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Van den Bulcke L, Peeters AM, Davidoff H, Vaessens R, Vansteelandt K, Van den Stock J, De Vos M, Testelmans D, Vandenbulcke M, Van Den Bossche M. Aggression Severity as a Predictor of Mortality in Dementia. J Am Med Dir Assoc 2024; 25:764-768. [PMID: 37972646 DOI: 10.1016/j.jamda.2023.10.007] [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: 08/29/2023] [Revised: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES In psychogeriatric units for patients with dementia and behavioral problems, aggression is prevalent. Predictions and timely interventions of aggression are essential to create a safe environment and prevent adverse outcomes. Our study aimed to determine whether aggression severity early during admission to these units could be used as an indicator of adverse outcomes. DESIGN During one year, all aggressive incidents on a psychogeriatric unit were systematically recorded using the Revised Staff Observation of Aggression Scale (SOAS-R). The study investigated the link between the severity of incidents within the first 48 hours of admission and adverse outcomes. SETTING AND PARTICIPANTS All patients included in the study were admitted to a psychogeriatric unit for dementia and behavioral problems between November 2020 and October 2021. METHODS The study population was categorized into groups according to the level of aggression severity during the first 48 hours of admission. The impact of aggression severity on the duration of admission, aggression frequency and severity during admission, medication usage at discharge, discharge destination, and mortality risk were examined. RESULTS During the initial 2 days of admission, 9 of 88 patients had 1 or more severe aggression incidents. An early manifestation of severe aggression was significantly associated with more incidents during hospitalization, a higher total SOAS-R score, and a sevenfold higher 1-year mortality risk compared with patients who did not or only mildly manifested aggression in the first 48 hours of admission. CONCLUSIONS AND IMPLICATIONS An early manifestation of aggression not only poses a direct safety risk to all involved but is also an early indicator of patients at risk for more detrimental outcomes, specifically mortality risk. By identifying patients at higher risk for adverse outcomes early, health care providers can provide preventive or timelier interventions, mitigating the risk of adverse outcomes and optimizing care services.
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Affiliation(s)
- Laura Van den Bulcke
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Anne-Marie Peeters
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Hannah Davidoff
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium; CSH (Circuits and Systems for Health) - Imec, Heverlee, Belgium
| | - Rebecca Vaessens
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Kristof Vansteelandt
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Jan Van den Stock
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Maarten De Vos
- Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium; Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Dries Testelmans
- Department of Pneumology, University Hospitals Leuven, Leuven, Belgium; Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), Department of Chronic Diseases and Metabolism, KU Leuven, Leuven, Belgium
| | - Mathieu Vandenbulcke
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Maarten Van Den Bossche
- Geriatric Psychiatry, University Psychiatric Center, KU Leuven, Leuven, Belgium; Neuropsychiatry, Research Group Psychiatry, Department of Neurosciences, Leuven Brain Institute, KU Leuven, Leuven, Belgium.
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Lam C. The Link between Patients' Aggressive Communication and Nurses' Emotional Health Outcomes. HEALTH COMMUNICATION 2023; 38:1033-1040. [PMID: 34641758 DOI: 10.1080/10410236.2021.1989788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The aggressive conduct of patients is a perennial problem that nurses face in health care. Studies have shown that such aggressiveness can be detrimental to the work and emotional wellbeing of nurses. Yet, the literature has had inconsistent findings; in some cases nurses are negatively affected by aggression, while in other cases nurses are not affected. Street and colleagues contended that such inconsistencies in research exist because social mechanisms embedded in communication are often not taken into consideration. This study adopts Street et al.'s pathways model and links patients' aggressive communication to nurses' emotional health outcomes, via the proximal outcome of communication satisfaction and the intermediate outcome of organizational identity. Results support Street et al.'s postulation and demonstrates that patients' aggressive communication does not have a direct effect on nurses' emotional health. Instead, the effect is indirect, mediated by communication satisfaction and organizational identity.
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Affiliation(s)
- Chervin Lam
- Department of Communications and New Media, National University of Singapore
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Emmerling SA, Croland JA, Nimtz-Rusch KL. Selecting an Instrument for Assessing the Risk of Patient Violence Across a Healthcare System. J Nurs Adm 2022; 52:314-318. [PMID: 35467597 DOI: 10.1097/nna.0000000000001152] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACT Physical violence is one of the leading causes of nurse injury in the workplace. Studies indicate patients most often incite the violence and both patient and organization factors contribute to violent events. It has been suggested that an assessment be done upon admission to identify those patients at risk for violent behavior. To implement this intervention, organizations must objectively select a screening instrument that is accurate, easy to use, and appropriate for multiple patient populations.
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Affiliation(s)
- Sheryl A Emmerling
- Author Affiliations: Director of Clinical Practice and Research (Dr Emmerling) and Vice President of Nursing and Clinical Education (Dr Nimtz-Rusch), OSF HealthCare, Peoria, IL; and Chief Nursing Officer and Vice President of Patient Care Services (Dr Croland), OSF HealthCare Saint Francis Medical Center, Peoria, IL
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Saridi M, Toska A, Latsou D, Giannakouli A, Geitona M. Verbal Abuse in the Operating Room: A Survey of Three General Hospitals in the Peloponnese Region. Cureus 2021; 13:e18098. [PMID: 34692310 PMCID: PMC8525541 DOI: 10.7759/cureus.18098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background The operating room is a special place in a hospital structure, which has a very high psychological load and many moments of tension, often leading to difficulties in communication between the health professionals involved, as well as cases of verbal and physical violence. Purpose The purpose of the study was to investigate the existence of verbal violence in the operating rooms of three general hospitals in the Peloponnese region of Greece. Methods A cross-sectional survey was conducted of health professionals (physicians and nurses) employed in the operating rooms of three general hospitals in the Peloponnese region. For the data collection, the Verbal Abuse Scale questionnaire (VAS) was used. A total number of 80 questionnaires were self-completed and collected. The statistical analysis was performed with the SPSS Statistics software v.25 (IBM Corp., Armonk, NY). Results Regarding the frequency of verbal violence faced by health professionals, 36.8% of physicians stated that they experience verbal violence once a year whereas more than 20% of nurses reported that such incidents occur more than once a month (p=0.148). For the physicians, the abuser was usually their supervisor, while for the nurses, a physician. The majority of physicians stated that they felt mainly anger (2.94 ± 1.35), disgust (2.58 ± 1.54), and sadness/hurt (2.35 ± 1.37) after the verbal abuse, whereas most of the nurses felt anger (3.49 ± 1.39), disgust (3.05 ± 1.52) and frustration (2.95 ± 1.47). Conclusion Nurses are more often the victims of verbal abuse than physicians and are more likely to feel frustrated after experiencing verbal abuse. Gradual change to the organizational culture is an important measure to stop the occurrence of such incidents.
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Affiliation(s)
- Maria Saridi
- Epidemiology and Public Health, General Department of Lamia, University of Thessaly, Lamia, GRC
| | - Aikaterini Toska
- Epidemiology and Public Health, General Department of Lamia, University of Thessaly, Lamia, GRC
| | - Dimitra Latsou
- Social and Educational Policy, University of Peloponnese, Corinth, GRC
| | | | - Mary Geitona
- Social and Educational Policy, University of Peloponnese, Corinth, GRC
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Ravyts SG, Perez E, Donovan EK, Soto P, Dzierzewski JM. Measurement of aggression in older adults. AGGRESSION AND VIOLENT BEHAVIOR 2021; 57:101484. [PMID: 34025202 PMCID: PMC8136141 DOI: 10.1016/j.avb.2020.101484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Aggressive behaviors are prevalent in late-life and are associated with important consequences for older adults, caregivers, and healthcare providers. Age-related changes in the manifestation of aggression are precipitated in part by the rise of cognitive impairment. Such changes necessitate the use of psychometrically sound measures. The present article identifies existing measures of aggression for older adults, highlights the strengths and limitations of these measures, and proposes avenues for future research in this area. Five full-scale measures of aggression, as well as five subscales of aggression embedded within larger non-aggression measures in older adults were identified. Overall, measures of aggression specific to late-life are predominately observational and limited to individuals with dementia or older adults living in long-term care settings. The psychometric properties of aggression scales in late-life generally indicate adequate internal consistency, interrater reliability, and concurrent validity. In contrast, the reliability and validity of subscales of aggression contained within larger neuropsychiatric measures are more difficult to ascertain due to limited research. Future investigations would benefit from examining the psychometric properties of widely-used self-report measures of aggression among older adults, further evaluating the psychometric properties of aggression subscales, and developing additional measures which are predictive of aggressive behaviors.
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Oliveira CDS, Martins JT, Galdino MJQ, Perfeito RR. Violence at work in emergency care units: nurses' experiences. Rev Lat Am Enfermagem 2020; 28:e3323. [PMID: 32813779 PMCID: PMC7426144 DOI: 10.1590/1518-8345.3856.3323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 04/07/2020] [Indexed: 02/03/2023] Open
Abstract
Objectives: to understand the perception of nurses in emergency care units about the violence experienced at work. Method: qualitative study conducted through 21 individual interviews between November and December 2018 in two emergency care units in a city in Paraná. Symbolic Interactionism was adopted as the theoretical framework and the Thematic Content Analysis technique was used to evaluate the data. Results: from the thematic category experiencing psychological violence in the nurses’ daily work, it was evidenced that it was related to threats against their lives, cursing, humiliation, embarrassment, attempt to defame them, as well as pressure from subordinates. In the category experiencing physical violence in the nurses’ daily work, it was found that it was imposed through pushing, pulling hair, throwing objects, the presence of firearms and knives and, even, witnessing murder. Conclusion: nurses suffered acts of violence by external and internal people, from the emergency care units themselves. Managers, nurses and society need to look reflexively and critically at the violence that happens and implement actions to avoid them, thus providing a safe working environment for all involved and educate society in order to make the reduction of violence a priority in public policies.
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Pai DD, Sturbelle ICS, Santos CD, Tavares JP, Lautert L. VIOLÊNCIA FÍSICA E PSICOLÓGICA PERPETRADA NO TRABALHO EM SAÚDE. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072018002420016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a presença da violência física e psicológica entre trabalhadores da saúde, identificar seus perpetradores e compreender a origem das agressões. Método: estudo de abordagem mista. Os dados quantitativos foram coletados sobre amostra aleatória de 269 profissionais da equipe de saúde em hospital público da Região Sul do Brasil, dentre os quais, 20 sujeitos, vítimas de violência, compuseram sequencialmente a etapa qualitativa. Resultados: a violência física atingiu 15,2% (n=42) dos profissionais e a violência psicológica 48,7% (n=135) dos trabalhadores por meio de agressões verbais, 24,9% (n=69) sofreram assédio moral, 8,7% (n=24) discriminação racial e 2,5% (n=7) assédio sexual. Mulheres foram as principais vítimas da violência física, assédio moral e discriminação racial (p<0,05). Técnicos de enfermagem foram os mais expostos à violência física e assédio moral (p<0,05). O paciente foi o principal agressor da equipe de saúde (35,4%, n=98), seguido pelos colegas de trabalho (25,3%, n=70), chefia (21,7%, n=60) e acompanhantes (15,5%, n=43). Agravos neurológicos, abuso de álcool e de outras drogas foram relacionados à origem da agressão, razões que atenuaram a culpa dos pacientes pela violência. As condições impróprias de trabalho geraram revolta dos pacientes e entre os profissionais. Aspectos da organização do trabalho no hospital público foram apontados como causas para conflitos que repercutem em violências. Conclusões: a violência psicológica foi prevalente, mulheres e técnicos de enfermagem foram os mais expostos e pacientes os principais perpetradores. São necessárias medidas de contenção e prevenção, bem como investimentos sobre as condições e a organização do trabalho no hospital.
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A systematic evaluation of impulsive-aggressive behavior in psychogeriatric inpatients using the staff observation aggression scale-revision (SOAS-R). Int Psychogeriatr 2018; 30:61-68. [PMID: 28851471 DOI: 10.1017/s1041610217001600] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Impulsive-aggressive behavior is a significant challenge in geriatric psychiatry and requires professional evaluation and management. METHODS SOAS-R scales (Staff Observation Aggression Scale-Revision) completed by medical staff on three secure psychiatric wards were analyzed during a period of 12 months. Patients were subdivided into the following two diagnostic subgroups: dementia and other diagnoses. RESULTS A total of 146 aggressive incidents involving 66 patients were reported (8.8% of patients treated during this period, n = 752). Fifty-seven percent of the incidents involved patients with dementia. In 20% of the incidents, no precipitating event could be identified; this was more common in patients without dementia (p = 0.005). The medical condition of the patient was considered the trigger in 55% of the cases. Aggression was directed at nurses in 82% of the cases. Visible injury was reported in 12 cases, 3 of which required medical treatment. Male gender, the presence of previous aggressive incidents, and the evening shift (in the case of dementia patients) were identified as risk factors. CONCLUSIONS Aggression in dementia is often reactive and seems to be more predictable than if occurring with other diagnoses. Prevention measures such as de-escalations techniques, warning notes in the patient's file with previous aggressive behavior and stepping up for evening shifts are of crucial importance. As nurses were primarily affected, employer support programs, and mental health interventions are proposed to avoid long-term consequences.
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Thomas SP. Aggression and Violence: Perennial Concerns for Psychiatric-Mental Health Nursing. Issues Ment Health Nurs 2016; 37:443-5. [PMID: 27391087 DOI: 10.1080/01612840.2016.1187507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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