A prospective study of patient assaults on nursing staff in a psychogeriatric unit

Workplace Violence Toward Doctors Working in Obstetrics and Gynecology Emergency Units in Khartoum North Locality, Sudan: A Cross-Sectional Study

BACKGROUND AND OBJECTIVES

Workplace violence (WPV) is any action, incident, or behavior that deviates from appropriate conduct and results in a person getting assaulted, threatened, harmed, or injured at work. This research aimed at studying the current state of WPV among doctors working in obstetrics and gynecology (OBGYN) emergency departments (EDs) in Khartoum north locality (KNL), Sudan   Methods: A descriptive cross-sectional study that included 128 doctors from six governmental hospitals in KNL. A self-administered questionnaire assessing the prevalence and outcomes of WPV was distributed. The descriptive statistics and frequency tables were generated using the Statistical Package for Social Sciences (SPSS) version 21 (IBM Corp., Armonk, NY).   Results: The respondents' mean age was 28.3±6.6 years (range: 21-70 years). Approximately half of the respondents (49.2%) experienced WPV. Verbal WPV was the most common type (93.3%), followed by physical (10%) and sexual (3.2%) type. Patients' relatives and friends are the most common group to commit WPV (92.9%). Night shifts were the time most WPV (58.6%) took place. The effect of WPV on respondents was mainly psychological (95.8%) compared to physical (4.2%).   Conclusion: WPV prevalence among health care workers (HCWs) working in the OBGYN EDs is alarming with detrimental effects. Evaluating the current state of WPV, outcome, and associated factors will help not only address the current problem but also guide future related research.

The Mediating Effect of Perceived Social Acknowledgment on the Relationship Between Patient Assaults and Posttraumatic Stress Reactions in Emergency Nurses

This study explored whether posttraumatic stress symptoms resulted from workplace assaults were mediated by the perception of social acknowledgment by the victim. A sample of 444 emergency room nurses in China completed questionnaires measuring the frequency and types of patient assaults, the severity of physical injury, the perception of social acknowledgment, and the posttraumatic stress symptoms. Cross-sectional design, multiregression, and bootstrapping mediation analyses were used to test the hypotheses. Results showed that general disapproval and family disapproval mediated the relationship between the frequency of patient assaults and the severity of posttraumatic stress symptoms. These two factors also mediated the links between the injury severity of patient assaults and the development of posttraumatic stress symptoms. Implications for clinical practice and future research were discussed.

Aggressive behavior in institutionalized elders: A theoretical framework

This review article explores current research on aggression in institutionc ized elders and proposes a theoretical framework for use by caregivers. The relationships of brain dysfunction, past behaviors, social networks and environmental triggers to the expression of aggression a te discussed. The framework can be used to generate research hypothesis, or as a guide for assessing rise factors associated with these behaviors.

The incidence and risk factors of workplace violence towards female nurses reported via internet in an acute psychiatric hospital

The authors conducted a prospective follow-up study to explore incidence and risk factors related to workplace violence towards nurses. Seventy-seven volunteers were recruited to complete a baseline questionnaire. Participants then used a designated Web site to report violent incidents they encountered during a 6-month period. A generalized estimating equation was used for data analysis. A total of 74 members completed the study; 456 events were reported. The incidence rates of various types of violence are reported in this paper. Risk factors for violence included short duration of employment, marital status, and a high level of anxiety. Strategies to reduce future violence from psychiatric patients include preplacement education that targets this high-risk group of nurses and efforts to reduce the staff anxiety levels.

Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland

Background

Aggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.

Objective

To describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.

Methods

We conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41'560 treatment days.

Results

A total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78) for physical attacks and 1.83 (1.70–1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9), longer length of stay (OR 2.7; 2.0–3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5–2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.

Conclusion

Aggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.

Nursing of young psychotic patients: analysis of work environments and attitudes

Being members of the team who spend most of their time in direct contact with patient, nurses contribute considerably to observational and inpatient treatment process. The aims of this study were to analyse working environment of psychiatric nurses, attitudes, needs and emotional aspects while working with young (15-35 years old) psychotic patients. Study population consisted of psychiatric nurses working in all 15 inpatient psychiatry units in Vilnius. Nurses filled in an anonymous questionnaire. Summary statistics using number of observations, mean and SD were reported for quantitative variables, with absolute and relative frequencies for categorical variables. Questionnaires were filled by 86 nurses. The mean working experience was 17 years in nursing and 14 years in psychiatric nursing. Data analysis revealed that majority of nurses rated their satisfaction with their job between average and high. Results showed that there was a lack of in-service training programmes. What especially difficult was nursing of young psychotic patients and required good professional knowledge, experience and individual approach to each patient. Majority of nurses were fully satisfied with their job and were interested in further continuous self-education. The major concern in working with young psychotic patients was reassurance of personal and patient's safety.

Impact of training on work-related assault

Although training is often recommended as a part of a comprehensive approach to address occupational violence, little empirical literature exists to support this recommendation. Over 40% of nurses responding to the Minnesota Nurses Study reported being trained about occupational violence, involving seven different training topics. Although at the univariate level, an increased risk was identified for nurses trained in managing assaultive/violent patients, no statistically significant results remained at the multivariate level. This lack of protection from training is consistent with previous research, although the explanations for this lack of effect remain unclear. Additional research is necessary to obtain more specific details on occupational violence training, including training content and methods, to understand more thoroughly the impact of training on occupational violence.

Staff's experience of and the management of violent incidents in elderly care

Violence towards staff has become an important issue, since it has been reported to be common in various health care settings. This study aimed to describe emotional reactions among staff being exposed to violence in residential community care for the elderly: to investigate consequences from violent incidents and to describe the management of violent incidents. Data were collected by telephone interviews with nursing staff reporting incidents of violence. During the period of investigation, 97 of 848 staff (11.4%) reported that they had been exposed to violence. More than one-third of them reported subsequent wound and bruises from the incident and two of the exposed staff consulted a doctor because of the violent incident. The most frequently reported reactions among the staff were aggression, astonishment, and antipathy against the perpetrating care recipient, as well as insufficiency, powerlessness, insult and fear. A majority of the incidents were judged as intentionally perpetuating from the care recipient. Most of the violent incidents were managed by informal discussions in the working team. A low number of the reported incidents of violence involved formal discussions with nurse managers.

The effect of a training course in aggression management on mental health nurses' perceptions of aggression: a cluster randomised controlled trial

Nurses' attitudes towards patient aggression may influence their behaviour towards patients. Thus, their enhanced capacity to cope with aggressive patients may nurture more positive attitudes and alleviate adverse feelings emanating from patient aggression. This cluster randomised controlled trial conducted on six psychiatric wards tested the hypotheses that a 5 day training course in aggression management would positively influence the following outcome measures: Nurses' perception and tolerance towards patient aggression and resultant adverse feelings. A repeated measures design was employed to monitor change. No effect was found. The short time frame between the training course and the follow up measurement or non-responsiveness of the measurement instruments may explain this finding.

An epidemiological study of the magnitude and consequences of work related violence: the Minnesota Nurses' Study

AIMS

To identify the magnitude of and potential risk factors for violence within a major occupational population.

METHODS

Comprehensive surveys were sent to 6300 Minnesota licensed registered (RNs) and practical (LPNs) nurses to collect data on physical and non-physical violence for the prior 12 months. Re-weighting enabled adjustment for potential biases associated with non-response, accounting for unknown eligibility.

RESULTS

From the 78% responding, combined with non-response rate information, respective adjusted rates per 100 persons per year (95% CI) for physical and non-physical violence were 13.2 (12.2 to 14.3) and 38.8 (37.4 to 40.4); assault rates were increased, respectively, for LPNs versus RNs (16.4 and 12.0) and males versus females (19.4 and 12.9). Perpetrators of physical and non-physical events were patients/clients (97% and 67%, respectively). Consequences appeared greater for non-physical than physical violence. Multivariate modelling identified increased rates for both physical and non-physical violence for working: in a nursing home/long term care facility; in intensive care, psychiatric/behavioural or emergency departments; and with geriatric patients.

CONCLUSIONS

Results show that non-fatal physical assault and non-physical forms of violence, and relevant consequences, are frequent among both RNs and LPNs; such violence is mostly perpetrated by patients or clients; and certain environmental factors appear to affect the risk of violence. This serves as the basis for further analytical studies that can enable the development of appropriate prevention and control efforts.

Incidence of violence towards staff caring for the elderly

A survey study concerning violence was conducted among staff (n=506) working with the elderly in residential settings and ordinary homes. The major aim of the study was to investigate the incidence of violence directed towards staff by elderly people living in residential settings. Furthermore, associations between the number of violent incidents and gender, age, year in service, year at present place of work, education of the staff, type of setting, the frequency and type of violence as well as the emotional reactions expressed by the staff should be examined. Forty percent of the staff was exposed to violence during the preceding year and 18% noted incidents of violence daily. A significantly larger proportion of staff working in nursing homes registered violence compared with those working in other types of settings. Physical violence was the most common (76%) type of violence. Powerlessness, sadness, anger and feelings of insufficiency were the most dominant feelings among staff facing by violent situations. Our results point to the necessity to further study caregivers' perception of patient violence and its impact on the quality of care.

Aggressive behaviour in the elderly

In this paper, the literature on aggressive behaviour in the elderly is reviewed, with emphasis on: definition; study samples; patient groups; study designs and methodology; data collection; instruments used to measure aggressive behaviour; social, clinical, demographic and biological correlates; prevalence and rates; precipitants; outcome; site; timing; daily and seasonal variation; patterns of usage of hospitals and other institutions; stuffing levels, staff morale, staff attitudes, staff training and other staffing factors.

Report form for aggressive episodes: preliminary report

This paper gives a description of the development and initial empirical testing of the Report Form for Aggressive Episodes, a behavioural rating scale used to measure displayed aggressive behaviour and the situational determinant(s) according to a list of 30 potential precipitants to aggression. Findings from a one-year study in a special secure unit for the long-term treatment of dangerous patients show very high rates of underreporting of aggressive episodes in ward journals and patient files compared to this scale. Illustrations of the clinical use of the scale are provided by scoring examples and two case vignettes.

The conceptualization of impulsivity for psychiatric nursing practice

This article conceptualizes impulsivity from the perspective of psychiatric nurses in the inpatient setting. A theoretical model of the nature and the process of impulsivity is developed phenomenologically from information obtained from psychiatric nurses and patient chart reviews. The impulsive event is characterized by three elements: (1) precipitants of the behavior, (2) characteristics of the impulsive event, and (3) staff response. The expression of these elements differentiates impulsivity according to patient domains of psychotic and nonpsychotic illnesses. The emerging differentiation provides the opportunity to develop distinct nursing interventions that target the impulsivity within each of these domains.

Goal-directed care: caring for aggressive nursing home residents with dementia

1. Aggressive behavior in elders with dementia occurs most often during personal care. It is often a response to invasion of private space and may be prevented or reduced by interpersonal approaches that reflect a set of individualized goals for the resident. 2. Five resident goals for preventing or reducing aggressive behavior are to feel safe, to feel physically comfortable, to experience a sense of control, to experience optimal stress, and to experience pleasure. 3. These goals provide a framework for humane care that respects the personhood of the individual and minimizes the need for psychotropic medications and physical restraints.