Staff Assaults Research Articles

Implementing Behavioral Optimization and Outcomes Support Team in a Medical/Surgical Telemetry Unit.

A community hospital reported 21 staff assaults with injuries and 242 emergency response code green (CG) calls for violent behaviors, resulting in a loss of time in the 2022 fiscal year. Evidence has shown that exposure to violent behavior can compromise effective patient care and lead to job dissatisfaction, high turnover, and higher healthcare costs. This quality improvement project aims to develop and implement behavioral optimization and outcome support team (BOOST) in a medical-surgical telemetry unit to reduce patient-to-staff assaults/injuries. BOOST was piloted for 15 weeks; process data included staff knowledge and satisfaction with BOOST; outcome data included the number of BOOST and CG calls and staff assaults/injuries. The team members included registered psychiatric nurses, nursing supervisors, and security officers. Data were collected and analyzed weekly using a run chart. The survey data demonstrated increased staff knowledge of the behavioral response team and staff satisfaction with the BOOST implementation. No staff injuries or assaults were reported during the BOOST implementation. Behavioral optimization and outcome support team was effective in de-escalating patients and the team provided support to nursing staff. BOOST utilization can effectively reduce assaults and injuries in the workplace.

Screening and Intervention to Prevent Violence Against Health Professionals from Hospitalized Patients: A Pilot Study

Health care providers, particularly nursing staff, are at risk of physical or emotional abuse from patients. This abuse has been associated with increased use of physical and pharmacological restraints on patients, poor patient outcomes, high staff turnover, and reduced job satisfaction. In this study, a multidisciplinary team at Tufts Medical Center implemented the Brøset Violence Checklist (BVC), a screening tool administered by nurses to identify patients displaying agitated behavior. Patients who scored high on the BVC received a psychiatry consultation, followed by assessments and recommendations. This tool was implemented in an inpatient medical setting in conjunction with a one-hour de-escalation training led by nursing and Public Safety. The intervention design was executed through a series of three distinct Plan-Do-Study-Act cycles. This study measured the number of BVCs completed and their scores, the number of psychiatric consults placed, the number of calls to Public Safety, the number of staff assaults, nursing restraint use, and staff satisfaction. During the study period, restraint use decreased 17.6% from baseline mean and calls to Public Safety decreased 60.0% from baseline mean. In the staff survey, nursing staff reported feeling safer at work and feeling better equipped to care for agitated patients. The BVC is an effective, low-cost tool to proactively identify patients displaying agitated or aggressive behavior. Simple algorithms for next steps in interventions and training help to mitigate risk and increase feelings of safety among staff. Regular psychiatric rounding and the identification of champions were key components in a successful implementation.

Occupational Hazards in Corrections: The Impact of Violence and Suicide Exposures on Officers’ Emotional and Psychological Health

Correction officers work in an occupational context where they are often exposed to violence; however, prior research assessing the relationship between violence exposure and officers’ mental health has been limited. The current study sought to better understand the impact of direct and indirect exposure to violence and suicide on psychological health outcomes. Analyzing data from a random sample of 317 correction officers in Massachusetts, findings indicate that personally knowing other officers who died by suicide is associated with greater anger, anxiety, depression, and post-traumatic stress disorder (PTSD). Increased strain-based work–family conflict and departmental discipline were also associated with elevated symptomatology. However, other types of violence exposures, including being assaulted, witnessing staff assaults, and suicides among the incarcerated population, did not predict any outcomes. Furthermore, family support did not serve as a stress buffer for officers exposed to violence, but higher levels of family support were associated with decreased PTSD.

Delays in commitment and treatment court proceedings worsen psychiatric and other medical conditions.

Adversarial hearings in hospital commitment and de novo treatment proceedings, or court hearings, delay psychiatric treatment in many jurisdictions. In Massachusetts, the "treatment over objection" process requires a court petition. For state hospital patients, the delay to treatment is an initial 34day waiting period in addition to continuances of court hearings that extend treatment delays. This study examined the frequency of adverse medical events due to delayed court hearings within a forensic state hospital in the US. The study reviewed all (n=355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems. 82.6% of treatment petitions led to involuntary treatment, 16.6% were withdrawn by the medical petition filer, and only 0.8% petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced. Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.

Just another day's work: The nexus between workplace experiences and Post-Traumatic Stress Disorder (PTSD) in jail settings

PurposeCorrectional officers experience more workplace violence and victimization than individuals in comparable public service occupations, and such experiences may lead to higher levels of post-traumatic stress disorder (PTSD). MethodsIn this study, we examine the officer- and facility-level correlates of PTSD among 1327 officers working in 20 jails and consider the relationships between exposure to violence (ETV), workplace stressors, personal demographics or experiences, and PTSD indicators. ResultsOur results suggested that officers who were assaulted or were threatened more often, who witnessed more staff assaults, and who perceived unreasonable workloads or greater role problems at work were more likely to exhibit PTSD symptoms. However, officers with greater family support, males, and non-white officers had a lower propensity for PTSD. ConclusionsJail workforces that perceived more dangerous conditions, greater role problems, and more daily interaction with those they supervised had higher levels of PTSD. Implications for research and policy are discussed.

What Do We Do When Things Fall Apart? Rapid Creation of a Pilot Psychiatric Intensive Care Unit in Response to Increased Acuity on a Psychiatric Inpatient Unit for Children and Adolescents

ABSTRACT The past two decades have seen a sharp increase in suicide and psychiatric hospitalizations for children and adolescents. While many youth are served well in the inpatient psychiatry setting, a subset of this population does not stabilize during an average length of stay and with the typical therapeutic interventions provided by an inpatient unit. This study examines the creation of a psychiatric Intensive Care Unit (ICU) for patients who exhibited the most severe and acute mental illness, self-injury, and aggressive behaviors on a child and adolescent psychiatric inpatient unit. The ICU was created in response to increasing numbers of restraints, assaults, and patient and staff injuries in the months preceding creation of the program and potential contagion effect of safety issues amongst patients. Post-implementation, nominal reductions in safety metrics were found in both the ICU and general milieus for patient and staff injuries and assaults. Nominal decreases in restraints and self-injury were also found in the ICU. Significant decreases in property destruction were found in both milieus and restraints significantly decreased in the general milieu. In addition, patients who participated in the ICU milieu were less likely to be re-admitted to an inpatient psychiatric unit following hospitalization. Overall, the ICU was well-received by staff and patients’ caregivers.

Zero Staff Assaults in the Psychiatric Emergency Room: Impact of a Multifaceted Performance Improvement Project.

INTRODUCTION: Our psychiatric emergency room (ER) averages 18 patient-to-staff physical assaults annually, with some incidents resulting in multiple injuries. AIMS: The purpose of this performance improvement project was to develop, implement, and evaluate a multifaceted approach to reducing the number of physical assaults on staff. METHODS: We assessed the impact of these bundled interventions on staff assault rate: (1) increasing behavioral response team drills, (2) implementing shift doses, (3) screening for patients' risk for violence, (4) posting signage to communicate patients' violence propensity (Golden Hand), (5) implementing mitigating countermeasure interventions, (6) conducting postassault debriefing, and (7) providing postassault support. Psychiatric ER nurses completed questionnaires measuring their perceived self-efficacy in managing patients with a propensity for violence before, during, and after the bundled interventions. Physical assaults on staff were recorded and tracked monthly from May 2016 to September 2018 through a retrospective review of the hospital's online incident report system. RESULTS: Staff perceived self-efficacy increased from 78% to 95% after attending at least two behavioral response team drills. The Golden Hand signage was rated useful as it flagged and communicated the presence of high-risk patients. Shift dose was evaluated as an informative tool and manageable at ≤5 minutes. The violence-screening tool was considered more accurate in identifying patients with violent tendencies than standard assaultive precautions. Physical assaults on staff by patients decreased to zero in our psychiatric ER, which was sustained for a year. CONCLUSIONS: This innovative, multifaceted, bundled approach provides an opportunity for nurse leaders to promote workplace safety while improving staff engagement and empowerment.

The Dignity Assaults Initiative Implementation within the Michigan Corrections Organization: Staff Acceptance and Application of a Contemporary Policy Approach

ABSTRACT This study examined the implementation of one facet of the Dignity Assaults Initiative (DAI) in the state of Michigan. The DAI focused upon the corrections environment and the consistent management of two different types of staff assaults, perpetrated by inmates: liquid assaults and sexually deviant behavior. This research applied a survey focused on the examination of the sexually deviant behaviors addressed by this policy initiative. The survey was distributed to Michigan corrections employees through the Michigan Corrections Organization, and collected data regarding the policy implementation, frequency of exposure to sexually abusive/harassing behaviors and the appropriate responses to such behaviors. The data in this study found that participants did not see the DAI as effectively reducing the numbers of sexually deviant behaviors; however, the majority of the participants were aware of the DAI. The types of appropriate responses necessary to combat the sexually abusive/harassing behaviors of inmates were focused upon the formal mechanisms – formal reporting and segregation prior to administrative review. The data also indicated that both male and female staff may be exposed to sexually abusive/harassing behaviors of inmates, but when the number of occurrences over a career is evaluated, the impact upon female corrections employees is much higher.

RCN warns the government will be blind to scale of NHS staff assaults

RCN warns the government will be blind to scale of NHS staff assaults

Macro-Correlates of Inmate Violence: The Importance of Programming in Prison Order

Identifying the facility-level correlates of inmate misconduct is necessary for improving safety for both inmates and staff. Assessing these factors is also critical to ensure the effectiveness of administrative controls and facility programming. Using a repeat measures analysis, this study examines a panel of 487 state correctional facilities to assess the dynamic effects that factors of administrative control and treatment availability have on inmate–inmate and inmate–staff assaults. Findings show that several types of facility programs were negatively associated with inmate–inmate assaults but not inmate–staff assaults. Also, several dimensions of administrative control were associated with inmate–staff assaults. Implications for research and correctional practice are discussed.

Behavioral Emergency Response Team: Implementation Improves Patient Safety, Staff Safety, and Staff Collaboration.

Staff members working on our nonmental health (non-MH) units (i.e., medical-surgical [MS] units) were not educated in recognizing or deescalating behavioral emergencies. Published evidence suggests a behavioral emergency response team (BERT) composed of MH experts who assist with deescalating behavioral emergencies may be beneficial in these situations. Therefore, we sought to implement a BERT on the inpatient non-MH units at our military treatment facility. The objectives of this evidence-based practice process improvement project were to determine how implementation of a BERT affects staff and patient safety and to examine nursing staffs' level of knowledge, confidence, and support in caring for psychiatric patients and patients exhibiting behavioral emergencies. A BERT was piloted on one MS unit for 5 months and expanded to two additional units for 3 months. Pre- and postimplementation staff surveys were conducted, and the number of staff assaults and injuries, restraint usage, and security intervention were compared. The BERT responded to 17 behavioral emergencies. The number of assaults decreased from 10 (pre) to 1 (post); security intervention decreased from 14 to 1; and restraint use decreased from 8 to 1. MS staffs' level of BERT knowledge and rating of support between MH staff and their staff significantly increased. Both MS and MH nurses rated the BERT as supportive and effective. A BERT can assist with deescalating behavioral emergencies, and improve staff collaboration and patient and staff safety.

An Examination of Inmate Physical Assaults on Jail Correctional Staff: Exploring Inmate-Level and Jail-Level Conditions in the United States

ABSTRACTThe current study examines individual-level determinants of inmate-on correctional staff assaults, particularly the demographic characteristics of inmates, and the context of structural/environmental characteristics of specific jails. Findings from a series of negative binomial regression models indicate some significant relationships, with additional analyses highlighting the nonlinear nature of the relationship between racial representation and assaults. The findings give credence to both the “lone-wolf” and “gang mentality” perspectives, in that jails with an unbalanced racial composition have higher rates of inmate assaults on correctional staff when groups are both under- and over-represented as a proportion of the jail population.

Fall in staff assaults is recorded but acute care attacks on the rise.

The number of reported physical assaults against all NHS staff in England in 2014/15 has fallen slightly on the previous year - down from 68,683 in 2013/14 to 67,864.

Prevalence of physical violence in a forensic psychiatric hospital system during 2011-2013: Patient assaults, staff assaults, and repeatedly violent patients.

Introduction We examined physical violence in a large, multihospital state psychiatric system during 2011-2013, and associated demographic and clinical characteristics of violent patients to better understand issues of patient and staff safety. Acts of physical violence committed by patients against other patients (n=10,958) or against staff (n=8429) during 2011-2013 were collected and analyzed for all hospitalized patients during the same time period to derive prevalence rates and associated odds ratios. Overall, 31.4% of patients committed at least 1 violent assault during their hospitalization. Differential risk factor patterns were noted across patient and staff assault. Younger age was associated with a higher prevalence of both patient and staff assault, as was nonforensic legal status. Females had a higher prevalence of staff assault than patient assault. Ethnic groups varied on rates of patient assault, but had no significant differences for staff assault. Schizoaffective disorder was associated with higher prevalence and odds of patient (OR 1.244, 95% CI 1.131 to 1.370) and staff (OR 1.346, 95% CI 1.202 to 1.507) assault when compared to patients diagnosed with schizophrenia. Most personality disorder diagnoses also had a higher prevalence and odds of physical violence. One percent of patients accounted for 28.7% of all assaults. Additionally, violent patients had a significantly longer length of hospitalization. Discussion Implications of these findings to enhance patient safety and inform future violence reduction efforts, including the need for new treatments in conjunction with the use of violence risk assessments, are discussed.

The late‐modern American jail: epistemologies of space and violence

One of the most troubling aspects of current trends in American mass incarceration is the extent to which ‘criminality’ is produced within prison walls, primarily in the form of inmate–inmate or inmate–staff assaults. Most methods of prison or jail control have the adverse, and perverse, effect of increasing inmates' levels of fear, terror, and ultimately violence – with stabbings, beatings, and other types of assaults common occurrences. The design of podular ‘direct supervision’ jails and their accompanying philosophies of punishment aspire to change these conditions. Direct supervision features correctional officers inside each housing unit with no physical barriers impeding supervision, and is intended to create a safe, more humane, stress‐free environment for both inmates and staff. This study draws on ethnographic evidence of inmate experiences with direct supervision at Douglas County Department of Corrections in Omaha, Nebraska (USA). The respondents generally do feel safe in this jail environment, for a combination of reasons, some of which are related to spatial design. Inmates identified a number of implications – gains and losses – of this more ‘humane’ form of incarceration in terms of power and empowerment. The study also documents the potential for inmate activism on their own behalf through this design.

Retrospective review of trends in assaults and seclusion at an acute psychiatric ward over a 5-year period

In developing countries such as South Africa, not much is known about the prevalence of assaults and seclusion occurring in mental health wards over time. Here, we describe a 5-year trend in assaults and seclusions, stratified by gender, at Stikland Hospital, South Africa. A retrospective review of clinical records of patients admitted to the acute psychiatric admission wards at Stikland and involved in assault and secluded was undertaken between 1 January 2005 and 31 December 2010. Data on the number of patient and staff assaults as well as seclusions, gender, age, marital status, level of education, level of income, duration of hospital admission and primary psychiatric diagnosis were collected. Significantly (P < 0.01) more men than women engaged in patient assaults, while significantly (P < 0.01) more men were secluded than women. On a monthly basis, the number of gender-stratified patient assaults and seclusions significantly increased (P < 0.01) throughout the study period. In conclusion, we show here that gender had a significant effect on both patient assault and seclusion numbers, which increased towards the end of the study period. Monitoring of these events is therefore important to continuously improve quality of care.

Serious assaults on prison staff: A descriptive analysis

Objective The current study sought to illuminate the patterns associated with serious inmate-on-staff assaults, as well as the characteristics of perpetrators and victims. Material and methods This study examined 79 assaults on prison staff requiring more than first aid treatment, perpetrated by 96 inmates, in a large state correctional department during a 14-month period (September 1, 2007 through October 31, 2008). Results These assaults were both infrequent (53 per 100,000 inmates annually) and progressively more infrequent as the severity increased (hospitalization for non-life threatening injury or required reconstructive surgery = 2.2 per 100,000 inmates annually; hospitalization for life-threatening injury = 0.5 per 100,000 inmates annually). Among staff victims, Black and female correctional officers were underrepresented. Inmate perpetrators who were younger, Black, prison gang members, and/or serving sentences for violent offenses were disproportionately represented among assailants. Conclusions The low overall rate of serious staff assaults attests to the level of professionalism and training in modern corrections departments. Nonetheless, situational factors uncovered in the current analysis suggest that particular circumstances increase the likelihood of staff assaults, hence the need for continued training and vigilance on the part of correctional staff that come in direct contact with inmates.

Angry Inmates Are Violent Inmates: A Poisson Regression Approach to Youthful Offenders

The importation model of inmate behavior posits that pre-confinement characteristics and behaviors contribute to inmate misconduct; however most of this research has centered on criminal history and not psychosocial characteristics that might predict misconduct, namely anger. Controlling for 14 confounds, including psychiatric symptoms, age, race, gender, commitment offense type, and four measures of prior delinquency, anger significantly predicted sexual misconduct, staff assaults, and aggressive misconduct and approached significance in predicting ward assaults. ROC-AUC analyses indicated that the MASYI-2 angry-irritable scale had significant but modest classification power, with sensitivities ranging from .58 to .66. Suggestions for future research are provided.

Patient receives indefinite custody for staff assaults

Patient receives indefinite custody for staff assaults

Better reporting of staff assaults

Better reporting of staff assaults