Incidents in an adolescent forensic secure inpatient service

Exposure to workplace trauma for forensic mental health nurses: A scoping review

BACKGROUND

Forensic mental health is a challenging workplace, with nurses subject to various trauma exposures in their professional role.

OBJECTIVES

To identify the key concepts related to the nature, extent and impact of workplace trauma for forensic mental health nurses.

DESIGN

A scoping review, informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) tool.

METHODS

Sources of evidence were identified and assessed for inclusion using an explicit search strategy. Relevant information was extracted and synthesised to present a descriptive summary of existing evidence.

RESULTS

Of the 16 articles on workplace trauma for forensic mental health nurses included in the review, nine reported data related to extent (incidence and severity) and 14 described the impact. The incidence (per bed/per year) of each workplace trauma type ranged from 0.95 - 7.15 for physical violence, 0.39-5.12 for verbal abuse, 0.03-0.12 for sexual violence, and 1.47-7.9 for self-harming behaviour. The proportion of incidents at the lowest severity rating ranged from 15.1% to 84.7%, and the range for the highest severity rating was 0% to 38.7%. In the single study that examined the incidence of vicarious trauma, 14.9% reported low levels and 27.7% reported high levels. Psychological distress was the most commonly reported impact of workplace trauma, identified in eight studies. Seven studies reported limited data for physical injury from workplace trauma. The impacts of exposure to workplace trauma reported in the remaining studies included needing to access psychological support, experiencing physiological symptoms, feeling less safe at work, and requiring time off work. With the exception of two studies providing limited data related to absenteeism, the impact for organisations was not explored in existing literature.

CONCLUSIONS

While studies indicated that forensic mental health nurses are frequently exposed to various forms of workplace trauma, reports of severe assaults on staff were rare. Although limited, these findings suggest that cumulative exposure to workplace trauma over time, or exposure to more severe forms of physical violence, increase forensic mental health nurse vulnerability to experiencing detrimental impacts on their personal and professional wellbeing.

The 'honeymoon effect' and 'gate fever' in a secure forensic adolescent psychiatric hospital: Do they exist?

There is limited research that comments on whether there are recurring patterns for incidents or significant events during inpatient admissions to psychiatric units. This is even more so the case for an adolescent population. This study looked at 30 consecutive female patient admissions to Bluebird House, a medium secure adolescent unit in the South of England, to identify whether both the 'honeymoon effect' (low incident rate in the first 28 days following admission) and 'gate fever' (high incident rate in the last 28 days prior to discharge) were identifiable phenomena. Analysis of the incident rate found that in our secure adolescent population, the number of incidents both in the first week and at the first 28 days was higher in comparison to the whole admission. We also did not find a consistent increase in incidents in the final 28 days of the admission.

Violent incidents in a secure service for individuals with learning disabilities: Incident types, circumstances and staff responses

BACKGROUND

The issue of violence in secure services has long been recognized both in the UK and worldwide. However, there is currently scarce literature available about violence within learning disability (LD) secure settings.

METHODS

Secondary data analysis was conducted on violent incidents, using information routinely collected by the staff over a 1-year period.

RESULTS

Physical assaults were the most frequent type of incident, and the distribution in terms of days or months was homogenous and incidents were concentrated in the corridors, lounges and dining rooms of secure facilities. Antipsychotic medication was not regularly prescribed. Generalized linear modelling analyses revealed significant predictors that increased the chances of seclusion and physical restraint, such as being female or directing the violence towards staff.

CONCLUSIONS

These findings can inform staff training on violence prevention and suggest that increased ward-based supervision and enhanced use of psychological formulations may help in reducing violence within this service context.

A review of violent incidents in a multilevel secure forensic psychiatric hospital: is there a seasonal variation?

There have been several attempts made to reduce the occurrence of violence in hospital settings, with most professional organizations taking a stance. The impact of violent incidence on the therapeutic environment and the cost in human terms led to the declaration by the World Health Organization that violence is a public health problem. There are strategies for reducing violence that flow out of known trends. We sought to examine the trends in institutional violence in a contextual sense. We reviewed the records of all incidents of violence, categorized by severity, victims and trends over five years in a multilevel secure forensic hospital in Canada. The rate of violence perpetrated by female patients was significantly higher than for male patients. Higher occurrence of violence was recorded in the winter months compared with any other season and was related to unstructured activities. There is a window of opportunity to develop some engaging programmes during the long winter months and improve supervision at all times of unstructured activity. The reasons for increased women perpetration and the winter peak of violence require further investigation.

Respiratory arrest and oversedation in an adolescent given intramuscular clonazepam for rapid tranquillization

Many young people in forensic adolescent units require intramuscular medication for rapid tranquillization. The efficacy and safety of the medications used is not well reported in this age group. Here we report a case of a 14-year-old girl experiencing severe oversedation and respiratory compromise on two occasions following intramuscular clonazepam.

The first three years of an inpatient adolescent forensic service

Bluebird House opened in February 2008. It was built to fill the gap of inpatient adolescent forensic services covering the South and South-West of England. This article describes the development of this highly specialized unit in its first three years.