Psychiatric Staff Research Articles

Changes in patient safety culture: A patient safety intervention for Finnish forensic psychiatric hospital staff.

To evaluate how a 3-year patient safety intervention, more specifically, the implementation of a patient safety incident reporting system, influences patient safety culture. Positive patient safety culture improves both the quality of health care and patient safety. Nevertheless, nursing managers need tools that can help them develop and evaluate patient safety culture. The Hospital Survey on Patient Safety Culture was used to evaluate patient safety culture at two Finnish forensic psychiatric hospitals (study and control) over two periods, baseline and follow-up. Data were analysed using Z-score and T test statistics. The follow-up results from the study hospital showed that five patient safety culture dimensions exhibited a significantly (p<0.05) positive change in positive response rates over the 3-year period. Furthermore, nine out of twelve patient safety culture dimensions at the study hospital showed a significant improvement in mean score. At the control hospital, only the dimension of frequency of reporting events showed a significantly positive change (p<0.05) in mean score. This research shows that the studied patient safety intervention (implementation of the patient safety incident reporting system) significantly influences patient safety culture. Nursing managers should utilize a variety of patient safety interventions to improve patient safety and focus on leveraging information from patient safety incidents to advance patient safety culture.

A Matter of Trust and Distrust: A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting

Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably. The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration. Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed. Two main themes were identified, namely, "care and protection" and "inclusion and involvement," and one subtheme, "information." These themes revealed the framework used by parents to construct a sense of "trust or distrust" about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting. Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.

精神科スタッフナースの怒り感情喚起場面での怒りに関与する要因の検討 – 認知傾向・感情・態度との関連–

精神科スタッフナースの怒り感情喚起場面での怒りに関与する要因の検討 – 認知傾向・感情・態度との関連–

Impact sur la prescription de psychotropes des conseils thérapeutiques formalisés dans un centre référent de réhabilitation psychosociale

IntroductionThe improvement of prescription constitutes a major challenge for public health. In France, medication is the third cause of serious adverse reaction. The report of the Parliamentary Commission for Evaluation of Health Policy on adequate use of psychotropics mentions their overconsumption. Promoting practices’ dissemination and guidelines’ respect is one of the missions of the referral psychosocial rehabilitation centers. Therapeutic advice that is offered consists of suggestions for revision in the patient's treatment with the aim of improving the patient's health. To our knowledge, to date no study has focused on the evaluation of therapeutic advice in psychiatry. The present study aimed at analyzing benefits of therapeutic advice for the patients. To this end: (1) a state of things related to actual practices was carried out: psychotropics prescriptions’ problems and therapeutic advice proposed by psychiatrists (quantitative and qualitative assessment); (2) the impact of advice on prescription was assessed; (3) patients’ benefits were identified. MethodThis monocentric trial was carried out at the referral psychosocial rehabilitation center of Lyon. This audit was a retrospective observation of electronic medical records (software CortexteNet V2.6). This project was developed by a multidisciplinary staff (pharmacists and psychiatrists) during summer 2015. All patients treated in this center between September 2010 and December 2014 were included. The collection of data was made by two auditors (pharmacist students) thanks to a collection grid with six parts: identification and epidemiology of patients with therapeutic advice, coding tips, benefits, quantitative and qualitative assessment of prescriptions before and after advice. ResultsOf the 601 records explored during this study, 66 advices (8.3% of patients) were identified. Patients concerned by therapeutic advice were mainly men with schizophrenia between 35 and 40 years, living in a town and addressed by public psychiatrists. Advice was taken into account in 81.7%, partially in 8.1%, and was beneficial in 97%. The main benefits were clinical improvement (48.5%) and reduction of adverse drug events (36.4%). There were no statistically significant differences between prescriptions (quantitatively and qualitatively) before and after therapeutic advice. ConclusionIn most cases, prescriptions of psychotropics were adequate since only 66 advices (8.3% of patients) were given. Psychosocial rehabilitation centers give medication prescribing advice and promote respect of the guidelines. The collaboration between rehabilitation's psychiatrists and other psychiatrists optimizes patient management. It reduces iatrogenic disorders and improves quality and safety of care. Very few studies deal with the prescription of psychotropics in adult psychiatry. This work highlights the positive effect of therapeutic advice for this population. Further controlled studies should clarify the benefits of therapeutic advice.

Detaining patients in the general hospital - current practice and pitfalls.

Much has been written about the use of the Mental Health Act in psychiatric settings. There is, however, little written on its use to detain patients with mental disorder in general hospitals. We therefore carried out a survey of the use of the Mental Health Act in general hospital settings in Aberdeen, and also posted a questionnaire to Scottish Liaison Psychiatrists, asking about their experience of the use of the Mental Health Act in general hospitals. Over a six-month period in Aberdeen Royal Infirmary, we identified 39 detentions. Out of hours, the use of Emergency Detention Certificates was more common than use of Short Term Detention Certificates - the latter is recommended by the Mental Welfare Commission, as patients are afforded more rights. When psychiatric staff were not directly involved, procedural and administrative errors were more likely to occur. Liaison psychiatrists elsewhere in Scotland reported similar observations. General hospital clinicians are unfamiliar with the Mental Health Act and its use. Errors in its application therefore arise, and are more common when psychiatric staff is not involved. Better education, including the provision of written information and consideration of an electronic system, may improve current practice.

Status of polypharmacy among elderly mentally illness patients

Objective To explore the polypharmacy and drug adverse reactions among elderly mentally illness patients so as to provide a basis for the training of individualized medication observation, nursing and safe medication. Methods From March to April 2018, we selected 180 patients of geriatrics department at Beijing Huilongguan Hospital and Peking University Sixth Hospital by successive sampling. We collected data involving demographic data, disease data, drug types and names, drug adverse reactions by consulting medical records. Results Among elderly mentally illness patients, schizophrenia (40.56%) and various types of dementia (40.56%) were the commonest; the number of accompanied diseases was (5.4±2.1) and the top 5 of the commonest was cerebral infarction, cardiovascular disease, hyperlipemia, osteoporosis and hypertension. The kinds of oral medicine were (6.5±2.4) ; the incidences of polypharmacy and drug adverse reactions were 90.56% and 73.33% respectively. The commonest drug adverse reactions included abnormal liver function (38.33%) , constipation (31.67%) and extrapyramidal syndrome (11.67%) . Conclusions The incidence of polypharmacy among elderly mentally illness patients is relatively high accompanied by severe problems. It prompts that psychiatric medical staff should understand and pay more attention to polypharmacy, and provide individualized medication observation and nursing to reduce the adverse effects of polypharmacy on patients. Key words: Aged; Mental disorders; Adverse Reactions; Polypharmacy

The Heyman Survey of nursing employees' attitudes towards mechanical restraints in Slovenia

Introduction: Attitudes of nursing employees towards mechanical restraint are directly connected to their incidence. The purpose of this research was to examine the attitudes of psychiatric nursing staff towards the use and administration of mechanical restraints.Methods: The cross-sectional descriptive study was conducted using a structured Heyman-type survey. All the Slovenian nursing staff in psychiatric hospitals participated on a given day (n = 367).Results: Differences were observed in the average duration of administered mechanical restraint between individual hospitals (χ2 = 43.770, p &lt; 0.001). Staff most often stated that patients felt angry when subjected to mechanical restraint (n = 328, 89.4 %). Nonetheless, the majority of respondents believe that mechanical restraints can be an effective therapeutic tool (n = 343, 91.6 %). Females (U = 11450.50, p = 0.025) and with higher education (U = 9527.00, p = 0.002) experience statistically significantly more negative emotions and are less inclined to use mechanical restraints.Discussion and conclusion: It is evident that in addition to the factors we researched some other factors are more influential when the incidences of coercive measures are closely studied. Due to some variation between hospitals it would be advisable to review the current clinical practices in this field. The management of health institutions should be considered an essential factor in the efforts to decrease mechanical restraint use.

END OF LIFE CARE IN INPATIENT PSYCHIATRY: A CASE STUDY ON END-STAGE ALZHEIMER'S DISEASE

Introduction Dementia is the sixth leading cause of death in the United States with Alzheimer's disease being the leading cause of dementia. To avoid unnecessary suffering and even harmful resuscitation, patients with dementia, or their designated decision-makers, can choose to sign a do-not-resuscitate (DNR) or do-not-intubate (DNI) order when they are critically ill. These patients and their designated decision-makers may also choose to receive hospice care to treat their symptoms and improve their quality of life in their final days. The percentage of patients with dementia receiving hospice care in 2018 was 11%, and this percentage is fast growing of hospice patients. However, caring for patients with advanced dementia who are nearing end of life poses many challenges for inpatient psychiatrists and staff. This case aims to examine a patient with Major Neurocognitive Disorder due to Alzheimer's disease with behavioral disturbances and the challenges to honoring the patient's DNR/DNI status and coordinating discharge to hospice. Methods Case Description: Patient is a 78-year old male diagnosed with Major Neurocognitive Disorder due to Alzheimer's disease with behavioral disturbances admitted to Vanderbilt Psychiatric Hospital for uncontrollable physical aggression. This was his second psychiatric hospitalization in one year due to aggression. On initial evaluation, he was oriented to self only, which was his baseline. He was admitted on the following medications: donepezil 10mg daily, haloperidol 3 mg twice daily, melatonin 1.5 mg at bedtime, finasteride 5 mg daily, tamsulosin 0.8 mg at bedtime, aspirin 81 mg daily, a multivitamin daily, and comfort medications as needed. Behavioral interventions were initiated to reduce agitation. On hospital days 1-6, he was physically aggressive towards staff during activities of daily living. During this time, he was tapered off haloperidol and risperidone was titrated to target physically aggressive behavior, although this was eventually discontinued due to ineffectiveness. On hospital day 8, he was started on olanzapine for physical aggression, resulting in improvement. During this time, olanzapine was adjusted to 5 mg at bedtime and melatonin to 3 mg at bedtime. While his aggressive behavior improved, his food intake and mobility continued to decline. The geriatric psychiatry team recommended patient's POA consider hospice care. Palliative care was consulted, but declined to see the patient while he was hospitalized psychiatrically. On hospital day 26, the patient started displaying autonomic instability, though did not appear to be in distress. He was started on supplemental oxygen. The Geriatric Medicine consult team recommended morphine 5-10 mg every 2 hours as needed for dyspnea or pain. Two community hospice services were consulted and determined him appropriate for their facilities. The psychiatric nursing staff expressed concern his DNR/DNI could not be honored if he were to decompensate further prior to transfer. The Chief Medical Officer was involved who confirmed the DNR/DNI status could be honored as the policy had recently changed. On hospital day 28, the patient was discharged to a nursing home with hospice care, and he died nine days later. Results Discussion: Inpatient psychiatrists and staff are not as familiar as their counterparts at a medical center in managing end-of-life care and death of patients, despite geriatric psychiatrists commonly treating patients of advanced age or with terminal illness. An increasing number of patients with advanced dementia and associated behavioral disturbances are psychiatrically hospitalized, and they represent the fastest growing group of hospice patients. This patient's agitation needed stabilizing before he could transfer to a nursing home safely. When he began displaying autonomic instability, multiple members of his treatment team were concerned his advanced directives would not be honored if he died while on the psychiatric unit, and expressed additional concerns around the impact his death would have on staff and other patients. Conclusions Experts suggest the final stage of Alzheimer's disease include the inability to ambulate, speak, perform activities of daily living, and appropriately swallow. When these signs are present, it is important to recognize any limitations in the care available, involving hospice or palliative care experts if needed, to honor a patient's end of life wishes accordingly. This research was funded by Not applicable.

Psychiatric nursing staffs' attitudes towards the use of containment methods in psychiatric inpatient care: An integrative review.

One of the international objectives in psychiatric care is reducing the use of coercion. Containment methods are meant to keep patients safe, yet usually include coercion. Nurses play a key role in deciding whether or not containment should be used and, as such, their attitudes towards containment can significantly impact the extent to which these methods are applied. The aim of this integrative review was to identify, analyse, and synthesize the available research on psychiatric nursing staffs' attitudes towards containment methods in inpatient psychiatric care. An electronic search was conducted using the CINAHL, Scopus, and PsycINFO databases. In addition, the citations of identified studies were screened for relevant research. A total of 24 relevant papers published between 2002 and 2017 were selected for further analysis. These studies revealed variation in nursing staffs' attitudes towards the use of containment methods. The use of containment methods seems to be widely accepted and nurses reported rarely considering alternative measures. It appears that attitudes towards containment have continuously become more negative, although the change has not been very pronounced. The concept of attitude was only defined in two studies. Thus, future research should strive to clarify this concept, as a generally accepted definition for attitude within nursing research and the utilization of all dimensions of this concept are both essential to the nursing field. Currently, it would be important to focus on changing attitudes among psychiatric nursing staff to reduce the use of containment methods; this calls for more research on nursing staffs' attitudes.

Religiosity and Spirituality: Is It an Appropriate Issue in Psychiatry and Psychotherapy? —Comparative Studies of Germany and South Korea

In patient-centred care, religious and spiritual needs and values of patients are increasingly underlined. The field of psychiatry and psychotherapy is no exception in this regard, so more attention and research are required. In addition to existing research, taking a further step, we would like to know whether there are any cultural differences in regard to staffs’ religious and spiritual values, and their attitudes to deal with religious or spiritual issues in clinical settings. For that reason, comparative studies were conducted in Germany and Korea. As a result, we found that German psychiatric staffs have more positive perspectives on religion and related aspects than Korean, not only in their personal lives but also in therapeutic settings. Furthermore, some contradictions regarding religiosity and spirituality were shown in staffs’ professional attitudes of both countries. Above all, in consideration of professional neutrality respondents are reluctant to handle such issues in therapeutic settings. For Korean psychiatric staffs, another important reason was that they are predominantly atheists or agonistics. German psychiatric staffs referred to have insufficient time. The kind of professionality which they are proclaiming to keep during the therapeutic processes is shown to be inadequate for several reasons. For genuinely wholistic care, more cross-cutural and in-depth studies are needed. Furthermore, professional self-contradictions deserve further attention and reflection, for the patients’ sake.

Empathy and Burnout - A Cross-Sectional Study Among Mental Healthcare Providers in France.

Previous studies have established a correlation between empathy and burnout among healthcare providers. The aim of this study is to explore whether empathy – the ability to understand what another person is experiencing, was related to mental healthcare staffs’ burnout.We performed a descriptive, cross-sectional, observational study among medical and nursing mental healthcare staff working in the district of Moselle, France. Participants completed a survey including The French versions of the Jefferson Scale of Empathy (JSPE) and The Maslach Burnout Inventory-Human Services Survey (MBI-HSS).The sample included 241 (n=241) participants (N=420, response rate=51.7%). 187 (77.6%) respondents had low burnout, 43 (17.8%) had intermediate burnout and 11 (4.6%) had high burnout. 41 (17%) had low empathy, 156 (64.7) had moderate empathy and 44 (18.3%) scored high.Empathy scores were positively correlated with scores of personal accomplishment of the MBI-HSS (r=0.2; p<0.001), but negatively correlated with scores of depersonalization (r=-0.2; p<0.003). Highest means of depersonalization (DP) (M=8.7; SD=6.8; p<0.009) and lowest means of compassionate care (M=40.05; SD=7.9; p=0.0001) were found among forensic psychiatric security units staff.Participation in the Omega educational program was associated with lower scores of EE on the MBI-HSS survey (mean score 14.7 versus a mean score of 19.7 for nonparticipants).Empathic mental healthcare providers have lower levels of burnout. Forensic psychiatric staff showed low means of compassionate care and high depersonalization.Interventions designed to foster attributes and skills such as empathy, resilience, and perception of security may be an essential step in reducing and preventing burnout.

Possibilities for Suicide Prevention Through Architecture in Child and Adolescent Psychiatry

Possibilities for Suicide Prevention Through Architecture in Child and Adolescent Psychiatry Abstract. In Germany, departments of Child and Adolescent Psychiatry are responsible for the treatment of young people with acute suicidal tendencies. Therefore, it is important to consider means of preventing suicide already during the construction and business operations of these institutions. Approaches to structural suicide prevention can be divided into restrictive and atmospheric-therapeutic measures. The latter includes ways to create an antisuicidal environment and to establish a setting amenable to close support and care by mental-health professionals. Restrictive measures comprise security measures and means of avoiding potential hazards, for example, through life-threatening jumps (e. g., staircases) or intentional strangulation (e. g., employing materials with predetermined breaking points). In addition to security issues, architectural and creative aspects must be incorporated to enable a suicide-preventive atmosphere, that is, satisfying protective needs, creating positive distractions (panoramic views, activities, occupational therapy opportunities), and using positive physiological and natural influences (such as colors and light). Secure access to a pleasant and protected external area as well as exercise spaces is also essential. Architects and construction managers should work closely with the institution's health personnel (e. g., doctors, therapists, and psychiatric nursing staff) during the planning stages for Departments of Child and Adolescent Psychiatry in order to come up with solutions that comprise appropriate, practical, and functional requirements and safety-restrictive measures. Thus, an inviting and atmospherically pleasant space can be created that simultaneously provides suicide prevention and protection, where adolescents with psychiatric disorders can be treated by mental-health professionals.

The Importance of Being Acceptable – Psychiatric Staffs’ Talk about Women Patients in Forensic Care

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead self-harm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff’s talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.

Staff and patient perspectives on therapeutic engagement during one-to-one observation.

WHAT IS KNOWN ON THE SUBJECT?: One-to-one observation uses continuous staff observation to safeguard patients judged likely to harm themselves or others. Policies increasingly mandate that staff engage therapeutically with patients during one-to-one observation. Yet not enough is known about factors facilitating or impeding such therapeutic engagement. WHAT DOES THIS PAPER ADD TO EXISTING KNOWLEDGE?: This study enriches existing literature on one-to-one observation through integrating the perspectives of staff of different levels of qualification, and patients of different diagnostic and risk profiles. Whilst previous research has highlighted the occurrence of counter-therapeutic staff-patient interactions, integration of patient and staff perspectives in the current study has demonstrated that patient and staff often attribute the causes differently, with each apportioning blame to the other, leading both parties to feel misunderstood, and staff lack confidence to overcome these challenges. A novel finding was that rapport-building via simple demonstrations of compassion and conversations about everyday things, was viewed as an essential prerequisite to encouraging patients to open up about their experiences of emotional distress, whilst implementation of techniques drawn from psychological interventions was viewed as less important than staff's core relational skills. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Therapeutic engagement during observation can enhance its risk management aims, providing thought is given to understanding and negotiating complex dynamics between staff and patients. Supervision for staff conducting observations should focus on building rapport in preference to emphasizing psychological intervention (e.g. DBT), and should enable staff to reflect on better understanding and managing their own emotions towards "hard-to-engage" patients. ABSTRACT: Introduction Policies increasingly focus on staff-patient interactions during one-to-one psychiatric nursing observations as an opportunity for therapeutic engagement - yet if and how this is feasible is unknown. Aim This study aimed to integrate staff and patient perspectives to determine what factors facilitate or impede therapeutic engagement during one-to-one observation. Method Thematic analysis of qualitative interviews with 31 psychiatric inpatient staff at different levels of seniority and 28 inpatients spanning a range of diagnoses and risk profiles. Results Negative experiences of observation were characterized by a reciprocal dynamic where both patients and staff withdrew from interactions, having felt the other did not want to engage with them. Staff and patients agreed that these difficulties could be overcome when staff showed patients that they cared, gradually building trust through simple demonstrations of compassion and 'normalizing' conversation about everyday things. This approach helped patients to feel safe enough to open up about their distress, which in turn helped staff to better understand their experiences and work with them to find solutions. Implications for practice Engagement during observation could be facilitated if staff receive more supervision in understanding difficult dynamics that impede rapport-building and in managing their emotions towards patients they experience as "hard-to-engage".

Measuring authoritarianism in a Greek health care setting.

Few studies have investigated the level of authoritarianism in the area of health. Staff with authoritarian personality may put in danger the quality of health services, especially towards stigmatized groups, such as the mentally ill and HIV positive people or the minority ethnic communities. Authoritarianism Scale (AS) by P. Heaven, is an instrument focusing on the multi-faced nature of authoritarianism and authoritarian behaviors. The aim of this study is to assess the psychometric properties of the Greek Authoritarianism Scale (AS) and to explore authoritarian attitudes of people employed in health services, in Greece. Initially, 600 individuals (health employees and medical students) were enrolled and completed AS. Additionally, 33 postgraduate students completed AS twice, in an interval of 30 days. In order to assess the psychometric properties of AS explanatory factor analysis was performed, which resulted in a 20-items scale and revealed five (5) factors: "Leadership", "Verbal hostility", "Military way of thinking", "Fear-Suspiciousness", "Achievement Motivation". Cronbach's alpha value overall was satisfactory (0.79), while values for every factor separately ranged from 0.55 to 0.76 showing moderate to satisfactory reliability. AS's test-retest reliability was high: ICC showed high to excellent agreement of AS total and factor scores between the two time points. Women and older people were less authoritarian while youngers, students and staff with primary education showed more authoritarianism. Psychiatric staff presents the lowest AS total score comparing to the other specialties. Significant differences in all categories of the sample arose in "Achievement Motivation". Greek version of AS, as evaluated in a Greek health staff sample, revealed interesting differences among participated subgroups and had overall satisfactory reliability. The influence of Authoritarianism on the major issues of our days, such as immigration flows, social and financial crisis, leads to the need of the existence of reliable measures of its assessment.

Psychiatric Disorders Comorbidity in Two General Medical Hospitals in Iran Between 2014 - 2015

Background: Although there is a high prevalence of psychiatric comorbidities in patients in general medical hospitals, they have remained undiagnosed in some cases. Objectives: This study was conducted to determine the psychiatric disorders comorbidity of patients in two general medical hospitals in Iran. Methods: This cross-sectional descriptive study was conducted in Imam Khomeini and Bu Ali Sina general university hospitals, in Sari, Northern Iran, and included 1,688 patients from different wards of these hospitals. Data were collected via a demographic questionnaire. Results: With regard to frequency distribution, according to age group and gender, the most consultations (393; 23.3%) were in the 20 - 29 year’s age group and 935 (55.4 %) cases were female. The highest number of consultation cases had been referred from the emergency wards (34%), followed by the neurosurgery (14.2%) and internal medicine wards (14.2%). Psychological assessment was the most common reason for requesting a consultation (26.8 %). In addition, the results indicated that mood disorder (22.3%) was the most prevalent psychiatric diagnosis. Conclusions: In order to improve the trend of psychiatric diagnosis in general hospitals, psychiatric liaison staff should be trained in multiple consulting roles, and must improve their skills in addressing inpatient and outpatient treatment. Moreover, other non-psychiatric physicians should increase their knowledge of attitude toward and psychosocial aspects of medical disorders.

The physical and mental health of acute psychiatric ward staff, and its relationship to experience of physical violence

To evaluate and describe the physical and mental health of staff on acute psychiatric wards and examine whether violence exposure is linked with health status. We undertook a cross-sectional survey with 564 nursing staff and healthcare assistants from 31 psychiatric wards in nine NHS Trusts using the SF-36, a reliable and valid measure of health status and compared summary scores with national normative data. Additional violence exposure data were collated simultaneously and also compared with health status. The physical health of staff was worse, and their mental health was better than the general population. Physical health data were skewed and showed a small number of staff in relatively poor health while the majority were above average. Better physical health was associated with less time in the current post, a higher pay grade, and less exposure to mild physical violence in the past year. Better mental health was associated with being older and from an ethnic minority background. Violence exposure influenced physical health but not mental health when possible confounders were considered. Mental health was strongly influenced by ethnicity, and further research might highlight the impact on own-group ethnic density on the quality of care. The impact of staff whom are physically unwell or impaired in the workplace needs to be considered as the quality of care may be compromised despite this being an example of inclusiveness, equal opportunities employment, and positive staff motivation.

Dobbeltdiagnosepatienters møde med det psykiatriske behandlingssystem

I denne artikel præsenterer vi en interviewundersøgelse med 17 dobbeltdiagnosepatienter (patienter der både har et misbrug og en anden psykiatrisk lidelse), der beskriver deres erfaringer med at blive afvist eller behandlet dårligt i mødet med det psykiatriske behandlingssystem. På baggrund af en indholdsanalyse af patienternes fortællinger har vi identificeret tre forskellige svar på, hvorfor patienterne bliver mødt på denne måde. For det første fordi stofmisbrug generelt i samfundet bliver omfattet af stigmatisering, og at det også gælder personalet på de psykiatriske afdelinger. For det andet fordi patienterne ikke lever op til rollen som rigtige patienter – bl.a. fordi de fortsætter med at misbruge, når de kommer i psykiatrisk behandling. Og for det tredje fordi psykiatrien arbejder med en forståelse af psykisk sygdom – som værende præcist afgrænsede sygdomsenheder – der vanskeliggør behandlingen af komplekse lidelser som dobbeltdiagnose. Som afsluttende perspektivering peger vi på de ønsker, som patienterne selv har til det psykiatriske behandlingssystem, nemlig at blive mødt som hele mennesker og at få behandlet deres problemer – inklusivt misbrug – professionelt af personalet.

Variation in admission rates between psychiatrists on call in a university teaching hospital

BackgroundHospital-based physicians must routinely decide whether patients receiving care in the emergency room require admission to an acute care bed. We endeavoured to understand clinician-related factors that influence the decision to admit.MethodsWe retrospectively examined data collected between August 1, 2013 and July 31, 2015 for patients triaged as mental health assessments in the emergency department of a university teaching hospital. We identified 1530 unique cases who had been reviewed by the staff psychiatrist for a decision on whether to admit to an acute care bed. Patient and physician characteristics were analyzed by standard descriptive methods, comparative statistics (Chi square and analysis of variance) and regression analyses using SPSS version 24.0 (IBM Corp. Armonk, NY, USA).ResultsThere were no differences in patient characteristics in the clinical encounters reviewed by different staff psychiatrists. The physician factor found significant in deciding whether to admit the patient was assignment to PES (psychiatric emergency services). This appeared to be the only physician variable impacting the decision to admit a patient with PES psychiatrists admitting less often than their colleagues (p = 0.018, Table 3). The effect size of the variable in terms of odds ratio was 0.592.InterpretationTraining and practice in emergency psychiatry lead to lower admission rates when these clinicians are on call. Training in emergency psychiatry for all psychiatrists participating in a call pool may result in lowered admission rates.

Cross-sectional study on nurses\u2019 attitudes regarding coercive measures: the importance of socio-demographic characteristics, job satisfaction, and strategies for coping with stress

BackgroundCoercive measures are containment methods used in psychiatry to curb patients’ disruptive and aggressive behaviours towards themselves, others or objects. The prevalence of the practice of coercive measures in psychiatry is directly related to the attitudes of the staff. When discussing these attitudes, nurses are often particularly singled out. The purpose of the study is to research the impact of individual factors on nurses’ attitudes in the decision-making process for the use of coercive measures.MethodsA cross-sectional study among all psychiatric nursing staff in Slovenia (n = 367, 79%) was conducted over the years 2013/2014. Standardized questionnaires were used, including a survey of nurses’ attitudes to the use of seclusion, the Job Descriptive Index, and the Folkman-Lazarus test.ResultsNurses’ attitudes towards special coercive measures are predominantly negative ( overline{x} = 11.312, SD = 2.641). The factors that explain a positive attitude are as follows: female gender (β = − 0.236, p < 0.001), fewer years of service (β = − 0.149, p = 0.023), emotion-focused strategies of coping with stress (β = 0.139, p = 0.020), and less-threatening patient behaviour (β = 0.157, p = 0.012).ConclusionsThe effects of some known factors did not prove important in the model. Newly recognized factors are “less-threatening patient behaviour” and “emotion-focused strategies of coping with stress”. Therefore, attitudes towards special coercive measures in psychiatry must be regarded as contextualized, interactive, and multidimensional phenomena that cannot be explained merely through a defined set of factors.