Case-controlled Analysis of Patient-based Risk Factors for Assault in the Healthcare Workplace

Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2017-2022

Since the 1960s, empirical research has focused on a better understanding of the characteristics of assaultive psychiatric patients. International research from 1960 to 2017 indicated that male and female patients with schizophrenia and substance use disorder presented the greatest risk for assault with nursing personnel being at higher risk. This present review of studies sought to assess the latest research findings on assaultive patients for the most recent five-year period, 2017-2022. It was hypothesized that patients with schizophrenia and substance use disorders would present the greatest assault risk for nursing personnel. The studies in this review supported this hypothesis. Assaults by patients with schizophrenia and substance abuse has been a consistent finding worldwide for 62 years of published research. Explanations for these findings, the possible role of posttraumatic stress disorder (PTSD) in assaultive patients, and an updated methodological review are presented.

Implementation of an Assault Prevention Quality Improvement Initiative in an Urban Emergency Department

BACKGROUND

Emergency department (ED) health care workers experience high rates of workplace violence (WPV).

LOCAL PROBLEM

Patient-to-staff physical assaults at an urban, academic adult ED ranged between 1 and 5 per month, with a rate of 0.265 per 1000 patient visits.

METHODS

A quality improvement initiative, guided by the Social Ecological Model framework that contextualized WPV in the ED setting, informed the development of a Risk for Violence Screening Tool (RVST) to screen adult patients presenting to the ED.

INTERVENTIONS

Plan-Do-Study-Act cycles were utilized to implement a violence prevention bundle that incorporated the RVST, an alert system, and focused assault reduction strategies.

RESULTS

Patient-to-staff physical assaults decreased to a rate of 0.146 per 1000 patient visits.

CONCLUSIONS

Risk for violence screening, an alert system, and assault prevention strategies provide opportunities for nurse leaders to promote ED workplace safety.

Identifying Predictors of Workplace Violence Against Healthcare Professionals: A Systematic Review

Understanding the predictors of workplace violence amongst healthcare professionals is important to develop and implement prevention and mitigation strategies. We conducted a systematic review to synthesize the recent evidence on predictors of workplace violence across healthcare settings. The review has been done as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Two electronic databases (PubMed and Google Scholar) were used to search peer-reviewed studies published for the year 2009-2020 to identify studies reporting predictors of workplace violence. The significant predictors were analyzed using descriptive statistics such as proportions in most of the studies and some studies used inferential statistics such as logistic regression analysis, Chi-square test, ANOVA and Student's t-test. A total of 46 studies were identified and overall evidence was graded using an adapted GRADE approach. Some of the moderate quality predictors associated with workplace violence were the patient with a history of mental health disease, psychiatric setting, professional's gender and work experience and evening shift workers. Being a nurse was the only high-quality predictor. Healthcare professionals and administration can identify the predictors relevant to their setting to mitigate episodes of violence against healthcare personnel.

Psychiatric Emergencies: Emergency Department Management of Altered Mental Status

In the United States, encounters related to mental and substance use disorders are common in emergency departments (EDs). Altered mental status (AMS) is a frequent presentation seen in EDs across the country. Individuals may present to the ED with altered thought processes, which may be attributed to intoxication from substances and/or psychoses, conditions that require immediate care and management. Health care providers must always ascertain the etiology of AMS, which may be challenging owing to the various causes of this impairment. The current article provides an overview of the most common disorders associated with AMS, which include underlying medical conditions, substance use, and mental disorders. [Journal of Psychosocial Nursing and Mental Health Services, 59(9), 16-25.].

The Effects of Emergency Room Violence toward Nurse's Intention to Leave-Resilience as a Mediator

(1) Background: Healthcare workplace violence has been a focused issue in the whole world. The rate of the occurrence is pretty high in every country. The emergency room is a high risk and high frequency place for violence to occur. Under the medical service demands from people, it is quite easy to bring about conflicts. This leads to serious physical and mental harm to nurses. When suffering from physical and mental injuries, resilience is a protective factor away from negative influence. It is rare to explore and study how the nurses' resilience ability, workplace violence and turnover intention are related. Thus, the aim of this study is to understand resilience as a mediator effect in emergency nurses toward the workplace violence. (2) Methods: A cross-sectional survey study was used to collect information from emergency room nurses of a medical center in northern Taiwan. There were 132 samples in total. Three research instruments were included as follows: Hospital Workplace Violence Prevention Questionnaire, Connor-Davidson Resilience Scale, and Turnover Intention Scale. Statistical analysis using t-test, ANOVA, Correlation, as well as Sobel test were used in this study. (3) Results: The results revealed that the average age was 29.5 ± 5.6. Almost 58% of nurses experienced workplace violence. Twelve percent of nurse had experienced physical violence and 53.8% had experienced mental violence. There was significant relationship between shift personnel and religious believers. To the people who suffered physical violence, there was a significant relationship between emergency room working years and the total working years. There was significant difference between those who had suffered mental violence and religious believers. Female nurses suffered mental violence to a much higher extent than male nurses. There was a significant relationship between nurses' working years, the total working years, resilience, and turnover intention. Resilience was not the mediator for workplace violence toward turnover intention in this study. (4) Conclusions: The outcome of this study suggested that on an individual level, nurses can enhance self-protection and communication skills to decrease workplace violence. For emergency environment settings, designing a good working environment, visitors' restriction, avoiding working alone, and enhancing supervising alarm system are recommended. As for hospital administrators, fitness for work and to set up a project team is necessary. These can be references in planning prevention on workplace violence and promoting quality of workplace and patient safety in the future.

Aggressive and Disruptive Behavior Among Psychiatric Patients With Major Depressive Disorder, Schizophrenia, or Alcohol Dependency and the Effect of Depression and Self-Esteem on Aggression

Aggressive and disruptive behavior in inpatient settings poses a serious challenge for clinical staff and fellow patients. Hence, the aim of this study was to identify different aspects of aggressive and disruptive behavior in the context of an aberrant self-esteem or clinically manifested depression as potentially influencing factors. We collected self-reported data from 282 psychiatric patients [ICD-10 diagnoses for alcohol dependency, schizophrenia or major depressive disorder (MDD)] and compared it to healthy norm groups. As expected, all three patient groups scored higher in the aggression questionnaires than the norm group. Specifically, patients with MDD exhibited significantly higher externally directed aggression, reactive aggression, and irritability compared to controls. Patients with schizophrenia displayed higher irritability, while all three groups showed distinctly higher self-aggressiveness than healthy persons. We found a lower inhibition of aggression in alcohol dependent subjects compared to both the patient groups and the norm sample. Yet, the higher the self-esteem among alcohol dependent and MDD patients, the lower were their aggression scores; similarly, a lower self-esteem among patients diagnosed with schizophrenia resulted in heighten self-aggressiveness. Thus, our data suggests that therapeutic interventions for strengthening self-esteem in patients with a diagnosis of MDD, alcohol dependency or schizophrenia could reduce certain aspects of aggressive behavior. Therefore, it seems conceivable that strengthening self-esteem in psychiatric patients could contribute to the prevention of violence in clinical practice.