Violence In Psychiatric Settings Research Articles

Assessment of Psychological Consequences of Violence in Psychiatric Nurses.

Workplace violence, particularly within psychiatric nursing environments, is an emerging concern globally and has been recognized as a significant occupational stressor with considerable psychological consequences, yet it remains underexplored, warranting an in-depth study. This study aimed to assess the psychological consequences of violence on psychiatric nurses in Jeddah, Saudi Arabia. A descriptive, cross-sectional design was used. A convenience sampling technique was used to select 198 psychiatric nurses working in two hospitals with psychiatric departments in Jeddah. A self-administered questionnaire and the Impact of Event Scale - Revised (IES-R) were used for data collection. Data were analyzed using SPSS Statistics version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.). Out of the 198 psychiatric nurses who participated in the study, 80.8% reported experiencing violence in their workplace, highlighting the need for effective interventions to prevent and manage violence in psychiatric settings. The majority of the participants had a diploma (68.2%), and 54.5% of the nurses had more than 10 years of experience. Among patient-related factors related to violence, drug abuse had the highest mean score of 4.07 (SD=0.89) and was ranked as the most significant factor, while among nursing-related factors, a lower level of experience in psychiatric care had the lowest mean score of 3.43 (SD=1.11) and was ranked as the least important factor. The nurses tended to avoid discussing the traumatic event, as indicated by the highest mean score of 2.10 (SD=1.18) for item 22, "I tried not to talk about it." The mean score for the avoidance subscale of the IES-R was 1.55 (SD=0.78), the highest mean score among the subscales and ranked first in terms of severity. This study highlighted the significant psychological consequences of violence on psychiatric nurses in Jeddah, Saudi Arabia.

Violence Prevention Climate Scale: Translation, Adaptation, and Psychometric Assessment of the French Canadian Version

Introduction: Violence in psychiatric settings has negative consequences on patients, staff, and the institution alike. Efforts to prevent violence cannot currently be assessed due to a lack of suitable indicators. The Violence Prevention Climate Scale (VPC-14) is a validated tool that can be filled out by both staff and patients to assess the violence prevention climate in mental health care units. Objective: This study aimed to conduct the translation and adaptation of the VPC-14 to a French Canadian context, and to assess its psychometric properties in general and forensic psychiatric settings. Methods: This study followed a transcultural approach for validating measuring instruments. Psychometric properties were assessed in 308 patients and staff from 4 mental health and forensic hospitals in Quebec (Canada). Content validity was assessed using a bilingual participant approach. Internal validity was examined through exploratory factor analysis and internal consistency for each care setting using Cronbach’s alpha coefficient analysis. Results: The Échelle modifiée du climat de prévention de la violence [Modified Violence Prevention Climate Scale] (VPC-M-FR) consists of 23 items with a 3-factor structure: 1) staff action, 2) patient action, and 3) the therapeutic environment. Cronbach’s alphas ranging from 0.69 to 0.89 were obtained for the internal consistency of the scale. Discussion and conclusion: The VPC-M-FR has satisfactory psychometric properties for measuring the violence prevention climate in mental health and forensic settings. By measuring the violence prevention climate from the standpoint of patients and staff, targeted preventive measures can be implemented to improve safety for all.

A qualitative study on the consequences of workplace violence in psychiatric settings

Abstract Background Violence against health care workers in psychiatric settings presents worrying data in the literature. Violence effects for healthcare professionals and organizations are absence from work for injury or illness, decreased job satisfaction and lower quality of work. The aim of the study was to identify the consequences of violence on health, work habits and performance of nurses who work with psychiatric patients. Methods The study was carried out by using a semi-structured interview with 12 nurses from different hospital and territorial psychiatric settings in Southern Italy. The interviews were conducted from July to October 2020 by telephone and recorded with the consent of the participants. The collected data were transcribed and analyzed. Results The data show that 91.7% of the interviewees were assaulted by patients. Eight nurses (66.7%) were aggressed several times and six (50%) suffered physical violence. The narratives revealed that patients mainly suffered from drug addiction and that half of them were on pharmacological treatment. Nurses reported feelings of anger, helplessness, fear and frustration; five nurses experienced health consequences, including low mood, anxiety, stress and nervousness. Some of them described pain from physical injuries and permanent effects caused by the assault. An attacked nurse has been absent from work for injury. The aggressions resulted in a change of nurses' work habits and performances; they were more careful after the aggression and modified their approach to the patient. Some of them developed skills and strategies to protect themselves and avoid aggression, others developed greater faith in the efficacy of the prescribed drug. However, the events also caused job dissatisfaction. Conclusions Aggression has a negative impact on nurses' health and work performance. Healthcare organizations should take into account the self-protection strategies identified by professionals and support them to prevent violence. Key messages Violence at work compromises nurses' health and work performance in psychiatric settings. Safer work settings could improve nurses' job satisfaction and the quality of patient care.

Violence in Psychiatric Settings: Demographic and Clinical Characteristics of Patients Who Were Targets of Aggression.

Violence is a serious concern in the psychiatric inpatient and emergency setting. Much of the research on victims of inpatient violence has focused on identifying and supporting staff who are at risk of being victimized when working in psychiatric settings. This article presents an analysis of 72 patients who were targeted during incidents of patient-on-patient physical aggression in hospital-based psychiatric settings (both inpatient and emergency) from 2014 to 2018. Results suggest that patients who are at risk of being targeted by another patient while in the hospital tend to be younger, are more likely to be male, and present with manic symptoms and recent cannabis use. These variables have all been identified as risk factors for perpetration of violence by patients with mental illness. This study adds to a literature demonstrating a consistent overlap between individuals with mental illness who are victimized and those who initiate violence.

Care Providers Experience of Violence in Psychiatric Setting

Nurses working in psychiatric setting experience violence from patients. This semi-structured interview explored psychiatric nurses’ experience of patient violence in psychiatric setting. Data collected from 90 nurses working in 8 hospitals of DK and Udupi Districts of Karnataka. Data was collected using a 24 item semi-structured interview guided questions. Descriptive statistics was used for analysis. The result showed that 84% of the nurses experienced verbal violence and 58% of the nurses experienced physical assault from patients. The study concludes that aggression management and violence prevention training program must be organized for nurses working in psychiatric setting.

Implementing an ecological approach to violence reduction at a forensic psychiatric hospital: approaches and lessons learned.

Existing literature on aggression within psychiatric hospitals suggests that treating an aggressive patient's symptoms could be complemented by (a) milieu environments that mitigate violence and (b) hospital-wide policies and procedures that focus on creating a safe environment. Described as an ecological approach, examples of how this broader, situational approach can reduce inpatient violence in psychiatric settings are provided throughout. The authors identify potential barriers to focusing on wards and institutional rules as well as patient treatment. Last, details of how this ecological approach has been implemented at one state hospital in California are provided.

Organizational model of ensuring safety and quality of treatment of aggressive psychiatric patients in mental health nursing in Slovenia

Introduction: The paper presents the organizational measures for managing violence in psychiatric settings and the study that introduces the preliminary success rate of the proposed model. 
 Methods: For the purpose of this study a non-experimental sampling method was employed using a structured questionnaire as a data collection instrument. The sample covered the personnel most frequently exposed to violence namely, the nursing staff in closed and/or intensive psychiatric units in 5 Slovenian psychiatric hospitals, 3 psychiatric homes and 2 special education, and work and care centres. The data were statistically analysed with the SPSS v20 software package, with p < 0.05 indicating statistical significance. 
 Results: The practical part of the functional training was conducted between 2010 and 2013 in specific psychiatric hospitals and wards. In a study carried out in 2013, preliminary results indicating the success rate of the proposed model were obtained. 
 Discussion and conclusions: Health care workers in psychiatry are responsible for providing safe and high quality treatment even in cases of aggressive outbursts, but they lack the necessary functional knowledge to cope with aggression in the workplace. The paper presents an organizational model for ensuring the safety of the patients and the quality of their treatment in case of an aggressive outburst, along with the presentation of the required functional training.

Routine enquiry for domestic violence is not enough

on theprevalence of domestic violence and acceptability of clinicalenquiry about abuse among female psychiatric patients. Thisstudy is highly topical, as our own review of the academicliterature identified a dearth of research on prevalence ofdomestic violence in psychiatric settings and low rates of staffdetection in routine clinical practice, particularly in the UK.

Predictors of violent behavior among acute psychiatric patients: Clinical study

Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated. Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

An analysis of nurses’ post‐incident manual restraint reports

Manual restraint techniques are associated with the management of violence in psychiatric settings. Restraint effectiveness and acceptability are under scrutiny, yet the nature and frequency of who or what were involved in restraint episodes have not previously been fully described or understood. The aim of this study was to describe the nature and frequency of manual restraint-related events and their components. This study was carried out using content analyses of nurses' post-incident reports from a psychiatric unit situated within a general hospital, and from its associated medium-secure unit. Requests for restraint occurred at the rate of about once per day, and the majority related to patients' ill-directed frustration, resistance to containment and their desire to leave the ward. Only half of responses to conflicts resulted in restraint implementation. The majority of restraint activities occurred during the afternoon and night. Male patients and detained patients were more frequent participants in restraint interventions. To a lesser extent, police, ambulance, fire services, hospital security, visitors and ex-patients were also involved in restraint episodes. Injuries were rare. In conclusion, training in restraint skills, clinical audit of adverse incidents, and research into psychiatric aggression all need to take into account the association of restraint with the enforcement of detention and treatment of acutely ill patients. The coupling of restraint with medication requires examination of its safety and efficacy. Interagency training may enable the essential services involved to coordinate restraint activities more effectively.

ARTICLE

This article reports on an exploratory study that attempted to identify aspects of the care organization that may affect the violent behaviour of clients. Having noted that violence in psychiatric settings is a significant problem, the authors pointed out that there was a dearth of literature that examined the influence of the organization in relation to violent client behaviour.

A Two-Factor Model of Aggression

This article synthesizes theoretical material from psychology research into a practical model for conceptualizing violence in psychiatric settings. Relevant research and theory are reviewed, focusing on two important behavioral models of aggressive behavior, hostile aggression and instrumental aggression. The concepts of reinforcement, anticipated rewards, specific and nonspecific stimulus-driven aggression, intermediary emotional states in aroused persons, and the aggression stimulus threshold are developed into a bimodal model applicable to the clinical management of violence. The model provides a broad framework for categorizing, understanding, and addressing aggressive behavior in clinical settings.

The CQI/TQM Journey in France

In France interest in continuous quality improvement (CQI) and other quality improvement (QI) approaches is recent and experience modest, but the pace of change should quicken now that the government has required that all hospitals be accredited within the next five years. In addition, in the face of increasing competition, hospitals, public and private, may find a quality strategy to be critical in helping them survive. In fall 1994 the National Agency for the Promotion of Medical Evaluation (ANDEM) was mandated by the Ministry of Health to set up a national demonstration project based on quality assurance and CQI methodologies. The program was designed to identify the key success factors for implementing such programs within hospitals. The program involves 28 18-month CQI projects, which deal with prevention of nosocomial infection, patient safety in anesthesia, medical records, blood transfusion safety, drug dispensing safety, and control of violence in psychiatric settings. Participating hospitals are required to analyze the variation in the involved processes and attempt to reduce variation through cross-departmental quality management programs. The general method for each team's management of the project closely follows the PDCA (Plan-Do-Check-Act) cycle. Preliminary experience suggests that the participating hospitals have benefited from following the same model and sharing of accounts of their progress. Representatives of the 28 teams met in fall 1995 and June 1996, and future meetings are planned. Most of the teams have collected quantitative data about the current processes and have started to pilot test process changes.

The evolution of a concept: Aggression and violence in psychiatric settings

In a series of studies examining aggression and violence by persons with a mental illness, a coercive interactional style emerged as an important predictive variable in hospital settings. This interactive style addresses one issue noted in the literature, the relative effect of personal versus environmental variables, by describing how violent individuals interact with their environment in purposeful ways. The findings from three specific studies are summaized to describe how this interactive style was identified, quantified and documented as a predictor of aggression and violence. It is hoped that this synthesis of research findings will facilitate the application of research to practice settings.

Toward a better understanding of violence in psychiatric settings: Debunking the myths

Because of the risk of dealing with violent patients on a daily basis, psychiatric clinicians must keep abreast of new developments in the field and alter their practice accordingly. However, belief in outdated theories results in the continuation of some traditional practices that are minimally effective for decreasing violence. Five myths about violence are identified and alternatives offered to clinicians interested in changing their approach. The five myths are: (1) the violent person is out of control, (2) the use of a punching bag decreases violence, (3) staff doing a good job means controlling patients, (4) unconscious staff conflicts result in aggression and violence by patients, and (5) the fearful clinician is most often assaulted.

A coercive interactional style as an antecedent to aggression in psychiatric patients.

As with society at large, violence in psychiatric settings is a serious clinical problem. Despite a great deal of attention, however, very little is currently known about the underlying theory or interventions to reduce aggression and violence in hospital settings. In this study, some psychiatric patients were viewed as having a general, aggressive, interactional style, motivated by the traits of Intimidation and Interpersonal Control, which when combined were labeled Coercion. A causal model in which violence and aggression were hypothesized to be predicted by a coercive interpersonal style and negatively predicted by an accommodating interpersonal style was tested. These interpersonal styles were proposed to mediate antecedent variables, that is, history of violence, psychiatric diagnoses, and length of hospitalization. Data were collected in two hospitals on psychiatric patients (N = 156) and analyzed using multiple regression techniques. The results of theoretical model testing suggested that 60% of the variance in Aggression was explained by four model variables: (a) Intimidation and Interpersonal Control (Coercion) (beta = .44), (b) Length of Hospitalization (beta = .26), (c) History of Violence (beta = .27), and (d) Bipolar Affective Syndrome (beta = .21). The implications for clinical care are discussed.

Family violence reported in a psychiatric emergency room

The prevalence of family violence reported in psychiatric emergency rooms is relatively undocumented, despite the clinical and legal concern for dangerousness. This study assesses the prevalence of aggression incidents reported to clinicians and physicians during evaluation interviews (n =389).Two-thirds of the total number of subjects reported being involved in an “aggression” incident sometime in their past. Only 8% reported being the victim of such incidents. About one-half of the cases involved physical assaults; nearly one-half of these assaults had family members as victims. One third of the total cases had been assaultive within 3 months; one sixth had been assaultive within 2 weeks of visiting the hospital. Clinicians and researchers are urged to consider more systematically family violence in psychiatric settings.