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Välimäki M, Lantta T, Lam YTJ, Cheung T, Cheng PYI, Ng T, Ip G, Bressington D. Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC Psychiatry 2022; 22:344. [PMID: 35585520 PMCID: PMC9118596 DOI: 10.1186/s12888-022-03974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggression in psychiatric hospitals has been of interest to researchers. Information on how different stakeholders perceive patient aggression remains equivocal. Even less is known about possible similarities or differences in stakeholders' perceptions of how aggressive behaviour is understood, managed and prevented in psychiatric hospitals. We aimed to explore multiple viewpoints on patient aggression, its possible causes and outcomes, and development ideas for prevention and management. METHODS A qualitative design was adopted. The data were collected using focus group interviews. A thematic approach was used for interpretation. The data were collected on 15 adult wards in two inpatient psychiatric settings in Hong Kong. Participants were nurses working on the psychiatric inpatient wards, patients admitted to the wards, and informal caregivers visiting inpatient wards (N = 94). RESULTS Commonalities between all groups were found on how patient aggression is perceived, and why it occurs. Patients and especially nurses described how patient aggression occurred with no clear reason or forewarning and how patients were physically controlled or restricted after aggressive events. Only nurses and patients expressed experiencing physical burden, while all groups considered psychological burden to be a consequence of aggression. All groups proposed that helpful attitudes among nurses, better communication, structural changes, and better self-management skills would prevent patient aggression. Risk assessment was proposed only by nurses and patients, while safety measures were proposed by nurses and informal caregivers only. The use of restrictive interventions to manage aggressive events was proposed by all groups. CONCLUSIONS Despite the complex diversity of perspectives in different stakeholder groups regarding patient aggression, the findings highlighted that it is possible to achieve some mutual understanding of aggression in psychiatric hospitals and identify areas to be developed. Staffs' attitudes and skills for engagement and communication with patients and informal caregivers should be improved. There is also still room to develop the therapeutic environment and culture toward meaningful activities during the treatment period.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China. .,Department of Nursing Science, ICT-city, University of Turku, 20014, Turku, Finland.
| | - Tella Lantta
- grid.1374.10000 0001 2097 1371Department of Nursing Science, ICT-city, University of Turku, 20014 Turku, Finland
| | - Yuen Ting Joyce Lam
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Teris Cheung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- grid.417134.40000 0004 1771 4093Community Psychiatric Services, 12/F, Block A, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- grid.417134.40000 0004 1771 4093Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- grid.415585.80000 0004 0469 9664Central Nursing Division, Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Ellengowan Drive, Casuarine, Darwin, NT 0909 Australia
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Välimäki M, Lam YTJ, Hipp K, Cheng PYI, Ng T, Ip G, Lee P, Cheung T, Bressington D, Lantta T. Physical Restraint Events in Psychiatric Hospitals in Hong Kong: A Cohort Register Study. Int J Environ Res Public Health 2022; 19:6032. [PMID: 35627570 PMCID: PMC9140463 DOI: 10.3390/ijerph19106032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/07/2022] [Accepted: 05/12/2022] [Indexed: 12/22/2022]
Abstract
The need to better monitor coercion practices in psychiatric hospitals has been recognised. We aim to describe how physical restraint events occur in psychiatric hospitals and identify factors associated with physical-restraint use. A cohort register study was used. We analyzed physical restraint documents among 14 wards in two psychiatric hospitals in Hong Kong (1 July and 31 December 2018). In total, 1798 incidents occurred (the rate of physical restraint event 0.43). Typically, physically restrained patients were in early middle-age, of both genders, diagnosed with schizophrenia-spectrum and other psychotic disorders, and admitted voluntarily. Alternate methods for physical restraint were reported, such as an explanation of the situation to the patients, time-out or sedation. A longer period of being physically restrained was associated with being male, aged ≥40 years, having involuntary status, and neurodevelopmental-disorder diagnosis. Our findings support a call for greater action to promote the best practices in managing patient aggression and decreasing the use of physical restraint in psychiatric wards. The reasons for the use of physical restraint, especially for those patients who are admitted to a psychiatric hospital on a voluntary basis and are diagnosed with neurodevelopmental disorders, needs to be better understood and analysed.
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Affiliation(s)
- Maritta Välimäki
- Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, Changsha 410083, China
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
| | - Yuen Ting Joyce Lam
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China;
| | - Kirsi Hipp
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
| | - Po Yee Ivy Cheng
- Community Psychiatric Services, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China; (P.Y.I.C.); (T.N.)
| | - Tony Ng
- Community Psychiatric Services, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR, China; (P.Y.I.C.); (T.N.)
| | - Glendy Ip
- Central Nursing Division, Kwai Chung Hospital, Kwai Chung, Hong Kong SAR, China;
| | - Paul Lee
- Department of Health Sciences, University of Leicester, Leicester LE1 7RH, UK;
| | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China;
| | - Daniel Bressington
- College of Nursing and Midwifery, Charles Darwin University, Casuarina, Larrakia Country, Darwin NT 0810, Australia;
| | - Tella Lantta
- Department of Nursing Science, University of Turku, 20014 Turku, Finland; (Y.T.J.L.); (K.H.); (T.L.)
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Lantta T, Varpula J, Cheung T, Wong WK, Cheng PYI, Ng T, Ng CF, Yam CP, Ip G, Bressington D, Välimäki M. Prevention and management of aggressive behaviour in patients at psychiatric hospitals: a document analysis of clinical practice guidelines in Hong Kong. Int J Ment Health Nurs 2020; 29:1079-1091. [PMID: 32602160 DOI: 10.1111/inm.12742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 05/04/2020] [Accepted: 05/05/2020] [Indexed: 01/01/2023]
Abstract
Patient aggressive behaviour remains a significant public health concern worldwide. The use of restraint and seclusion remains a last resort but not an uncommon practice in clinical psychiatry in the management of aggressive events. There seems to be a paucity of evidenced-based research examining the policy framework guiding the use of restraint and seclusion in Asia contexts. The purpose of this study was to conduct an analysis on the guidelines in psychiatric hospitals in Hong Kong, and to explore the extent to which these guidelines were aligned with the international clinical guidelines for the prevention and management of patient aggression in psychiatry. A descriptive document analysis was used to analyse the guidelines from four psychiatric hospitals in Hong Kong in comparison with the NICE (National Institute of Health and Care Excellence UK) guidelines. Data were collected from December 2017 to June 2018. A total of 91 written documents were retrieved. Preventing violence and aggression has the highest level of agreement (31%,) while the use of restrictive interventions has the lowest level of agreement (12%). The sub-recommendation with most in line with the NICE guidelines were restrictive interventions, de-escalation, and improving service users' experiences. However, for example, staff training, working with police, and reduced use of restrictive interventions seemed to have no agreement with the NICE guidelines. Variation exists between the Asian (Hong Kong) local policy framework/guidelines and the European (UK) national policy framework. There are also large discrepancies in the written guidelines on patient aggressive behaviour when comparing local policy frameworks, cluster-based documents, and departmental practices.
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Affiliation(s)
- Tella Lantta
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Jaakko Varpula
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Teris Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Wai Kit Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Chi Fai Ng
- Department of Psychiatry, Tai Po Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Chun Pong Yam
- Department of Psychiatry, Kowloon Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Maritta Välimäki
- Department of Nursing Science, University of Turku, Turku, Finland.,School of Nursing, The Hong Kong Polytechnic University, Hong Kong (SAR), China
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Chien WT, Cheung EFC, Mui JHC, Gray R, Ip G. Adherence therapy for schizophrenia: a randomised controlled trial. Hong Kong Med J 2019; 25 Suppl 2:4-9. [PMID: 30674700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Affiliation(s)
- W T Chien
- Nethersole School of Nursing, The Chinese University of Hong Kong
| | - E F C Cheung
- Castle Peak Hospital, Hospital Authority, Hong Kong
| | - J H C Mui
- Castle Peak Hospital, Hospital Authority, Hong Kong
| | - R Gray
- Faculty of Medicine & Health Sciences, University of East Anglia, United Kingdom
| | - G Ip
- Kwai Chung Hospital, Hospital Authority, Hong Kong
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Chien WT, Chan ZC, Chan SW, Yip LK, Ip G. Psychometric properties of a Chinese version of the Level of Expressed Emotion scale and expressed emotion of family members perceived by patients with severe mental illness. Hong Kong Med J 2016; 22 Suppl 6:28-34. [PMID: 27807314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Affiliation(s)
- W T Chien
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - Z Cy Chan
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - S Wc Chan
- Alice Lee Centre for Nursing Studies, National University of Singapore, Singapore
| | - L K Yip
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
| | - G Ip
- Kwai Chung Hospital, Hospital Authority, Hong Kong
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Pak AS, Ip G, Wright MA, Young MR. Treating tumor-bearing mice with low-dose gamma-interferon plus tumor necrosis factor alpha to diminish immune suppressive granulocyte-macrophage progenitor cells increases responsiveness to interleukin 2 immunotherapy. Cancer Res 1995; 55:885-90. [PMID: 7850804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Production of granulocyte-macrophage (GM) colony-stimulating factor by murine metastatic Lewis lung carcinoma cells (LLC-LN7) increases the number and distribution of GM progenitor cells that are suppressive to T cell responsiveness to interleukin 2 (IL-2). The presence of these GM suppressor cells can be diminished by treatment of LLC-LN7-bearing mice with low doses of 100 units IFN-gamma plus 10 units tumor necrosis factor alpha (TNF-alpha). The aim of this study was to determine whether treatment of LLC-LN7-bearing mice with IFN-gamma/TNF-alpha to diminish GM suppressor cell presence would increase the responsiveness to IL-2 immune stimulatory therapy (100-1000 IU, twice daily for 5 days). Treatment first with IFN-gamma/TNF-alpha and then also with low dose IL-2 increased both the numbers of CD4+ and CD8+ cells within the tumor and the levels of their expression of the p55 IL-2 receptor. These intratumoral T cells also had an increased cytolytic capacity toward autologous tumor cells and an increased capacity to proliferate and secrete IL-2. Such effects were observed to a lesser extent in mice that were treated with either IFN-gamma/TNF-alpha alone or with low doses of IL-2 only. The combination treatment regimen of IFN-gamma/TNF-alpha and then IL-2 was also significantly more effective at reducing the size of the primary tumor and the formation of metastatic lung nodules than were the individual treatments. These results show that treatment to minimize the presence of GM suppressor cells enhances the effectiveness of IL-2 to stimulate anti-tumor immune responses and to diminish tumor growth and metastasis.
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Affiliation(s)
- A S Pak
- Research Service, Department of Veterans Affairs, Hines VA Hospital, Illinois 60141
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Hegele RA, Evans AJ, Tu L, Ip G, Brunt JH, Connelly PW. A gene-gender interaction affecting plasma lipoproteins in a genetic isolate. Arterioscler Thromb 1994; 14:671-8. [PMID: 8172844 DOI: 10.1161/01.atv.14.5.671] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The Hutterite Brethren are a genetic isolate characterized by high indices of relatedness and a communal agrarian lifestyle. We hypothesized that variation in their apolipoprotein (apo) E and lipoprotein lipase (LPL) genes would be associated with variation in fasting plasma lipoproteins. We measured plasma lipids, lipoproteins, and apolipoproteins and analyzed DNA for genotypes of apoE and LPL in 803 Hutterites. We observed that apoE and LPL genotypes were significantly associated with variations in plasma total cholesterol, low-density lipoprotein (LDL) cholesterol, and apoB. When the data were subdivided by sex, apoE genotype was associated with plasma apoB-related traits in men, but LPL genotype was not. In contrast, LPL genotype was associated with plasma apoB-related traits in women, including triglycerides and LDL cholesterol. After accounting for age, body mass index, and colony of origin, the variation in these variables was much more significantly associated with LDL genotype than with apoE genotype in women but not in men. The association of LPL variation with plasma lipoproteins in women suggests that the functional effects of important structural elements within, flanking, or proximal to the LPL gene on chromosome 8p22 may be sex related.
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Affiliation(s)
- R A Hegele
- Department of Medicine, St Michael's Hospital, University of Toronto, Ontario, Canada
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