1
|
Rodwell D, Frith H. 'A ward full of emotional, aggressive people': Social climate and interpersonal relationships in forensic settings caring for patients with borderline personality disorder. Int J Ment Health Nurs 2024; 33:1049-1061. [PMID: 38400517 DOI: 10.1111/inm.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/04/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Abstract
Therapeutic relationships play a central role in maintaining a positive social climate in forensic settings. The interpersonal difficulties characteristic of Borderline Personality Disorder, alongside the secure environment of forensic wards, can make developing positive therapeutic relationships with this patient group challenging. Qualitative interviews aimed to explore how ward staff understand and experience the interaction of interpersonal relationships and social climate when caring for patients with Borderline Personality Disorder on forensic wards. Interviews with 11 staff members working across UK forensic inpatient settings were analysed using Reflexive Thematic Analysis and reported following COREQ guidelines. Six interrelated themes were generated; three describe relational cycles that occur between ward staff and patients with Borderline Personality Disorder and three describe systemic factors that influence the context in which ward staff operate. From these themes, an integrative model was developed to summarise how factors in the wider forensic system and the interpersonal relationships between staff and patients with Borderline Personality Disorder in forensic wards influence one another, affecting staff experiences of the social climate of forensic settings. The model illustrates how complex cycles within the therapeutic relationships with staff and patients with Borderline Personality Disorder can interact with systemic influences in the wider forensic context to influence staff experiences of forensic settings. Clinical implications of the model are discussed, offering recommendations for improving therapeutic relationships and the social climate on forensic wards caring for patients with Borderline Personality Disorder, to better support staff and patient wellbeing.
Collapse
Affiliation(s)
- Devon Rodwell
- School of Psychology, University of Surrey, Guildford, UK
| | - Hannah Frith
- School of Psychology, University of Surrey, Guildford, UK
| |
Collapse
|
2
|
Degrauwe S, Dierckx K, Van Bulck V, Gouwy MC, Verbeke L, Vergauwe J, De Clercq B. Good-enough Care? How Patients' Perceptions of Counselors' Professional Skills Relate to Everyday Life in Forensic Long-stay Units. J Psychiatr Pract 2024; 30:284-291. [PMID: 39058528 DOI: 10.1097/pra.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
The overall goal of long-term forensic care is to strive toward acceptable levels of adaptation and quality of life (QoL) of the forensic patient in the institutional context. While the bulk of the literature has focused on the deleterious consequences of personality pathology in this regard, research investigating the contribution of the quality of the therapeutic relationship has remained rather scant. Assuming that the perceived competence of the direct counselor, as perceived by patients, forms an important aspect in this regard, the central aim of this study was to investigate the relationship between patients' perceptions of their therapist's professional skills, their self-reported maladaptive behavior on the ward, and their experienced QoL. To this end, we recruited patients (N = 60) in long-stay forensic units and investigated their perceptions of 10 specific skills displayed by their therapist, along a "too little-too much" rating scale. The results revealed that patients who had the overall impression that their counselor was equipped with an adequate set of professional skills showed less maladaptive behavior and perceived a higher QoL on the ward. Conversely, at a more specific competence level, only a positive relationship between a counselor's predictability and self-reported QoL was found. Taken together, these results highlight that an overall professional skill evaluation matters in the context of forensic patients' adaptation and QoL in their long-stay units, with the counselor's predictability serving as a crucial aspect in obtaining the most favorable outcomes.
Collapse
Affiliation(s)
| | - Kim Dierckx
- Ghent University, Faculty of Psychological and Educational Sciences, Department of Developmental, Personality, and Social Psychology, Belgium
| | | | - Marie-Céline Gouwy
- Ghent University, Faculty of Psychological and Educational Sciences, Department of Developmental, Personality, and Social Psychology, Belgium
| | - Lize Verbeke
- Ghent University, Faculty of Psychological and Educational Sciences, Department of Developmental, Personality, and Social Psychology, Belgium
| | - Jasmine Vergauwe
- Vrije Universiteit Brussels, Faculty of Psychology, Department of Work and Organizational Psychology, Belgium
| | - Barbara De Clercq
- Ghent University, Faculty of Psychological and Educational Sciences, Department of Developmental, Personality, and Social Psychology, Belgium
| |
Collapse
|
3
|
Grigorovich A, Kontos P, Popovic MR. Rehabilitation professionals' perspectives and experiences with the use of technologies for violence prevention: a qualitative study. BMC Health Serv Res 2023; 23:899. [PMID: 37612649 PMCID: PMC10464386 DOI: 10.1186/s12913-023-09789-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/05/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND There is growing public policy and research interest in the development and use of various technologies for managing violence in healthcare settings to protect the health and well-being of patients and workers. However, little research exists on the impact of technologies on violence prevention, and in particular in the context of rehabilitation settings. Our study addresses this gap by exploring the perceptions and experiences of rehabilitation professionals regarding how technologies are used (or not) for violence prevention, and their perceptions regarding their efficacy and impact. METHODS This was a descriptive qualitative study with 10 diverse professionals (e.g., physical therapy, occupational therapy, recreation therapy, nursing) who worked across inpatient and outpatient settings in one rehabilitation hospital. Data collection consisted of semi-structured interviews with all participants. A conventional approach to content analysis was used to identify key themes. RESULTS We found that participants used three types of technologies for violence prevention: an electronic patient flagging system, fixed and portable emergency alarms, and cameras. All of these were perceived by participants as being largely ineffective for violence prevention due to poor design features, malfunction, limited resources, and incompatibility with the culture of care. Our analysis further suggests that professionals' perception that these technologies would not prevent violence may be linked to their focus on individual patients, with a corresponding lack of attention to structural factors, including the culture of care and the organizational and physical environment. CONCLUSIONS Our findings suggest an urgent need for greater consideration of structural factors in efforts to develop effective interventions for violence prevention in rehabilitation settings, including the design and implementation of new technologies.
Collapse
Affiliation(s)
- Alisa Grigorovich
- Recreation and Leisure Studies, Brock University, St Catharines, Canada.
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.
| | - Pia Kontos
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Milos R Popovic
- KITE Research Institute, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
- Institute of Biomedical Engineering, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
4
|
Hu YH, Hung JH, Hu LY, Huang SY, Shen CC. An analysis of Chinese nursing electronic medical records to predict violence in psychiatric inpatients using text mining and machine learning techniques. PLoS One 2023; 18:e0286347. [PMID: 37285344 DOI: 10.1371/journal.pone.0286347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 05/14/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND The prevalence of violence in acute psychiatric wards is a critical concern. According to a meta-analysis investigating violence in psychiatric inpatient units, researchers estimated that approximately 17% of inpatients commit one or more acts of violence during their stay. Inpatient violence negatively affects health-care providers and patients and may contribute to high staff turnover. Therefore, predicting which psychiatric inpatients will commit violence is of considerable clinical significance. OBJECTIVE The present study aimed to estimate the violence rate for psychiatric inpatients and establish a predictive model for violence in psychiatric inpatients. METHODS We collected the structured and unstructured data from Chinese nursing electronic medical records (EMRs) for the violence prediction. The data was obtained from the psychiatry department of a regional hospital in southern Taiwan, covering the period between January 2008 and December 2018. Several text mining and machine learning techniques were employed to analyze the data. RESULTS The results demonstrated that the rate of violence in psychiatric inpatients is 19.7%. The patients with violence in psychiatric wards were generally younger, had a more violent history, and were more likely to be unmarried. Furthermore, our study supported the feasibility of predicting aggressive incidents in psychiatric wards by using nursing EMRs and the proposed method can be incorporated into routine clinical practice to enable early prediction of inpatient violence. CONCLUSIONS Our findings may provide clinicians with a new basis for judgment of the risk of violence in psychiatric wards.
Collapse
Affiliation(s)
- Ya-Han Hu
- Department of Information Management, National Central University, Taoyuan City, Taiwan
- Asian Institute for Impact Measurement and Management, National Central University, Taoyuan City, Taiwan
| | - Jeng-Hsiu Hung
- Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
- School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Li-Yu Hu
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Sheng-Yun Huang
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
| | - Cheng-Che Shen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Psychiatry, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
- Center for Innovative Research on Aging Society (CIRAS), National Chung Cheng University, Minxiong, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| |
Collapse
|
5
|
Hammarström L, Andreassen Devik S, Häggström M, Hellzen O. Meanings of carers' lived experience of "regulating oneself" in forensic psychiatry. Int J Qual Stud Health Well-being 2022; 17:2094088. [PMID: 35762066 PMCID: PMC9310649 DOI: 10.1080/17482631.2022.2094088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study aimed to illuminate the essential meanings of carers' lived experience of regulating themselves when caring for patients with mental illnesses in forensic inpatient care. METHODS Qualitative analysis was used to analyse data from narrative interviews with open-ended questions conducted with nine carers, which were analysed using a phenomenological-hermeneutic approach. RESULTS Findings revealed three themes, "preserving oneself as a carer," "building an alliance with the patient" and "maintaining stability in the community." Carers not only regulated emotions related to patients but also the ward to facilitate a caring climate. For carers, encounters with patients meant facing expressions of suffering that evoked unwanted emotions. Regulating one's emotions also meant being emotionally touched and facing one's vulnerability. CONCLUSION Regulating oneself was a strategy used by carers to get closer to the patient and establishing a trusting relationship. Regulating oneself meant becoming aware of one's shortcomings, not projecting them onto others, which may impair establishing relationships with patients and fulfilling the aim and caring task of forensic psychiatry. This study stresses the importance of carers being guided to manage their conflicting emotions and vulnerabilities and finding courage and an approach that allows a permissive climate of self-reflection.
Collapse
Affiliation(s)
| | | | - Marie Häggström
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Ove Hellzen
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| |
Collapse
|
6
|
Forsman J, Cornish R, Fazel S. Integrating static and modifiable risk factors in violence risk assessment for forensic psychiatric patients: a feasibility study of FoVOx. Nord J Psychiatry 2022; 77:240-246. [PMID: 35697296 PMCID: PMC10108825 DOI: 10.1080/08039488.2022.2084158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Risk assessment is integral to forensic psychiatry. Previous work has highlighted the benefits of using scalable and evidence-based actuarial risk tools developed within forensic populations, such as the online Forensic Psychiatry and Violence Oxford (FoVOx) violence risk assessment tool. We examined the feasibility of using FoVOx in a Swedish forensic cohort and tested whether adding modifiable (dynamic) factors would increase its useability to clinicians. METHODS We completed FoVOx assessments on all patients discharged from forensic psychiatric hospitals in Stockholm County, Sweden, between 2012 and 2017 and investigated recidivism rates. In addition, interviews were conducted with the clinicians responsible for each patient on the perceived accuracy, usefulness, and impact of FoVOx, which was examined using thematic analysis. RESULTS Ninety-five discharges from forensic psychiatric hospitals were followed up. The median FoVOx score was a 7% likelihood of violent reoffending in two years after discharge. Six discharged patients (6%) were confirmed as violent recidivists using official records with a similar distribution of FoVOx risk categories as the rest of the sample. FoVOx was considered accurate by clinicians in more than half of cases, who suggested that modifiable risk factors could be added to increase acceptability. All clinicians thought that FoVOx was useful, and in 20% of discharges, it would have materially altered patient care. Overall, FoVOx was thought to impact decision-making and risk management, was practical to use, and could be completed without reference to written case material. CONCLUSION Completing FoVOx in forensic psychiatric hospitals can complement current approaches to clinical decision-making on violence risk assessment and management.
Collapse
Affiliation(s)
- Jonas Forsman
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Robert Cornish
- The Oxford Clinic, Littlemore Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Seena Fazel
- The Oxford Clinic, Littlemore Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| |
Collapse
|
7
|
Waxell A, Wiklund Gustin L. "Walking Together Towards Freedom." Patients' Lived Experiences of Participation in Outpatient Forensic Care. Issues Ment Health Nurs 2022; 43:455-462. [PMID: 34762558 DOI: 10.1080/01612840.2021.1998262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
There is a general agreement regarding the significance of patient participation in care. In forensic psychiatric care, however, this appears to be troublesome because of the paradoxical nature of having responsibility; to give person-centered, recovery-oriented psychiatric care and to protect society from potentially dangerous individuals. The aim of this study was to describe patients' lived experiences of participation in outpatient forensic psychiatric care. Data were collected by means of individual interviews with five patients. The phenomenological hermeneutical analysis shed light on patient participation as having two dimensions. The outer dimension focuses on participation as "doing" and as a means of developing the understanding and skills necessary for being discharged from forensic care, while the inner dimension is related to "being" and experiences of acceptance and inclusion in communion with other people. This emphasises the importance of supporting patients' experiences of being involved in everyday life together with others, even in periods when patients' possibilities to affect decisions regarding their care are limited.
Collapse
Affiliation(s)
- Anni Waxell
- Division of Psychiatry, Region Vastmanland, Västerås, Sweden
| | - Lena Wiklund Gustin
- School of Health, Care and Social Welfare, Mälardalen University Sweden, Västerås, Sweden.,Department of Health and Care Sciences, UiT/The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
8
|
Fletcher A, Crowe M, Manuel J, Foulds J. Comparison of patients' and staff's perspectives on the causes of violence and aggression in psychiatric inpatient settings: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:924-939. [PMID: 33837640 DOI: 10.1111/jpm.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.
Collapse
Affiliation(s)
- Alice Fletcher
- Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, Vic., Australia
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
9
|
Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
Collapse
Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| |
Collapse
|
10
|
Fernandes H, Brandão MB, Castilho-Júnior RAD, Hino P, Ohara CVDS. The care for the persistent family aggressor in the perception of nursing students. Rev Lat Am Enfermagem 2020; 28:e3287. [PMID: 32901763 PMCID: PMC7478885 DOI: 10.1590/1518-8345.3991.3287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/08/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to analyze the perception of nursing students about the care given to the persistent family aggressor. METHOD a descriptive study, with a qualitative approach. Madeleine Leininger's Theory of Diversity and Universality of Care was used as a theoretical reference. The data collection took place with 37 in the last year of at a public university in Southeast Brazil. We used the technique of Projective Design with a Topic and semi-structured interview. The data were analyzed with the content analysis. RESULTS the examination of the narratives underpinned the construction of four categories: The care of the aggressor with the family, Recognition of family values and culture, The search for knowledge to care for the aggressor and family, Multidisciplinary and intersectoral care to confront violence. CONCLUSION there is an acknowledgment that the care for the aggressor should not only be individual but should involve all those affected. For this, multidisciplinary work is important, and the search for knowledge on the subject is essential for culturally significant care.
Collapse
Affiliation(s)
- Hugo Fernandes
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | - Maykon Brito Brandão
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | - Roberto Alvarenga de Castilho-Júnior
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil.,Scholarship holder at the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil
| | - Paula Hino
- Universidade Federal de São Paulo, Escola Paulista de Enfermagem, São Paulo, SP, Brazil
| | | |
Collapse
|
11
|
Urheim R, Palmstierna T, Rypdal K, Gjestad R, Senneseth M, Mykletun A. Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward. BMC Psychiatry 2020; 20:200. [PMID: 32370794 PMCID: PMC7201664 DOI: 10.1186/s12888-020-02524-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patients' perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward. METHODS During a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents. RESULTS A substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward. CONCLUSIONS Findings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.
Collapse
Affiliation(s)
- Ragnar Urheim
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Tom Palmstierna
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway ,grid.4714.60000 0004 1937 0626Social and Forensic Psychiatry Program, Stockholm Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Knut Rypdal
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Rolf Gjestad
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Mette Senneseth
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway. .,Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway.
| |
Collapse
|
12
|
Marklund L, Wahlroos T, Looi GME, Gabrielsson S. 'I know what I need to recover': Patients' experiences and perceptions of forensic psychiatric inpatient care. Int J Ment Health Nurs 2020; 29:235-243. [PMID: 31642598 DOI: 10.1111/inm.12667] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/25/2019] [Accepted: 09/30/2019] [Indexed: 01/10/2023]
Abstract
Patients find forensic psychiatric care inadequate in that they are not treated as individuals and not involved in their own care. The purpose of this study was to describe patients' experiences and perceptions of forensic psychiatric inpatient care. Semi-structured interviews were conducted with 11 inpatients. A qualitative content analysis resulted in a recurring theme, 'I know what I need to recover', and three main categories: 'A need for meaning in a meagre existence', 'A need to be a person in an impersonal context', and 'A need for empowerment in a restricted life'. Participants experienced and perceived forensic care as predominantly monotonous, predetermined, and not adapted to them as individuals, forcing them to fight and adapt to get through it and not lose themselves. Perceived needs were largely ignored or opposed by staff due to the content and structure of care. Findings suggest a need for reflective practices and patient involvement in order to develop and maintain a person-centred and recovery-oriented nursing practice. The study adds to previous research showing the importance of patients in forensic psychiatric inpatient care being listened to and involved in their care. The study is reported in accordance with the COREQ guidelines.
Collapse
Affiliation(s)
- Lisa Marklund
- Department of Forensic Psychiatric Care, Region Norrbotten, Piteå, Sweden
| | - Terese Wahlroos
- Department of Forensic Psychiatric Care, Region Norrbotten, Piteå, Sweden
| | | | | |
Collapse
|
13
|
Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
Collapse
Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| |
Collapse
|
14
|
Rodrigues RAP, Silva LM, Seredynskyj FL, Fhon JRS, Bolina AF, Miyamura K, Kobayasi DY. Analysis of violence against older adults in police reports. Arch Psychiatr Nurs 2019; 33:407-413. [PMID: 31280787 DOI: 10.1016/j.apnu.2019.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/25/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze a historical series of cases of elder abuse as described in police reports. METHOD Descriptive, retrospective and documentary study based on police reports issued at the older adult police department whose information was collected through an instrument developed by the researchers. RESULTS Five categories were identified: 1 - physical violence; 2 - violence report; 3 - psychological violence; 4 - habits related to psychoactive substance use; 5 - reasons for violence. CONCLUSION Elder abuse is a complex issue that requires intervention on the part of nurses by the report of incidents and provision of support to the victim.
Collapse
Affiliation(s)
| | | | - Fernanda Laporti Seredynskyj
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil
| | - Jack Roberto Silva Fhon
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil
| | - Alisson Fernandes Bolina
- School of Health Sciences, University of Brasília, Darcy Ribeiro University Campus, Brasilia, Federal District, Brazil
| | - Karen Miyamura
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil
| | - Dieyeni Yuki Kobayasi
- University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, Brazil
| |
Collapse
|
15
|
Akther SF, Molyneaux E, Stuart R, Johnson S, Simpson A, Oram S. Patients' experiences of assessment and detention under mental health legislation: systematic review and qualitative meta-synthesis. BJPsych Open 2019; 5:e37. [PMID: 31530313 PMCID: PMC6520528 DOI: 10.1192/bjo.2019.19] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Understanding patient experiences of detention under mental health legislation is crucial to efforts to reform policy and practice. AIMS To synthesise qualitative evidence on patients' experiences of assessment and detention under mental health legislation. METHOD Five bibliographic databases were searched, supplemented by reference list screening and citation tracking. Studies were included if they reported on patient experiences of assessment or detention under mental health legislation; reported on patients aged 18 years or older; collected data using qualitative methods; and were reported in peer-reviewed journals. Findings were analysed and synthesised using thematic synthesis. RESULTS The review included 56 papers. Themes were generally consistent across studies and related to information and involvement in care, the environment and relationships with staff, as well as the impact of detention on feelings of self-worth and emotional state. The emotional impact of detention and views of its appropriateness varied, but a frequent theme was fear and distress during detention, including in relation to the use of force and restraint. Where staff were perceived as striving to form caring and collaborative relationships with patients despite the coercive nature of treatment, and when clear information was delivered, the negative impact of involuntary care seemed to be reduced. CONCLUSIONS Findings suggest that involuntary in-patient care is often frightening and distressing, but certain factors were identified that can help reduce negative experiences. Coproduction models may be fruitful in developing new ways of working on in-patient wards that provide more voice to patients and staff, and physical and social environments that are more conducive to recovery. DECLARATION OF INTEREST None.
Collapse
Affiliation(s)
| | - Emma Molyneaux
- Research Associate and Honorary Lecturer, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Ruth Stuart
- Research Assistant, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Sonia Johnson
- Professor of Social and Community Psychiatry, Division of Psychiatry, Faculty of Brain Sciences, University College London, and Camden and Islington NHS Foundation Trust, UK
| | - Alan Simpson
- Professor of Collaborative Mental Health Nursing, Division of Nursing, School of Health Sciences, City University, UK
| | - Sian Oram
- Lecturer in Women's Mental Health, Health Service & Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| |
Collapse
|
16
|
Pelto-Piri V, Wallsten T, Hylén U, Nikban I, Kjellin L. Feeling safe or unsafe in psychiatric inpatient care, a hospital-based qualitative interview study with inpatients in Sweden. Int J Ment Health Syst 2019; 13:23. [PMID: 30996733 PMCID: PMC6452515 DOI: 10.1186/s13033-019-0282-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background A major challenge in psychiatric inpatient care is to create an environment that promotes patient recovery, patient safety and good working environment for staff. Since guidelines and programs addressing this issue stress the importance of primary prevention in creating safe environments, more insight is needed regarding patient perceptions of feeling safe. The aim of this study is to enhance our understanding of feelings of being safe or unsafe in psychiatric inpatient care. Methods In this qualitative study, interviews with open-ended questions were conducted with 17 adult patients, five women and 12 men, from four settings: one general psychiatric, one psychiatric addiction and two forensic psychiatric clinics. The main question in the interview guide concerned patients' feelings of being safe or unsafe. Thematic content analysis with an inductive approach was used to generate codes and, thereafter, themes and subthemes. Results The main results can be summarized in three themes: (1) Predictable and supportive services are necessary for feeling safe. This concerns the ability of psychiatric and social services to meet the needs of patients. Descriptions of delayed care and unpredictable processes were common. The structured environment was mostly perceived as positive. (2) Communication and taking responsibility enhance safety. This is about daily life in the ward, which was often perceived as being socially poor and boring with non-communicative staff. Participants emphasized that patients have to take responsibility for their actions and for co-patients. (3) Powerlessness and unpleasant encounters undermine safety. This addresses the participants' way of doing risk analyses and handling unpleasant or aggressive patients or staff members. The usual way to act in risk situations was to keep away. Conclusions Our results indicate that creating reliable treatment and care processes, a stimulating social climate in wards, and better staff-patient communication could enhance patient perceptions of feeling safe. It seems to be important that staff provide patients with general information about the safety situation at the ward, without violating individual patients right to confidentiality, and to have an ongoing process that aims to create organizational values promoting safe environments for patients and staff.
Collapse
Affiliation(s)
- Veikko Pelto-Piri
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Tuula Wallsten
- 2Centre for Clinical Research, Uppsala University, County Hospital Västerås, Västerås, Sweden
| | - Ulrika Hylén
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | | | - Lars Kjellin
- 1University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| |
Collapse
|
17
|
Møllerhøj J, Os Stølan L. 'First and foremost a human being…': user perspectives on mental health services from 50 mentally disordered offenders. Nord J Psychiatry 2018; 72:593-598. [PMID: 30261792 DOI: 10.1080/08039488.2018.1502352] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND This is the first study of this kind in a Danish context. Knowledge and research on user perspectives is rather limited in Danish as well as Nordic psychiatry. AIMS The aim of the study was to create new knowledge on patient and user perspectives and how mentally disordered offenders perceive their hopes and expectancies as well as their interactions with staff in mental health services. Furthermore, the aim was to establish what constitutes helpful care and treatment seen from a user perspective, and how the users themselves look at and perceive their sentences and how, according to them, the overall aim to prevent future crime can be fulfilled. METHOD The study is based on 50 semi-structured qualitative research interviews. Main themes and patterns were condensed and synthesized in a qualitative analysis. RESULTS The study has provided useful knowledge of service users' experiences with nursing, treatment and rehabilitation practices. As part of the interviews, patients were asked to contribute with advice on how to improve practices within mental health services. There are remarkable similarities between the answers, and central points were reiterated from interview to interview: The importance of mental health staff acting with respect and empathy in their interaction with patients, improved communication between patients and professionals involved in clinical pathways, responsiveness and shared decision-making when adjusting medical treatment as well as a greater variety of activities offered within inpatient units. CONCLUSION When asked what it is like to be a forensic patient, the informants underline that despite severe mental illness, social marginalization as well as various criminal records they are still, first and foremost, human beings. However, they often feel dehumanized and monstrous.
Collapse
Affiliation(s)
- Jette Møllerhøj
- a Competence Centre for Forensic Psychiatry, Mental Health Centre Sct. Hans, Mental Health Services , Capital Region , Denmark
| | - Liv Os Stølan
- a Competence Centre for Forensic Psychiatry, Mental Health Centre Sct. Hans, Mental Health Services , Capital Region , Denmark
| |
Collapse
|
18
|
Hörberg U. 'The Art of Understanding in Forensic Psychiatric Care' - From a Caring Science Perspective Based on a Lifeworld Approach. Issues Ment Health Nurs 2018; 39:802-809. [PMID: 30273078 DOI: 10.1080/01612840.2018.1496499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Patients in forensic psychiatric clinics are a vulnerable and exposed patient group due to suffering from a severe mental disorder, having committed a crime and being cared for against their will in an institutional environment with a high level of security. The art of understanding in forensic psychiatric care is discussed from a caring science perspective, based on a lifeworld approach. The aim is to contribute knowledge that can support staff, who daily meet patients on forensic psychiatric wards, in applying a caring attitude.
Collapse
Affiliation(s)
- Ulrica Hörberg
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| |
Collapse
|
19
|
Olsson H, Schön UK. Reducing violence in forensic care - how does it resemble the domains of a recovery-oriented care? J Ment Health 2016; 25:506-511. [PMID: 26854519 DOI: 10.3109/09638237.2016.1139075] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Forensic psychiatry is characterized by involuntary treatment and risk of violence. The concept of recovery is rarely in focus as the primary focus is on risk assessment, violence prevention and reducing coercion in care. AIM To determine what resources forensic staff use to avoid or prevent violent situations, and to explore how these practices resemble the domains of recovery-oriented care. METHOD Semi-structured interviews with staff who were identified by forensic patients as key workers in their recovery process. Interview texts were analyzed using interpretive content analysis. RESULTS Staff prevent violent situations using tacit knowledge and experience, and through a shared collegial responsibility. Staff safeguard patients, encourage patient participation, and provide staff consistency. CONCLUSIONS The results have implications for forensic care as well as psychiatry regarding the process of making recovery a reality for patients in the forensic care setting.
Collapse
Affiliation(s)
| | - Ulla-Karin Schön
- b Department of Social Science , School of Education, Health and Social Studies, Dalarna University , Falun , Sweden
| |
Collapse
|