Vulnerability Factors in the Explanation of Workplace Aggression: The Construction of a Theoretical Framework

An analysis of Chinese nursing electronic medical records to predict violence in psychiatric inpatients using text mining and machine learning techniques

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.

Risk Factors Associated With Inpatient Violence During Medium Security Treatment

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.

Employees exposed to work-related threats and violence in human services sectors: Are any employees members particularly exposed to violence and threats and what role do supervisors play?

BACKGROUND

The frequency of being exposed to work-related violence and threats is high in employees working in the human service sector. The question is whether certain employees are particularly exposed to violence and threats than others.

OBJECTIVE

This study examined whether particular employees were especially exposed to work-related violence and threats due to personal characteristics, coping styles, attitudes or participating in violence prevention training. We also examined the role played by supervisors.

METHODS

Questionnaire data were collected in 2010 and 2011. In all, 3584 employees from special schools, psychiatric wards, eldercare and the Prison and Probation Service participated. We used multivariate logistic regression analyses.

RESULTS

We found persons high on the extroversion and introversion scales were associated with statistical significant increased risk for work-related threats. Furthermore, accepting attitudes concerning work-related violence were also statistical significant associated with increased the risk for both work-related threats and violence. Associations between coping styles and work-related threats and violence were very small and statistically non-significant and we found no effect of violence prevention training. The risk for work-related threats for persons high on the extroversion scale was decreased if supervisor violence prevention behaviour was high. Furthermore, if supervisor prevention behaviour was high, prevention training decreased the risk for work-related violence. However, these associations weren't statistically significant.

CONCLUSION

The results stress that effective prevention requires involvement of both employees and supervisors.