audits were completed to record initial patient DASA scores observed at triage and at subsequent intervals during the ED encounter. ED staff documented interventions used for patients. Inclusion criteria included adults 21 years and older following a telepsychiatry consultation with a recommendation for BH inpatient admission. Pre-/post-implementation aggressive events were collected to assess ED DASA use. DASA scores from BH ED patients were examined to increase understanding of patient utilization. Staff workplace safety was examined to compare staff safety perception pre- and post-DASA implementation. RESULTS Violent events were reported statistically significantly higher post-DASA implementation. There was an increased risk of elevated DASA scores for specific diagnoses and genders. An increased awareness of the importance of reporting workplace violence improved documentation. DISCUSSION Using an evidence-based screening tool helped identify BH patients with behaviors associated with aggressive ED events. Proactive use of interventions, including use of Comfort Cart items, de-escalation, and prescribed medications, can positively influence reduction of risk from aggressive behaviors within BH patient populations in EDs.
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Hvidhjelm J, Berring LL, Whittington R, Woods P, Bak J, Almvik R. Short-term risk assessment in the long term: A scoping review and meta-analysis of the Brøset Violence Checklist. J Psychiatr Ment Health Nurs 2023. [PMID: 36718598 DOI: 10.1111/jpm.12905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 12/17/2022] [Accepted: 01/22/2023] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Existing literature on the Brøset Violence Checklist (BVC) is examined in the context of usability, implementation and validity to provide evidence-based recommendations on its application and identify opportunities for future development. AIM/QUESTION To identify current knowledge on the BVC and guide clinicians and researchers toward the next steps in using this tool in clinical practice to prevent violence in healthcare settings. METHOD A scoping review approach with a meta-analysis supplement was adopted to broadly identify and map available evidence on the BVC and provide specific estimates of predictive validity in different contexts. RESULTS Sixty-two studies conducted in 23 countries addressed the implementation of the BVC across various settings. Many studies adapted the original BVC, and the clinical utility was noted as an important feature. A meta-analysis of the original BVC format estimated a pooled area under the curve at 0.83 (95% CI 0.78-0.87) in a subset of 15 studies. DISCUSSION The BVC combines high predictive validity and good clinical utility across a wide range of settings and cultures. It should continue to be incorporated into routine practice in mental health services focused on preventing violence and coercion. IMPLICATIONS FOR PRACTICE Development of collaborative approaches with service users involved in assessing their own risk of future violence.
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Affiliation(s)
- Jacob Hvidhjelm
- Clinical Mental Health and Nursing Research Unit, Mental Health Center, Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Lene Lauge Berring
- Psychiatric Research Unit, Centre for Relation & De-escalation, Mental Health Services, Region Zealand, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Richard Whittington
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Phil Woods
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Jesper Bak
- Clinical Mental Health and Nursing Research Unit, Mental Health Center, Sct Hans, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Roger Almvik
- Centre for Research & Education in Security, Prisons and Forensic Psychiatry, St. Olav's University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Davoren M, O'Reilly K, Mohan D, Kennedy HG. Prospective cohort study of the evaluation of patient benefit from the redevelopment of a complete national forensic mental health service: the Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) protocol. BMJ Open 2022; 12:e058581. [PMID: 35868830 PMCID: PMC9315909 DOI: 10.1136/bmjopen-2021-058581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Secure forensic mental health services are low volume, high cost services. They offer care and treatment to mentally disordered offenders who pose a high risk of serious violence to others. It is therefore incumbent on these services to systematically evaluate the outcomes of the care and treatment they deliver to ensure patient benefit in multiple domains. These should include physical and mental health outcomes, as well as offending related outcomes. The aim of Dundrum Forensic Redevelopment Evaluation Study (D-FOREST) is to complete a structured evaluation study of a complete national forensic mental health service, at the time of redevelopment of the National Forensic Mental Health Service for the Ireland. METHODS AND ANALYSIS D-FOREST is a multisite, prospective observational cohort study. The study uses a combination of baseline and repeated measures, to evaluate patient benefit from admissions to forensic settings. Patients will be rated for physical health, mental health, offending behaviours and other recovery measures relevant to the forensic hospital setting at admission to the hospital and 6 monthly thereafter.Lagged causal model analysis will be used to assess the existence and significance of potential directed relationships between the baseline measures of symptomatology of schizophrenia and violence risk and final outcome namely length of stay. Time intervals including length of stay will be measured by median and 95% CI using Kaplan-Meier and Cox regression analyses and survival analyses. Patient related measures will be rated as changes from baseline using general estimating equations for repeated measures, analysis of variance, analysis of covariance or logistic regression. ETHICS AND DISSEMINATION The study has received approval from the Research Ethics and Effectiveness Committee of the National Forensic Mental Health Service, Ireland. Results will be made available to the funder and to forensic psychiatry researchers via international conferences and peer-reviewed publications. TRIAL REGISTRATION NUMBER NCT05074732.
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Affiliation(s)
- Mary Davoren
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
- Health Service Executive, National Forensic Mental Health Service, Dundrum, Ireland
| | - Ken O'Reilly
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
- Health Service Executive, National Forensic Mental Health Service, Dundrum, Ireland
| | - Damian Mohan
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Harry G Kennedy
- Dundrum Centre for Forensic Excellence, Trinity College Dublin School of Medicine, Dublin, Ireland
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Amunrud A, Bjorklund P. Implementation of the dynamic appraisal of situational aggression in inpatient mental health. Perspect Psychiatr Care 2022; 58:1153-1159. [PMID: 34263454 DOI: 10.1111/ppc.12915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 06/09/2021] [Accepted: 06/19/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To implement structured violence risk assessment (VRA) using the Dynamic Appraisal of Situational Aggression (DASA) on a 25-bed, adult, inpatient psychiatric unit. DESIGN AND METHODS Inpatient DASA screening for 13 weeks with nursing communication orders (NCOs) to highlight patients at high risk for violence. Pre/posttests measured registered nurse (RN) knowledge and perceptions of the DASA. FINDINGS DASA completion rate equaled 81.8% with an NCO issue rate of only 32.8%. RN perceptions of the DASA were positive, and knowledge of structured violence risk assessment increased. PRACTICE IMPLICATIONS Structured violence risk assessment with the DASA is feasible and well-accepted on psychiatric units.
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Affiliation(s)
- Alina Amunrud
- Department of Graduate Nursing, The College of St. Scholastica, Duluth, Minnesota, USA
| | - Pamela Bjorklund
- Department of Graduate Nursing, The College of St. Scholastica, Duluth, Minnesota, USA
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Lockertsen Ø, Varvin S, Færden A, Vatnar SKB. Short-term risk assessments in an acute psychiatric inpatient setting: A re-examination of the Brøset Violence Checklist using repeated measurements - Differentiating violence characteristics and gender. Arch Psychiatr Nurs 2021; 35:17-26. [PMID: 33593511 DOI: 10.1016/j.apnu.2020.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 11/30/2022]
Abstract
This study investigated the association between short-term risk assessment measured by the Brøset Violence Checklist (BVC) and imminent violence using repeated measurements and differentiating violence characteristics and gender. All patients admitted to an acute psychiatric ward during one year (N = 528) were included. Logistic regression and generalized linear mixed model (GLMM) analyses were conducted. Results confirmed BVC's suitability for both male and female inpatients throughout their hospitalization also when differentiating threats and physical violence, and adjusting for diagnostic subpopulations and circadian variability. Results point to modified interpretations of the BVC sum scores. Future research should adjust for repeated measurements.
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Affiliation(s)
- Øyvind Lockertsen
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway; Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway.
| | - Sverre Varvin
- OsloMet - Oslo Metropolitan University, Faculty of Health Sciences, Department of Nursing and Health Promotion, Oslo, Norway
| | - Ann Færden
- Oslo University Hospital, Division of Mental Health and Addiction, Acute Psychiatric Department, Oslo, Norway
| | - Solveig Karin Bø Vatnar
- Oslo University Hospital, Centre for Research and Education in Forensic Psychiatry, Oslo, Norway; Molde University College, Faculty of Health Sciences and Social Care, Molde, Norway
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Baker J, Berzins K, Canvin K, Benson I, Kellar I, Wright J, Lopez RR, Duxbury J, Kendall T, Stewart D. Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ObjectivesThe study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing.BackgroundIncidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content.DesignSystematic mapping study and analysis.Data sourcesEnglish-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo®and PubMed. Databases were searched from 1999 to 2019.Review methodsBroad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy.ResultsThe final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques).LimitationsMany interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records.ConclusionsStudies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways.Future workPrior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery.Study registrationThe study is registered as PROSPERO CRD42018086985.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Krysia Canvin
- School of Healthcare, University of Leeds, Leeds, UK
| | - Iris Benson
- Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Joy Duxbury
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | | | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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Kennedy HG, Mullaney R, McKenna P, Thompson J, Timmons D, Gill P, O’Sullivan OP, Braham P, Duffy D, Kearns A, Linehan S, Mohan D, Monks S, McLoughlin L, O’Connell P, O’Neill C, Wright B, O’Reilly K, Davoren M. A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders). BMC Psychiatry 2020; 20:515. [PMID: 33097036 PMCID: PMC7583300 DOI: 10.1186/s12888-020-02912-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 10/11/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others. METHODS In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. RESULTS A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A 'Pareto' group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours. CONCLUSION Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms.
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Affiliation(s)
- Harry G. Kennedy
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Ronan Mullaney
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Paul McKenna
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - John Thompson
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - David Timmons
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Pauline Gill
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Owen P. O’Sullivan
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.451052.70000 0004 0581 2008Camlet Lodge Medium Secure Unit, North London Forensic Service, Chase Farm Hospital, Barnet Enfield and Haringey NHS MHT, London, UK
| | - Paul Braham
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Dearbhla Duffy
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Anthony Kearns
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Sally Linehan
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Damian Mohan
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Stephen Monks
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Lisa McLoughlin
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Paul O’Connell
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Conor O’Neill
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Brenda Wright
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland
| | - Ken O’Reilly
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland
| | - Mary Davoren
- grid.459431.e0000 0004 0616 8533National Forensic Mental Health Service, Central Mental Hospital, Dundrum, Dublin 14, Ireland ,grid.8217.c0000 0004 1936 9705DUNDRUM Centre for Forensic Excellence, Department of Psychiatry, Trinity College Dublin, Dublin 2, Ireland ,Broadmoor High Security Hospital, Berkshire, UK
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Connor M, Armbruster M, Hurley K, Lee E, Chen B, Doering L. Diagnostic Sensitivity of the Dynamic Appraisal of Situational Aggression to Predict Violence and Aggression by Behavioral Health Patients in the Emergency Department. J Emerg Nurs 2020; 46:302-309. [DOI: 10.1016/j.jen.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/20/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022]
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Dickens GL, O'Shea LE, Christensen M. Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis. Int J Nurs Stud 2020; 104:103526. [DOI: 10.1016/j.ijnurstu.2020.103526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
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Wang HT, Yang CM, Chen KR, Chueh KH. Relationship between heart rate variability and aggressive behavior among patients with schizophrenia hospitalized in acute wards. Perspect Psychiatr Care 2020; 56:321-329. [PMID: 31410853 DOI: 10.1111/ppc.12433] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 07/17/2019] [Accepted: 08/01/2019] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To explore the state of mental treatment, heart rate variability (HRV), level of aggressive behavior, and their relationships among hospitalized patients with schizophrenia. DESIGN AND METHODS This study adopted a follow-up design and convenience sampling. Thirty-three subjects completed the questionnaire, and their HRV indices were measured. FINDINGS Patients' psychiatric symptoms showed a significant downward trend after hospitalization (P = .003). The standard deviation of the normal-to-normal intervals in the morning was significantly correlated with overall aggression, physical aggression, and verbal aggression. PRACTICE IMPLICATIONS HRV can be regularly monitored among inpatients with schizophrenia with a risk of high aggression as an indicator of possible aggressive behavior.
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Affiliation(s)
- Hsiao-Tzu Wang
- Department of Nursing, Bali Psychiatric Center, MOHW, New Taipei City, Taiwan, ROC
| | - Chien-Ming Yang
- Department of Psychology, National Chengchi University, Taipei City, Taiwan, ROC
| | - Kai-Ren Chen
- Department of Public Health, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan, ROC
| | - Ke-Hsin Chueh
- Department of Nursing, Fu Jen Catholic University; and Deputy Director of Department of Nursing, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, ROC
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Maguire T, Daffern M, Bowe SJ, McKenna B. Evaluating the impact of an electronic application of the Dynamic Appraisal of Situational Aggression with an embedded Aggression Prevention Protocol on aggression and restrictive interventions on a forensic mental health unit. Int J Ment Health Nurs 2019; 28:1186-1197. [PMID: 31290238 DOI: 10.1111/inm.12630] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2019] [Indexed: 01/04/2023]
Abstract
Risk assessment is a pre-requisite for violence prevention in mental health settings. Extant research concerning risk assessment and nursing intervention is limited and has focused on the predictive validity of various risk assessment approaches and instruments, with few attempts to elucidate and test interventions that might prevent aggression, and reduce reliance on coercive interventions. The integration of risk assessment and violence prevention strategies has been neglected. The aim of this feasibility study was to test a novel Aggression Prevention Protocol designed to prioritize the instigation of less restrictive interventions on an acute forensic mental health unit for female patients. A prospective quasi-experimental study was designed to test an Aggression Prevention Protocol, linked to an electronic application of the Dynamic Appraisal of Situational Aggression (DASA). Following introduction of the DASA and Aggression Prevention Protocol, there were reductions in verbal aggression, administration of Pro Re Nata medication, the rate of seclusion, and physical and mechanical restraint. There was also an increase in documented nursing interventions. Overall, these results support further testing of the electronic application of the DASA and the Aggression Prevention Protocol.
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Affiliation(s)
- Tessa Maguire
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Michael Daffern
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Victoria, Australia
| | - Steven J Bowe
- Faculty of Health, Biostatistics Unit, Deakin University, Melbourne, Victoria, Australia
| | - Brian McKenna
- Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Victoria, Australia.,Auckland University of Technology, Auckland, New Zealand
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14
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Väkiparta L, Suominen T, Paavilainen E, Kylmä J. Using interventions to reduce seclusion and mechanical restraint use in adult psychiatric units: an integrative review. Scand J Caring Sci 2019; 33:765-778. [PMID: 31058332 DOI: 10.1111/scs.12701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/24/2019] [Indexed: 11/28/2022]
Abstract
The aim of this integrative review was to describe interventions aimed at reducing seclusion and mechanical restraint use in adult psychiatric inpatient units and their possible outcomes. CINAHL, MEDLINE, PsycINFO and Medic databases were searched for studies published between 2008 and 2017. Based on electronic and manual searches, 28 studies were included, and quality appraisal was carried out. Data were analysed using inductive content analysis. Interventions to proactively address seclusion were environmental interventions, staff training, treatment planning, use of information and risk assessment. Interventions to respond to seclusion risk were patient involvement, family involvement, meaningful activities, sensory modulation and interventions to manage patient agitation. Interventions to proactively address mechanical restraint were mechanical restraint regulations, a therapeutic atmosphere, staff training, treatment planning and review of mechanical restraint risks. Interventions to respond to mechanical restraint risks included patient involvement, therapeutic activities, sensory modulation and interventions to manage agitation. Outcomes related to both seclusion and mechanical restraint reduction interventions were varied, with several interventions resulting in both reduced and unchanged or increased use. Outcomes were also reported for combinations of several interventions in the form of reduction programmes for both seclusion and mechanical restraint. Much of the research focused on implementing several interventions simultaneously, making it difficult to distinguish outcomes. Further research is suggested on the effectiveness of interventions and the contexts they are implemented in.
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Affiliation(s)
- Laura Väkiparta
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Tarja Suominen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Eija Paavilainen
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Jari Kylmä
- Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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15
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Levin SK, Nilsen P, Bendtsen P, Bülow P. Adherence to planned risk management interventions in Swedish forensic care: What is said and done according to patient records. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 64:71-82. [PMID: 31122642 DOI: 10.1016/j.ijlp.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 01/26/2019] [Accepted: 02/16/2019] [Indexed: 06/09/2023]
Abstract
Both structured and unstructured clinical risk assessments within forensic care aim to prevent violence by informing risk management, but research about their preventive role is inconclusive. The aim of this study was to investigate risk management interventions that were planned and realized during forensic care by analysing patient records. Records from a forensic clinic in Sweden, covering 14 patients and 526 months, were reviewed. Eight main types of risk management interventions were evaluated by content analysis: monitoring, supervision, assessment, treatment, victim protection, acute coercion, security level and police interventions. Most planned risk management interventions were realized, both in structured and clinical risk assessments. However, most realized interventions were not planned, making them more open to subjective decisions. Analysing risk management interventions actually planned and realized in clinical settings can reveal the preventive role of structured risk assessments and how different interventions mediate violence risk.
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Affiliation(s)
- Sara K Levin
- Regional Forensic Psychiatric Hospital, Vadstena, Sweden; Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden.
| | - Per Nilsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Preben Bendtsen
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden; Department of Medical Specialist, Department of Medicine and Health Sciences, Linköping University, Motala, Sweden
| | - Per Bülow
- Regional Forensic Psychiatric Hospital, Vadstena, Sweden; Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden; Department of Behavioural Science and Social Work, School of Health Sciences, Jönköping University, Jönköping, Sweden
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