An audit of the use of breakaway techniques in a large psychiatric hospital: a replication study

The importance and feasibility of hospital interventions to prevent and manage patient aggression and violence against physicians in China: a Delphi study

BACKGROUND

Aggression and violence by patient (and their relatives/friends) is widely acknowledged as a serious occupational hazard, with physicians being particularly susceptible to witnessing and experiencing such incidents within hospitals. Research has shown that the negative consequences of such aggression and violence are not only felt at the individual level, but also at the team and organizational levels. Understanding how to prevent and manage this behavior towards physicians in hospitals is urgent and not fully researched. While there are many potentially effective interventions, it is unclear which ones would be valuable and feasible for Chinese hospitals. Because patient aggression and violence may occur more frequently in Chinese hospitals than in other countries, this suggests that cultural differences play a role and that tailored interventions may be needed.

METHOD

We conducted a Delphi study to reach a consensus on the importance and feasibility of hospital interventions to prevent and manage patient (and their relatives/friends) aggression and violence against physicians in Chinese hospitals. Seventeen experts in China were invited to complete online questionnaires over three rounds.

RESULTS

After three rounds, consensus was achieved concerning 44 interventions, five other interventions were rejected, and no consensus was reached on another two. These interventions were clustered into eight categories: environment design, access and entrance, staffing and working practices, leadership and culture, training and education, support, during/after-the-event actions, and hospital policy. Each category is considered important in preventing and managing patient (and their relatives/friends) aggression and violence towards physicians in Chinese hospitals. This study also investigated the feasibility of the suggested interventions and found that 36 of the 44 interventions were considered not only relevant, but also feasible for implementation in Chinese hospitals.

CONCLUSIONS

This study provides an overview of interventions that can be implemented in Chinese hospitals to prevent and manage patient (and their relatives/friends) aggression and violence before, during, and after a violent incident occurs.

A Realist Review of Violence Prevention Education in Healthcare

Violence from patients and visitors towards healthcare workers is an international concern affecting the safety and health of workers, quality of care, and healthcare system sustainability. Although the predominant intervention has been violence prevention (VP) education for healthcare workers, evaluating its effectiveness is challenging due to underreporting of violence and the inherent complexity of both violence and the health care environment. This review utilized a theory-driven, realist approach to synthesize and analyze a wide range of academic and grey literature to identify explanations of how and why VP education makes a difference in preventing violence and associated physical and psychological injury to workers. The review confirmed the importance of positioning VP education as part of a VP strategy, and consideration of the contexts that influence successful application of VP knowledge and skills. Synthesis and analysis of patterns of evidence across 64 documents resulted in 11 realist explanations of VP education effectiveness. Examples include education specific to clinical settings, unit-level modeling and mentoring support, and support of peers and supervisors during violent incidents. This review informs practical program and policy decisions to enhance VP education effectiveness in healthcare settings.

The Gender-Related Impact of a Violence Management Training Program on Medical School Students-Preliminary Results

Phenomenon: Patient aggression directed toward medical personnel, including medical school students during their internships, is an increasingly important issue. To minimize this phenomenon, violence management training programs were carried out. Approach: To assess the efficacy of a violence management training program among medical school students and evaluate changes in the perception of aggressive behavior in relation to the participants’ sense of self-efficacy and self-confidence by sex. A quasi-experimental examination of medical school students was performed before and after completion of a training program. Two hundred seventy-six students, including students of medicine, nursing, emergency medical services, and physiotherapy, participated in the study. Three standardized questionnaires were used: The Perception of Aggression Scale (POAS), the Hope for Success Questionnaire (HSQ), and the General Self -Efficacy Scale (GSES). Findings: The training program had a positive impact on the sense of self-efficacy in both men and women. However, the perception of aggressive behavior changed only in women and the impact of such intervention was higher for women. Further studies should look at the long-term outcomes.

Uso da simulação na capacitação sobre violência no trabalho da enfermagem

Resumo Objetivo Avaliar a aplicabilidade e os resultados do uso da simulação nos processos de capacitação de estudantes e profissionais de enfermagem sobre violência no trabalho. Métodos Revisão integrativa da literatura que seguiu recomendações metodológicas para responder à questão: a simulação pode ajudar estudantes e trabalhadores de enfermagem a lidarem com a violência no trabalho? Construiu-se estratégias de busca a partir de operadores booleanos e termos relacionadas à simulação e violência no trabalho, que foram inseridas ao CINAHL, MEDLINE e Proquest Central juntamente com os demais filtros. Dois revisores independentes selecionaram os estudos mediante critérios e houve análise do nível de evidência. Resultados Nove estudos foram selecionados e revelaram a flexibilidade da simulação pela possibilidade de utilizá-la com diferentes propósitos em capacitações. Identificou-se nos estudos que houve o uso de recursos variados de simulação, assim como a abordagem de diferentes tópicos de violência. Os cenários com pacientes ou agressores e a violência com origem no paciente foram os mais frequentes. Os estudos indicaram benefícios da simulação, mas nem todos os resultados foram consensuais. Conclusão A simulação é um recurso com potencial de ajudar estudantes e profissionais de enfermagem a lidarem com casos de violência no trabalho, prevenindo sua ocorrência ou reduzindo danos. Os estudos neste tema são recentes e várias necessidades de pesquisa emanam da aliança entre simulação e violência no trabalho, algumas das quais destacadas nesta revisão e que podem orientar a construção de evidências mais robustas.

Implementation of the Safewards model in public mental health facilities: A qualitative evaluation of staff perceptions

BACKGROUND

The Safewards model is gaining increasing acceptance in the mental health field in Australia and overseas. One of the most important goals of inpatient psychiatric services is to provide a safe and therapeutic environment for both patients and staff. However, this goal can be difficult to achieve if staff-patient interaction is not conducive to preventing violence and aggression.

OBJECTIVE

The purpose of this study was to explore nursing staff perceptions of the factors impacting on their capacity to establish Safewards in acute adult inpatient wards.

DESIGN

This study was guided by a phenomenological approach to develop a rich understanding of staff perceptions using semi-structured interviews.

SETTING AND SAMPLE

The setting was three acute mental health wards attached to general hospitals; one in a large provincial hospital and two in metropolitan hospitals in south-east Queensland. Interview participants were a purposive sample of fifteen registered nurses across each of the three wards.

METHOD

Semi-structured interviews were conducted at 12 months post-implementation of Safewards. The study was underpinned by Michie's integrative framework of behaviour change that helped identify target areas in order to enhance successful implementation of this model.

RESULTS

Content analysis of interview transcripts highlighted a range of factors including failure to address the difficulties encountered by some staff in engaging with Safewards interventions, lack of support from management, poor use of nurse educator time, the 'language' of Safewards, high acuity on the study wards, and staff and patient turnover.

CONCLUSION

This study highlights some difficulties with implementing Safewards and maintaining fidelity of the Safewards interventions in busy acute inpatient wards. Although these findings are from a qualitative study consisting of only 15 staff, our results indicate that efforts to implement Safewards need to address challenges faced by staff in engaging with the interventions, ensure buy-in from management, ensure adequate training and support during implementation and review training materials to ensure they fit with the local (i.e. Australian) context. Safewards provides an opportunity for a change in attitudes and development of a more therapeutic ward environment.