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Foye U, Wilson K, Jepps J, Blease J, Thomas E, McAnuff L, McKenzie S, Barrett K, Underwood L, Brennan G, Simpson A. Exploring the use of body worn cameras in acute mental health wards: a mixed-method evaluation of a pilot intervention. BMC Health Serv Res 2024; 24:681. [PMID: 38812029 PMCID: PMC11138092 DOI: 10.1186/s12913-024-11085-x] [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: 01/03/2024] [Accepted: 05/07/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND Body worn cameras (BWC) are mobile audio and video capture devices that can be secured to clothing allowing the wearer to record some of what they see and hear. This technology is being introduced in a range of healthcare settings as part of larger violence reduction strategies aimed at reducing incidents of aggression and violence on inpatient wards, however limited evidence exists to understand if this technology achieves such goals. AIM This study aimed to evaluate the implementation of BWCs on two inpatient mental health wards, including the impact on incidents, the acceptability to staff and patients, the sustainability of the resource use and ability to manage the use of BWCs on these wards. METHODS The study used a mixed-methods design comparing quantitative measures including ward activity and routinely collected incident data at three time-points before during and after the pilot implementation of BWCs on one acute ward and one psychiatric intensive care unit, alongside pre and post pilot qualitative interviews with patients and staff, analysed using a framework based on the Consolidated Framework for Implementation Research. RESULTS Results showed no clear relationship between the use of BWCs and rates or severity of incidents on either ward, with limited impact of using BWCs on levels of incidents. Qualitative findings noted mixed perceptions about the use of BWCs and highlighted the complexity of implementing such technology as a violence reduction method within a busy healthcare setting Furthermore, the qualitative data collected during this pilot period highlighted the potential systemic and contextual factors such as low staffing that may impact on the incident data presented. CONCLUSION This study sheds light on the complexities of using such BWCs as a tool for 'maximising safety' on mental health settings. The findings suggest that BWCs have a limited impact on levels of incidents on wards, something that is likely to be largely influenced by the process of implementation as well as a range of contextual factors. As a result, it is likely that while BWCs may see successes in one hospital site this is not guaranteed for another site as such factors will have a considerable impact on efficacy, acceptability, and feasibility.
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Affiliation(s)
- Una Foye
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK.
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King's College London, London, UK.
| | - Keiran Wilson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King's College London, London, UK
| | - Jessica Jepps
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King's College London, London, UK
| | - James Blease
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
| | | | | | | | | | | | - Geoff Brennan
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King's College London, London, UK
| | - Alan Simpson
- Mental Health Nursing, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Mental Health Nursing, King's College London, London, UK
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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.
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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
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Rolin SA, Scodes J, Dambreville R, Nossel IR, Bello I, Wall MM, Scott Stroup T, Dixon LB, Appelbaum PS. Feasibility and Utility of Different Approaches to Violence Risk Assessment for Young Adults Receiving Treatment for Early Psychosis. Community Ment Health J 2022; 58:1130-1140. [PMID: 34981276 PMCID: PMC8723812 DOI: 10.1007/s10597-021-00922-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 11/17/2021] [Indexed: 12/24/2022]
Abstract
This pilot study examined violence risk assessment among a sample of young adults receiving treatment for early psychosis. In this study, thirty participants were assessed for violence risk at baseline. Participants completed follow-up assessments at 3, 6, 9 and 12 months to ascertain prevalence of violent behavior. Individuals were on average 24.1 years old (SD = 3.3 years) and predominantly male (n = 24, 80%). In this sample, six people (20%) reported engaging in violence during the study period. Individuals who engaged in violence had higher levels of negative urgency (t(28) = 2.21, p = 0.035) This study sought to establish the feasibility, acceptability, and clinical utility of violence risk assessment for clients in treatment for early psychosis. Overall, this study found that most individuals with early psychosis in this study (who are in treatment) were not at risk of violence. Findings suggest that violent behavior among young adults with early psychosis is associated with increased negative urgency.
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Affiliation(s)
- Stephanie A Rolin
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA.
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA.
| | - Jennifer Scodes
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Renald Dambreville
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Ilana R Nossel
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Iruma Bello
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Melanie M Wall
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - T Scott Stroup
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Lisa B Dixon
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Irving Medical Center, 1051 Riverside Drive, Suite 1300, New York, NY, 10032, USA
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, USA
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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.
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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
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Predicting forensic inpatient violence with odor identification and neuropsychological measures of impulsivity: A preliminary study. J Psychiatr Res 2022; 147:154-158. [PMID: 35033786 DOI: 10.1016/j.jpsychires.2022.01.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 12/25/2021] [Accepted: 01/09/2022] [Indexed: 11/20/2022]
Abstract
Although most persons with a schizophrenia-spectrum disorder are not aggressive, a minority is at higher risks to commit violent acts, especially in forensic settings. The first goal of this study was to assess inpatients in a maximum-security hospital with a self-report questionnaire, neuropsychological tests of behavioral impulsivity/attentional capacities and olfactory functions to determine the strength of association between these measures. A secondary objective was to assess the predictive value of these measures for the commission of violent acts within the institution. Sixty-two male inpatients were evaluated with the neuropsychological battery. As expected, self-report assessment of trait impulsivity (questionnaire) did not significantly correlate with behavioral measures of state impulsivity. In addition, neuropsychological measures of impulsivity and attention were significantly associated with odor identification capacities. Finally, attentional deficits (but not impulsivity) and odor identification were both significant and independent predictors of institutional violence. Neuropsychological assessments and odor functions might help predicting (and explaining) institutional violence committed in forensic settings.
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Beaudry G, Canal-Rivero M, Ou J, Matharu J, Fazel S, Yu R. Evaluating the Risk of Suicide and Violence in Severe Mental Illness: A Feasibility Study of Two Risk Assessment Tools (OxMIS and OxMIV) in General Psychiatric Settings. Front Psychiatry 2022; 13:871213. [PMID: 35845463 PMCID: PMC9280292 DOI: 10.3389/fpsyt.2022.871213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 05/30/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Two OxRisk risk assessment tools, the Oxford Mental Illness and Suicide (OxMIS) and the Oxford Mental Illness and Violence (OxMIV), were developed and validated using national linked registries in Sweden, to assess suicide and violence risk in individuals with severe mental illness (schizophrenia-spectrum disorders and bipolar disorders). In this study, we aim to examine the feasibility and acceptability of the tools in three different clinical services. METHOD We employed a two-step mixed-methods approach, by combining quantitative analyses of risk scores of 147 individual patients, and thematic analyses of qualitative data. First, 38 clinicians were asked to use OxMIS and OxMIV when conducting their routine risk assessments in patients with severe mental illness. The risk scores for each patient (which provide a probability of the outcome over 12 months) were then compared to the unstructured clinical risk assessment made by the treating clinician. Second, we carried out semi-structured interviews with the clinicians on the acceptability and utility of the tools. Thematic analysis was conducted on the qualitative data to identify common themes, in terms of the utility, accuracy, and acceptability of the tools. The investigations were undertaken in three general adult psychiatric clinics located in the cities of Barcelona and Sevilla (Spain), and Changsha (China). RESULTS Median risk probabilities over 12 months for OxMIS were 1.0% in the Spanish patient sample and 1.9% in the Chinese sample. For OxMIV, they were 0.7% (Spanish) and 0.8% (Chinese). In the thematic analysis, clinicians described the tools as easy to use, and thought that the risk score improved risk management. Potential additions to predictors were suggested, including family history and the patient's support network. Concordance rates of risk estimates between the tools and clinicians was high for violence (94.4%; 68/72) and moderate for suicide (50.0%; 36/72). CONCLUSION Both OxMIS and OxMIV are feasible and practical in different general adult psychiatric settings. Clinicians interviewed found that both tools provide a useful structured approach to estimate the risk of suicide and violence. Risk scores from OxMIS and OxMIV can also be used to assist clinical decision-making for future management.
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Affiliation(s)
- Gabrielle Beaudry
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Manuel Canal-Rivero
- Hospital Universitario Virgen del Rocío, Seville, Spain.,CIBER de Salud Mental, Instituto de Salud Carlos III, Madrid, Spain.,Instituto de Biomedicina de Sevilla (IBIS), Seville, Spain
| | - Jianjun Ou
- Hunan Key Laboratory of Psychiatry and Mental Health, National Clinical Research Center for Mental Disorders, Institute of Mental Health, National Technology Institute on Mental Disorders, Central South University, Changsha, China
| | - Jaskiran Matharu
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rongqin Yu
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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