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de Boer T, Pietersma M, Tiemens B. Prediction of Disruptive Behavior over Time from Changes in Patients' Global Functioning in Acute Psychiatric Care. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2024; 51:725-737. [PMID: 38521871 PMCID: PMC11379775 DOI: 10.1007/s10488-024-01355-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2024] [Indexed: 03/25/2024]
Abstract
Disruptive behavior of patients in acute psychiatric care is a problem for both patients and staff. Preventing a patient's impending disruption requires recognizing and understanding early signals. There are indications that a change in a patient's global functioning may be such a signal. The global functioning of patients is a multidimensional view on their functioning. It captures a patient's psychological symptoms, social skills, symptoms of violence, and activities in daily living. The aim of this study was to gain insight into the predictive value of global functioning on the risk of disruptive behavior of patients in acute psychiatric care. Also assessed was the time elapsed between the change in global functioning and a patient's disruptive behavior, which is necessary to know for purposes of early intervention. In a longitudinal retrospective study, we used daily measurements with the Brøset Violence Checklist (BVC) and the Kennedy Axis V (K-As) of each patient admitted to two acute psychiatric units over a period of six years. Data from 931 patients for the first 28 days after their admission were used for survival analysis and cox regression analysis. Disruptive behavior was mostly observed during the first days of hospitalization. Global functioning predicted disruptive behavior from the very first day of hospitalization. A cut-off score of 48 or lower on the K-As on the first admission day predicted a higher risk of disruptive behavior. If functioning remained poor or deteriorated substantially over three days, this was an additional signal of increased risk of disruptive behavior. Improvement in global functioning was associated with a decreased risk of disruptive behavior. More attention is needed for early interventions on global functioning to prevent disruptive behavior.
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Affiliation(s)
- Tamar de Boer
- Pro Persona Pompestichting, Nijmegen, The Netherlands
| | | | - Bea Tiemens
- Pro Persona Research, Wolfheze, The Netherlands.
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
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Lawrence J, Emory J, Sousa S, Thompson D, Jenkins K, Bettencourt AP, McLaughlin MK, Russell-Babin K. Implementing the Brøset Violence Checklist in the ED. Am J Nurs 2024; 124:52-60. [PMID: 38900125 DOI: 10.1097/01.naj.0001025656.82073.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
ABSTRACT The emerging field of implementation science (IS) facilitates the sustainment of evidence-based practice in clinical care. This article, the second in a series on applying IS, describes how a nurse-led IS team at a multisite health system implemented the Brøset Violence Checklist-a validated, evidence-based tool to predict a patient's potential to become violent-in the system's adult EDs, with the aim of decreasing the rate of violence against staff. The authors discuss how they leveraged IS concepts, methods, and tools to achieve this goal.
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Affiliation(s)
- John Lawrence
- John Lawrence is a sepsis coordinator at Inova Mount Vernon Hospital in Alexandria, VA. Johanna Emory is a pediatric ED nurse at Inova Loudoun Hospital in Leesburg, VA. Sara Sousa is an ED nurse manager at Inova Fairfax Hospital in Falls Church, VA. Danielle Thompson is a clinical mentor at Inova Alexandria Hospital in Alexandria, VA. Kenya Jenkins is an education coordinator at Inova Health System in Falls Church, VA, where Maureen Kirkpatrick McLaughlin is an implementation science consultant and Kathleen Russell-Babin is vice president of professional practice. Amanda P. Bettencourt is an assistant professor in the University of Pennsylvania School of Nursing in Philadelphia and an implementation science consultant. Contact author: Kathleen Russell-Babin, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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Quinn M, Jutkowitz E, Primack J, Lenger K, Rudolph J, Trikalinos T, Rickard T, Mai HJ, Balk E, Konnyu K. Protocols to reduce seclusion in inpatient mental health units. Int J Ment Health Nurs 2024; 33:600-615. [PMID: 38193620 DOI: 10.1111/inm.13277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/04/2023] [Indexed: 01/10/2024]
Abstract
The use of seclusion to manage conflict behaviours in psychiatric inpatient settings is increasingly viewed as an intervention of last resort. Many protocols have, thus, been developed to reduce the practice. We conducted a systematic review to determine the effectiveness of protocols to reduce seclusion on process outcomes (e.g., seclusion, restraint), patient outcomes (e.g., injuries, aggressive incidents, satisfaction), and staff outcomes (e.g., injuries, satisfaction). We searched Medline, Embase, the Cochrane Register of Clinical Trials, PsycINFO, CINAHL, cairn.info, and ClinicalTrials.gov for protocols to reduce seclusion practices for adult patients on inpatient mental health units (from inception to September 6, 2022). We summarised and categorised reported elements of the protocols designed to reduce seclusion using the Behaviour Change Wheel Intervention Functions and resources needed to implement the protocol in psychiatric units. We assessed risk of bias and determined certainty of evidence using GRADE. Forty-eight reports addressed five approaches to reduce seclusion: hospital/unit restructuring (N = 4), staff education/training (N = 3), sensory modulation rooms (N = 7), risk assessment and management protocols (N = 7), and comprehensive/mixed interventions (N = 22; N = 6 without empirical data). The relationship between the various protocols and outcomes was mixed. Psychiatric units that implement architecturally positive designs, sensory rooms, the Brøset Violence Checklist, and various multi-component comprehensive interventions may reduce seclusion events, though our certainty in these findings is low due to studies' methodological limitations. Future research and practice may benefit from standardised reporting of process and outcome measures and analyses that account for confounders.
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Affiliation(s)
- McKenzie Quinn
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Eric Jutkowitz
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
| | - Jennifer Primack
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Katherine Lenger
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - James Rudolph
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Center of Innovation in Long-Term Services and Supports, Providence VA Medical Center, Providence, Rhode Island, USA
| | - Thomas Trikalinos
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Taylor Rickard
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
| | - Htun Ja Mai
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Ethan Balk
- Evidence Synthesis Program Center Providence VA Medical Center, Providence, Rhode Island, USA
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
| | - Kristin Konnyu
- Department of Health Services, Policy & Practice, Brown University, Providence, Rhode Island, USA
- Center for Evidence Synthesis in Health, Brown University, Providence, Rhode Island, USA
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
- Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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4
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Derks JL, Vermeulen JM, Boyette LL, Waldorp LJ, de Haan L. Short-term sequences of aggressive behavior in psychiatric inpatients with psychotic disorders using Markov models. J Ment Health 2024; 33:193-201. [PMID: 32930022 DOI: 10.1080/09638237.2020.1818188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/26/2020] [Accepted: 08/10/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Aggression in inpatients with psychotic disorders is harmful to patients and health care professionals. AIMS The current study introduces a novel approach for assessing short-term sequences of different types of aggression. METHODS Occurrence and type of aggressive behavior was assessed retrospectively by reviewing hospital charts in a sample of 120 inpatients with psychotic disorders, admitted to the psychiatric wards of an academic hospital using the Modified Overt Aggression Scale (MOAS). Behavioral sequences of verbal aggression, physical aggression against objects, physical aggression against oneself and physical aggression against others were analyzed by using Markov models, a statistical technique providing the probabilities of transferring from one state to another. RESULTS The Markov models showed that when patients behave aggressively, they are likely to either show the same type of aggression or to be non-aggressive consecutively. Patients are, however, unlikely to subsequently show another type of aggression. Non-aggressive behavior is very unlikely to result in physical aggression or aggression against objects. CONCLUSION The current study introduced a novel approach on how to investigate aggressive behavior in patients with psychotic disorders. Replication of our results in a bigger sample is needed to reliably develop a day-to-day risk assessment tool for aggressive behavior.
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Affiliation(s)
- Joël L Derks
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Lindy-Lou Boyette
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lourens J Waldorp
- Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam UMC, Amsterdam, The Netherlands
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Eisenstein M, Chung J, Domaleski V, Lantz S. Development of a Pediatric Behavioral Early Warning Scale (Pedi-BEWS) for Children. J Nurs Meas 2023; 31:370-377. [PMID: 37558252 DOI: 10.1891/jnm-2021-0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Background and Purpose: The prevention of aggressive behavior in child and adolescent inpatient settings is essential. However, it can be difficult to prompt a quick appropriate intervention without an early warning scale for the prevention and management of behavioral emergencies in a psychiatric inpatient adolescent unit. Behavioral emergencies often result in restraint/seclusion and/or administration of psychotropic medications. The objectives are to develop and evaluate the Pediatric Behavioral Early Warning Scale (Pedi-BEWS) as a screening tool to prompt quick appropriate interventions and to decrease incidents of restraint/seclusion and/or administration of psychotropic medications. Methods: A two-phase methodological design was applied. A total of 447 inpatients and 21 nurses were used to test internal consistency reliability and validity. Results: Receiver operating characteristic curve areas for the developed instrument were calculated to be 0.890 (cognition), 0.959 (affect), and 0.951 (behavior). The overall Pedi-BEWS indicated high reliability (Cronbach's alpha = .98). Conclusions: The Pedi-BEWS shows high internal consistency and validity. The use of the newly developed tool may reduce or eliminate episodes of seclusion and restraint for pediatric patients with a behavioral problem. In addition, the tool has the potential to enhance psychiatric nurses' assessment skills and competencies. The use of the newly developed Pedi-BEWS can promote an appropriate and timely nursing assessment and intervention before the deterioration in psychiatric nursing practice.
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Fujimoto H, Greiner C, Mukaihata T, Hashimoto T. Associations between psychiatric home‐visit nursing staff's exposure to violence and conditions of visit to community‐living individuals with mental illness. Jpn J Nurs Sci 2022; 19:e12485. [DOI: 10.1111/jjns.12485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 01/31/2022] [Accepted: 02/25/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Chieko Greiner
- Kobe University Graduate School of Health Sciences Kobe Japan
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Baker J, Berzins K, Canvin K, Benson I, Kellar I, Wright J, Lopez RR, Duxbury J, Kendall T, Stewart D. Non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings: the COMPARE systematic mapping review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09050] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
ObjectivesThe study aimed to provide a mapping review of non-pharmacological interventions to reduce restrictive practices in adult mental health inpatient settings; classify intervention components using the behaviour change technique taxonomy; explore evidence of behaviour change techniques and interventions; and identify the behaviour change techniques that show most effectiveness and those that require further testing.BackgroundIncidents involving violence and aggression occur frequently in adult mental health inpatient settings. They often result in restrictive practices such as restraint and seclusion. These practices carry significant risks, including physical and psychological harm to service users and staff, and costs to the NHS. A number of interventions aim to reduce the use of restrictive practices by using behaviour change techniques to modify practice. Some interventions have been evaluated, but effectiveness research is hampered by limited attention to the specific components. The behaviour change technique taxonomy provides a common language with which to specify intervention content.DesignSystematic mapping study and analysis.Data sourcesEnglish-language health and social care research databases, and grey literature, including social media. The databases searched included British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials (CCRCT), Cochrane Database of Systematic Reviews (CDSR), Database of Abstracts of Reviews of Effects (DARE), EMBASE, Health Technology Assessment (HTA) Database, HTA Canadian and International, Ovid MEDLINE®, NHS Economic Evaluation Database (NHS EED), PsycInfo®and PubMed. Databases were searched from 1999 to 2019.Review methodsBroad literature search; identification, description and classification of interventions using the behaviour change technique taxonomy; and quality appraisal of reports. Records of interventions to reduce any form of restrictive practice used with adults in mental health services were retrieved and subject to scrutiny of content, to identify interventions; quality appraisal, using the Mixed Methods Appraisal Tool; and data extraction, regarding whether participants were staff or service users, number of participants, study setting, intervention type, procedures and fidelity. The resulting data set for extraction was guided by the Workgroup for Intervention Development and Evaluation Research, Cochrane and theory coding scheme recommendations. The behaviour change technique taxonomy was applied systematically to each identified intervention. Intervention data were examined for overarching patterns, range and frequency. Overall percentages of behaviour change techniques by behaviour change technique cluster were reported. Procedures used within interventions, for example staff training, were described using the behaviour change technique taxonomy.ResultsThe final data set comprised 221 records reporting 150 interventions, 109 of which had been evaluated. The most common evaluation approach was a non-randomised design. There were six randomised controlled trials. Behaviour change techniques from 14 out of a possible 16 clusters were detected. Behaviour change techniques found in the interventions were most likely to be those that demonstrated statistically significant effects. The most common intervention target was seclusion and restraint reduction. The most common strategy was staff training. Over two-thirds of the behaviour change techniques mapped onto four clusters, that is ‘goals and planning’, ‘antecedents’, ‘shaping knowledge’ and ‘feedback and monitoring’. The number of behaviour change techniques identified per intervention ranged from 1 to 33 (mean 8 techniques).LimitationsMany interventions were poorly described and might have contained additional behaviour change techniques that were not detected. The finding that the evidence was weak restricted the study’s scope for examining behaviour change technique effectiveness. The literature search was restricted to English-language records.ConclusionsStudies on interventions to reduce restrictive practices appear to be diverse and poor. Interventions tend to contain multiple procedures delivered in multiple ways.Future workPrior to future commissioning decisions, further research to enhance the evidence base could help address the urgent need for effective strategies. Testing individual procedures, for example, audit and feedback, could ascertain which are the most effective intervention components. Separate testing of individual components could improve understanding of content and delivery.Study registrationThe study is registered as PROSPERO CRD42018086985.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 9, No. 5. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- John Baker
- School of Healthcare, University of Leeds, Leeds, UK
| | | | - Krysia Canvin
- School of Healthcare, University of Leeds, Leeds, UK
| | - Iris Benson
- Mersey Care NHS Foundation Trust, Prescot, UK
| | - Ian Kellar
- School of Psychology, University of Leeds, Leeds, UK
| | - Judy Wright
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Joy Duxbury
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | | | - Duncan Stewart
- Department of Health Sciences, University of York, York, UK
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8
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Viljoen JL, Vincent GM. Risk assessments for violence and reoffending: Implementation and impact on risk management. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2020. [DOI: 10.1111/cpsp.12378] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Moskovitz J, Sapadin J, Guttenberg M. Interfacility ambulance transport of mental health patients. J Am Coll Emerg Physicians Open 2020; 1:173-182. [PMID: 33000032 PMCID: PMC7493513 DOI: 10.1002/emp2.12012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 12/12/2019] [Accepted: 12/13/2019] [Indexed: 11/21/2022] Open
Abstract
The transportation of mental health patients between facilities by emergency medical services personnel poses a unique risk to both patients and their providers. Increasingly, common injuries are occurring and difficulties are arising during this transition in care. Proximal causes exist that could be addressed to help mitigate many of the complexities that occur during this shift in care. Patient safety, quality of care, and provider safety are all at risk if improvements are not made and problems not identified or rectified.
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Affiliation(s)
- Joshua Moskovitz
- Albert Einstein College of MedicineBronxNew YorkUSA
- Hofstra School of Health and Human ServicesHempsteadNew YorkUSA
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10
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Dickens GL, O'Shea LE, Christensen M. Structured assessments for imminent aggression in mental health and correctional settings: Systematic review and meta-analysis. Int J Nurs Stud 2020; 104:103526. [DOI: 10.1016/j.ijnurstu.2020.103526] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/20/2022]
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Ghosh M, Twigg D, Kutzer Y, Towell-Barnard A, De Jong G, Dodds M. The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review. Int J Ment Health Nurs 2019; 28:1248-1267. [PMID: 31454144 DOI: 10.1111/inm.12645] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2019] [Indexed: 11/27/2022]
Abstract
To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases - CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty-one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user-friendly, standardized evidence-based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability.
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Affiliation(s)
- Manonita Ghosh
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Di Twigg
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Yvonne Kutzer
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Amanda Towell-Barnard
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Gideon De Jong
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Mary Dodds
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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Senz A, Ilarda E, Klim S, Kelly AM. Introducing routine risk assessment for occupational violence and aggression in the emergency department. Emerg Med Australas 2019; 31:897-898. [PMID: 31342639 DOI: 10.1111/1742-6723.13358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 06/26/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Ainslie Senz
- Emergency Medicine, Footscray Hospital, Melbourne, Victoria, Australia
| | - Elisa Ilarda
- Occupational Violence and Aggression Prevention, Safety, Risk and Improvement, Western Health, Melbourne, Victoria, Australia
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School - Western Precinct, The University of Melbourne, Melbourne, Victoria, Australia
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13
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Hirsch S, Steinert T. Measures to Avoid Coercion in Psychiatry and Their Efficacy. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 116:336-343. [PMID: 31288909 PMCID: PMC6630163 DOI: 10.3238/arztebl.2019.0336] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 08/20/2018] [Accepted: 03/12/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Coercive measures such as seclusion and restraint encroach on the patient's human rights and can have serious adverse effects ranging from emotional trauma to physical injury and even death. At the same time, they may be the only way to avert acute danger for the patient and/or the hospital staff. In this article, we provide an overview of the efficacy of the measures that have been studied to date for the avoidance of coercion in psychiatry. METHODS This review is based on publications retrieved by a systematic search in the Medline and Cinahl databases, supplemented by a search in the reference lists of these publications. We provide a narrative synthesis in which we categorize the interventions by content. RESULTS Of the 84 studies included in this review, 16 had a control group; 6 of these 16 were randomized controlled trials (RCTs). The interventions were categorized by seven different types of content: organization, staff training, risk assessment, environment, psychotherapy, debriefings, and advance directives. Most interventions in each category were found to be effective in the respective studies. 38 studies investigated complex treatment programs that incorporated elements from more than one category; 37 of these (including one RCT) revealed effective reduction of the frequency of coercion. Two RCTs on the use of rating instruments to assess the risk of aggressive behavior revealed a relative reduction of the number of seclusion measures by 27% and a reduction of the cumulative duration of seclusion by 45%. CONCLUSION Complex intervention programs to avoid coercive measures, incorporating elements of more than one of the above categories, seem to be particularly effective. In future, cluster-randomized trials to investigate the individual categories of intervention would be desirable.
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Affiliation(s)
- Sophie Hirsch
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
| | - Tilman Steinert
- ZfP Südwürttemberg, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm, Weissenau
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Moursel G, Çetinkaya Duman Z, Almvik R. Assessing the risk of violence in a psychiatric clinic: the Brøset Violence Checklist (BVC) Turkish version-validity and reliability study. Perspect Psychiatr Care 2019; 55:225-232. [PMID: 30468250 DOI: 10.1111/ppc.12338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 11/03/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study was conducted for the purpose of adapting the Brøset Violence Checklist (BVC) for Turkish patients and testing its validity and reliability in measuring and predicting the risk of violence psychiatric in patients. DESIGN AND METHODS The BVC and the Overt Aggression Scale (OAS) were used in the study. The BVC was distributed to 126 patients at the psychiatric clinic. The receiver operating characteristic (ROC), the Mann-Whitney U test and χ 2 analysis were carried out. FINDINGS With a BVC total score cutoff of two points, 52% sensitivity and 100% specificity were found. A total of 47 violent episodes were observed in 25 patients. PRACTICE IMPLICATIONS These results support the validity and reliability of the BVC. The Turkish version of the BVC was found to be a reliable and valid tool suitable for use in psychiatric inpatients.
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Affiliation(s)
- Gülşen Moursel
- Dokuz Eylul University Adult Mental Health and Diseases Clinic, Izmir, Turkey
| | - Zekiye Çetinkaya Duman
- Faculty of Nursing, Psychiatric Nursing Department, Dokuz Eylul University, Izmir, Turkey
| | - Roger Almvik
- Forensic Department Brøset, St. Olavs University Hospital, Centre for Research and Education in Forensic Psychiatry, Trondheim, Norway
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Anderson KK, Jenson CE. Violence risk-assessment screening tools for acute care mental health settings: Literature review. Arch Psychiatr Nurs 2019; 33:112-119. [PMID: 30663614 DOI: 10.1016/j.apnu.2018.08.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/06/2018] [Accepted: 08/25/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Violence is a large concern for mental health professionals: 90% of physicians and nurses working in mental health areas have been subject to violence from patients. Approximately 80% of violent acts from patients are directed toward nurses. OBJECTIVE The purpose of this integrative literature review was to identify violence risk-assessment screening tools that could be used in acute care mental health settings. DESIGN The Stetler model of evidence-based practice guided the literature search, in which 8 violence risk-assessment tools were identified, 4 of which were used for further examination. RESULTS The Brøset Violence Checklist and Violence Risk Screening-10 provided the best assessment for violence in the acute care mental health setting. CONCLUSIONS Using a violence risk assessment screening tool helps identify patients at risk for violence allowing for quick intervention to prevent violent episodes.
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Affiliation(s)
- Kendra K Anderson
- Department of Nursing, Mayo Clinic, Rochester, MN, United States of America.
| | - Carole E Jenson
- Graduate Programs in Nursing, Winona State University-Rochester, Rochester, MN, United States of America
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16
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Sarver WL, Radziewicz R, Coyne G, Colon K, Mantz L. Implementation of the Brøset Violence Checklist on an Acute Psychiatric Unit. J Am Psychiatr Nurses Assoc 2019; 25:476-486. [PMID: 30638107 DOI: 10.1177/1078390318820668] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Violence on inpatient psychiatric settings has significant consequences for patients and staff. Research is needed to determine if Brøset Violence Checklist (BVC) is an accurate predictor of violence. AIMS: The study aims were to determine the relationship between BVC scores and incidence of violent behavior within 24 hours, to compare scores among those requiring high-level nursing interventions for violence, and to investigate the impact of scores on length of stay (LOS) and 30 day-readmission rates. METHOD: Retrospective cohort study. RESULTS: Logistic regression indicates 3.4 times greater risk of violence for every additional point on admission BVC (odds ratio = 3.4, 95% confidence interval = [2.29, 5.08], p < .0001). Patients requiring high-level interventions for violence had higher mean BVC scores on both Day 1 and 2 of admission. Pearson correlation was significant for positive association between BVC on admission and LOS (p < .001). Findings did not establish a link between BVC scores and violence with 30-day readmission rates. CONCLUSIONS: Efforts toward early identification and management of agitation and disruptive behavior is encouraged. Results showed increased risk of violence with every additional point on BVC on admission; further attention should be paid to these patients on admission when using violence screening tools.
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Affiliation(s)
- Wendy L Sarver
- Wendy L. Sarver, PhD(c), RN, NEA-BC, The MetroHealth System, Cleveland, OH, USA
| | - Rosanne Radziewicz
- Rosanne Radziewicz, MSN, APRN-CNS, The MetroHealth System, Cleveland, OH, USA
| | - Georgean Coyne
- Georgean Coyne, BSN, RN-BC, The MetroHealth System, Cleveland, OH, USA
| | - Kelly Colon
- Kelly Colon, BSN, RN-BC, The MetroHealth System, Cleveland, OH, USA
| | - Lisa Mantz
- Lisa Mantz, Med, RN, The MetroHealth System, Cleveland, OH, USA
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Souli I, Vandyk A, Versailles D, Marcoux I, Salvador A, Peterson WE, Hu J, Stacey D. [Barriers to and facilitators for using a risk assessment tool to prevent violent behaviour in patients with mental health conditions: Perspectives of health care providers]. Rech Soins Infirm 2018:45-57. [PMID: 30066506 DOI: 10.3917/rsi.133.0045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Regular assessment of risk of violence is shown to be effective in reducing violence in mental health services. PURPOSE To evaluate health care providers' use of a violence risk assessment tool on a mental health unit and the facilitators for and barriers to its use. METHODS A descriptive study using the Dillman approach and informed by the Knowledge to Action framework was conducted. RESULTS Twenty-six health care providers responded to the survey; 62% reported using the violence risk assessment tool available on their unit, but not on a daily basis. Common barriers were lack of knowledge of the tool, lack of resources and time, and negative attitudes toward patients. 42% of participants indicated the need for further training on violence risk assessment. CONCLUSION Despite high exposure to violence, health professionals were not conducting daily risk assessments. The barriers and facilitators identified provide direction for interventions that are necessary if the daily use of violence risk assessment tools is to be increased.
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Partridge B, Affleck J. Predicting aggressive patient behaviour in a hospital emergency department: An empirical study of security officers using the Brøset Violence Checklist. Australas Emerg Care 2018; 21:31-35. [PMID: 30998863 DOI: 10.1016/j.auec.2017.11.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/10/2017] [Accepted: 11/16/2017] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The Brøset Violence Checklist (BVC) is a six item checklist that rates patients according to their risk of violence in the subsequent 24h - a score of ?3 indicates a "high risk" of violence. This study is the first to evaluate the statistical utility of the BVC when administered by a security officer in a hospital emergency department (ED). METHOD A healthcare security officer conducted BVC assessments on patients who presented to the ED of a public hospital in metropolitan South East Queensland, Australia, over a two month period. Violent/aggressive acts requiring security intervention were registered in a database. RESULTS 2064 ED patients were assessed on the BVC and 35 patients committed a violent/aggressive act (1.7%). BVC sensitivity was 45.7% and specificity 99.4%. At a cut-off score of BVC3, the positive predictive value was 55.2%. Violent patients were around 71 times more likely to score BVC?3 than non-violent patients. CONCLUSIONS The BVC has good sensitivity, specificity, and predictive value in this setting. Using the BVC may help to implement measures that mitigate the impact of violent patients in the ED, or ideally, implement procedures that prevent violence towards ED workers in the first place.
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Affiliation(s)
- Bradley Partridge
- Research Development Unit, Caboolture Hospital, Caboolture, Queensland, Australia; School of Clinical Medicine, Prince Charles Hospital Northside Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - Julia Affleck
- Research Development Unit, Caboolture Hospital, Caboolture, Queensland, Australia
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Gooshi M, Siratinir M, Ebadi A, Tavallai A, Mohammadi A. Psychometric Properties of the Persian Version of the Staff Observation Aggression Scale-Revised (SOAS-R) in Psychiatric Patients. J Caring Sci 2018; 6:335-343. [PMID: 29302573 PMCID: PMC5747592 DOI: 10.15171/jcs.2017.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 05/17/2017] [Indexed: 11/21/2022] Open
Abstract
Introduction: In psychiatric settings, aggressive events frequently occur during
therapy. The use of a proper standard scale to register aggression can facilitate the
assessment and control of aggression and help reduce its frequency and severity. The
aim of this study is to evaluate the validity and reliability of the Staff Observation
Aggression Scale—Revised (SOAS-R).
Methods: This psychometric study of the scale was conducted to determine the validity
and reliability of the SOAS-R. The validation of the scale was assessed on the basis of
319 aggressive events in the psychiatric wards of the Baqiyatallah and Roozbeh
hospitals. Convenience sampling was used for subject selection. Psychometric
properties of SOAS-R were studied in two stages. First, the standard scale was
translated according to the International Quality of Life Assessment (IQOLA)
translation methodology. The face validity, content, and construct validity of the
translated version were then determined. The construct validity of the scale was
assessed by comparing the known groups.
Results: The internal consistency of the whole scale was 0.99. The intra-class
correlation coefficients (ICC) were 0.85–0.99 while kappa coefficient was 0.43 to 0.65
for different aspects of the SOAS-R. The validity of the scale was concurrently
assessed by using the Visual Analogue Scale (VAS), with a Spearman-Brown
correlation coefficient of 0.90.
Conclusion: These results showed a favourable validity and reliability for the Persian
version of the SOAS-R for the assessment of aggressive behaviour in psychiatric
patients.
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Affiliation(s)
- Muhammad Gooshi
- Department of Nursing, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Masoud Siratinir
- Department of Psychiatric Nursing, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Department of Psychiatric Nursing, Behavioral Sciences Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Abbas Tavallai
- Department of Psychiatry, Behavioral Sciences Research Center, Baqiyatollah University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mohammadi
- Department of Psychiatry, Tehran University of Medical Sciences, Tehran, Iran
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Blair EW, Woolley S, Szarek BL, Mucha TF, Dutka O, Schwartz HI, Wisniowski J, Goethe JW. Reduction of Seclusion and Restraint in an Inpatient Psychiatric Setting: A Pilot Study. Psychiatr Q 2017; 88:1-7. [PMID: 26897657 DOI: 10.1007/s11126-016-9428-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The authors describe a quality and safety initiative designed to decrease seclusion/restraint (S/R) and present the results of a pilot study that evaluated the effectiveness of this program. The study sample consisted of consecutive admissions to a 120-bed psychiatric service after the intervention was implemented (October 2010-September 2012, n = 8029). Analyses compared S/R incidence and duration in the study sample to baseline (consecutive admissions during the year prior to introduction of the intervention, October 2008-September 2009, n = 3884). The study intervention, which used evidence-based therapeutic practices for reducing violence/aggression, included routine use of the Brøset Violence Checklist, mandated staff education in crisis intervention and trauma informed care, increased frequency of physician reassessment of need for S/R, formal administrative review of S/R events and environmental enhancements (e.g., comfort rooms to support sensory modulation). Statistically significant associations were found between the intervention and a decrease in both the number of seclusions (p < 0.01) and the duration of seclusion per admission (p < 0.001). These preliminary results support the conclusion that this intervention was effective in reducing use of seclusion. Further study is needed to determine if these prevention strategies are generalizable, the degree to which each component of the intervention contributes to improve outcome, and if continuation of the intervention will further reduce restraint use.
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Affiliation(s)
- Ellen W Blair
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
| | - Stephen Woolley
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Bonnie L Szarek
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Theodore F Mucha
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Olga Dutka
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Harold I Schwartz
- The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - Jeff Wisniowski
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
| | - John W Goethe
- Burlingame Center for Psychiatric Research and Education, The Institute of Living, Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
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21
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Faay MDM, Valenkamp MW, Nijman H. Warning Signs prior to Aggressive Behavior in Child Psychiatric Units. Arch Psychiatr Nurs 2017; 31:43-47. [PMID: 28104057 DOI: 10.1016/j.apnu.2016.07.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 10/21/2022]
Abstract
This study aims at detecting and categorizing early warning signs of aggressive behavior in child psychiatric units. We analyzed 575 violent incident report forms and developed a coding scheme consisting of 16 warning signs. From the 575 incident report forms, a total of 1087 signs were coded. Most common warning signs were 'restlessness' (21.2%), 'not listening' (15.2%) and 'anger' (9.8%). These were also the most prevalent warning signs for the severe incidents. Although warning signs differ for each individual child, this study indicates that there are common warning signs for imminent aggressive incidents in child psychiatric facilities.
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Affiliation(s)
- Margo D M Faay
- Brain Center Rudolf Magnus, department of Psychiatry, University Medical Center Utrecht, The Netherlands.
| | - Marije W Valenkamp
- Erasmus Medical Center Sophia Children's Hospital, department of Child and Adolescent Psychiatry, Rotterdam, The Netherlands; VanMontfoort Consultancy, Woerden, The Netherlands
| | - Henk Nijman
- Behavioural Science Institute (BSI), Radboud University, Nijmegen, The Netherlands; Aventurijn - Fivoor, Den Dolder, The Netherlands
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22
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Fleury MJ, Grenier G, Vallée C, Aubé D, Farand L, Bamvita JM, Cyr G. Implementation of the Quebec mental health reform (2005-2015). BMC Health Serv Res 2016; 16:586. [PMID: 27756297 PMCID: PMC5069811 DOI: 10.1186/s12913-016-1832-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 10/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background This study evaluates implementation of the Quebec Mental Health (MH) Reform (2005–2015) which aimed to improve accessibility, quality and continuity of care by developing primary care and optimizing integrated service networks. Implementation of MH primary care teams, clinical strategies for consolidating primary care, integration strategies to improve collaboration between primary care and specialized services, and facilitators and barriers related to these measures were examined. Methods Eleven Quebec MH service networks provided the study setting. Networks were identified in consultation with 20 key MH decision makers and selected based on variation in services offered, integration strategies, best practices, and geographic criteria. Data collection included: primary documents, structured questionnaires completed by 25 managers from MH primary care teams and 16 respondent-psychiatrists working in shared-care, and semi-structured interviews with 102 network stakeholders involved in the reform. The study employed a mixed method approach, triangulating the three data sources across networks. Results While implementation was not fully achieved in most networks, the Quebec reform succeeded in improving primary care services with the creation of adult primary care teams, and one-stop services which increased access to care, mainly for clients with common MH disorders. In terms of clinical strategies implemented, the functions provided by respondent-psychiatrists had a greater impact on the MH primary care teams than on general practitioners (GPs) in medical clinics; whereas the implementation of best practices were indirect outcomes of another reform developed simultaneously by the Quebec substance use disorders program. The main integration strategies used for increasing continuity of care and collaboration between primary care and specialized services were those involving fewer formal procedures such as referrals between teams and organizations. The lack of operational mechanisms and protocols governing new services and structures were important barriers to primary care consolidation and service integration, as was the lack of interest and involvement of most GPs in MH. Conclusions Successful and sustained healthcare reform requires attention to process and outcomes as well as structural change or service reorganization. Six recommendations for more successful implementation of the Quebec MH Reform are provided, with implications for healthcare reform internationally. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1832-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 845 Sherbrooke Street, Montreal, H3A 0G4, Quebec, Canada. .,Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada.
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
| | - Catherine Vallée
- Rehabilitation Department, Laval University, Quebec, Quebec, GIV 0A6, Canada
| | - Denise Aubé
- Department of Social and Preventive Medicine, Laval University, National Public Health Institute of Québec, Quebec, Quebec, GIV 0A6, Canada
| | - Lambert Farand
- Department of Health Administration, Policy and Evaluation, School of Public Health, University of Montreal, Montreal, Quebec, H3T 3J7, Canada
| | - Jean-Marie Bamvita
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
| | - Geneviève Cyr
- Douglas Mental Health University Institute Research Centre, 6875 LaSalle Blvd., Montreal, Quebec, H4H 1R3, Canada
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23
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Literature Synthesis: Patient Aggression Risk Assessment Tools in the Emergency Department. J Emerg Nurs 2016; 42:19-24. [DOI: 10.1016/j.jen.2015.01.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/07/2015] [Accepted: 01/28/2015] [Indexed: 11/21/2022]
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24
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Jackson D, Wilkes L, Luck L. Cues that predict violence in the hospital setting: Findings from an observational study. Collegian 2014; 21:65-70. [DOI: 10.1016/j.colegn.2013.02.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Yao X, Li Z, Arthur D, Hu L, Cheng G. Validation of the Violence Risk Screening-10 instrument among clients discharged from a psychiatric hospital in Beijing. Int J Ment Health Nurs 2014; 23:79-87. [PMID: 23360576 DOI: 10.1111/j.1447-0349.2012.00890.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The Violence Risk Screening-10 is one of the few instruments available for evaluating violence risk in mental health clients during and after hospitalization. This prospective study examined the applicability of this brief instrument with a sample of 289 clients in the 6 months after discharge from a general psychiatric hospital in Beijing. During the research period, 24 of the 289 clients demonstrated aggression. The receiver-operator characteristic curve yielded an area under the curve of 0.62. At the cut-off point of 4.5, its sensitivity/specificity was 79.2%/33.3%, and the corresponding positive/negative predictive value was 9.9%/94.5%. The predictive accuracy of this instrument was lower compared with the results of the original study, and was also less accurate than when it was administered while the clients were in the hospital. While promising in its utility for use beyond the hospital, it deserves further modification prior to its wide use across culturally-diverse China.
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Affiliation(s)
- Xiuyu Yao
- School of Nursing, Peking Union Medical College, Beijing, China
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26
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Yao X, Li Z, Arthur D, Hu L, An FR, Cheng G. Acceptability and psychometric properties of Brøset Violence Checklist in psychiatric care settings in China. J Psychiatr Ment Health Nurs 2014; 21:848-55. [PMID: 24548404 DOI: 10.1111/jpm.12132] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2013] [Indexed: 11/30/2022]
Abstract
Short-term risk assessment instrument owns great importance for psychiatric nurses in China; however, the lack of a standardized violence risk assessment instrument has disadvantaged them in clinical practice. The Brøset Violence Checklist (BVC), a behavioural observation tool, is the most frequently cited instrument available for evaluating violence risk in psychiatric inpatients, then worth to be tested in Chinese culture. This study, conducted in two closed wards in a psychiatric hospital in Beijing, revealed that the instrument has favourable reliability, validity and predictive accuracy in Chinese population. BVC provides nurses with a quick and easily administered method to screening out patients with violence potential, thus allowing for early intervention. Feedback from the nurses was quite encouraging and the further use of BVC seems promising. The lack of standardized violence risk assessment instrument has disadvantaged nurses in clinical practice in China, where violent behaviour is an increasing problem. This study conducted a validation of the Brøset Violence Checklist that has proven effective in violence risk prediction in other countries. A sample of 296 patients consecutively admitted to two wards of a psychiatric hospital in Beijing was recruited. These patients were assessed on day shift and evening shift for the first seven days of hospitalization. Violence data and preventive measures were concurrently collected from nursing records and case reports. A total of 3707 assessments for 281 patients were collected revealing 93 episodes of violence among 55 patients. Receiver operating characteristics yielded an area under the curve of 0.85. At the cut-off point of one, its sensitivity/specificity was 78.5%/88.2% and the corresponding positive/negative predictive value was 14.6%/99.4%. In some false positive cases, intense preventive measures had been implemented. Positive feedback from the nurses was gained. The Brøset Violence Checklist was proved as an easy-to-use and time-saving instrument, therefore, regarded as a promising tool to determine if the psychiatric users are potentially violent in the short term.
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Affiliation(s)
- X Yao
- School of Nursing, Peking Union Medical College, Beijing, China
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van de Sande R, Noorthoorn E, Wierdsma A, Hellendoorn E, van der Staak C, Mulder CL, Nijman H. Association between short-term structured risk assessment outcomes and seclusion. Int J Ment Health Nurs 2013; 22:475-84. [PMID: 23841809 DOI: 10.1111/inm.12033] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Research findings indicate that the symptoms and behaviour of acute psychiatric patients can fluctuate drastically within hours, and that structured daily risk assessments can reduce the risk of aggressive incidents and the duration of seclusion. The aim of this study was to investigate the validity of two structured observation tools, the Brøset Violence Checklist (BVC) and the Kennedy Axis V), as an aid in seclusion-related clinical decision-making. In this study, 7403 day-to-day risk assessments were collected over 10 725 admission days (72% of the maximum number of structured assessments). A total of 7055 daily assessment scores from 301 acute psychiatric patients were used for the multilevel analysis. The sample demonstrated that dynamic and static factors were related to seclusion. Dynamic factors included dysfunctional scores on the item 'confusion' of the Brøset Violence Checklist, and psychological impairment and impairment of social skills on the Kennedy Axis V. Static factors included non-Western descent, male sex, age less than 35 years, unmarried, and to some extent, a personality disorder. McFadden's pseudo R(2) value showed that most of the final model was related to the dynamic factors. We concluded that the incorporation of the BVC and the Kennedy Axis V into standard practice was helpful in identifying patients at high risk of seclusion.
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Affiliation(s)
- Roland van de Sande
- Department of Health, Utrecht University of Applied Science, Utrecht, Netherlands; Acute Psychiatric Care, ParnassiaGroep, Capelle aan den Ijsel, Netherlands
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Chu CM, Thomas SDM, Daffern M, Ogloff JRP. Should clinicians use average or peak scores on a dynamic risk-assessment measure to most accurately predict inpatient aggression? Int J Ment Health Nurs 2013; 22:493-9. [PMID: 23211005 DOI: 10.1111/j.1447-0349.2012.00846.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent advancements in risk assessment have led to the development of dynamic risk-assessment measures that are predictive of inpatient aggression in the short term. However, there are several areas within this field that warrant further empirical investigation, including whether the average, maximum, or most recent risk state assessment is the most valid for predicting subsequent aggression in the medium term. This prospective study compared the predictive validity of three indices (i.e. mean score, peak score, and most recent single time-point rating) of the Dynamic Appraisal of Situational Aggression (DASA) for inpatient aggression. Daily risk ratings were completed for 60 psychiatric inpatients (from the acute wards of a forensic psychiatric hospital) for up to 6 months; a total of 1054 DASA ratings were obtained. Results showed that mean and peak scores on the DASA were better predictors of interpersonal violence, verbal threat, and any inpatient aggression than the DASA single time-point most recent ratings. Overall, the results support the use of the prior week's mean and peak scores to aid the prediction of inpatient aggression within inpatient forensic psychiatric settings in the short to medium term. These results also have practical implications for clinicians considering risk-management strategies and the scoring of clinically-relevant items on risk-assessment measures.
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Affiliation(s)
- Chi Meng Chu
- Centre for Forensic Behavioural Science, School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia; Clinical and Forensic Psychology Branch, Ministry of Social and Family Development, Singapore
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Dumais A, Larue C, Michaud C, Goulet MH. Predictive validity and psychiatric nursing staff's perception of the clinical usefulness of the French version of the Dynamic Appraisal of Situational Aggression. Issues Ment Health Nurs 2012; 33:670-5. [PMID: 23017043 DOI: 10.3109/01612840.2012.697254] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study seeks to evaluate the predictive validity of the French version of the Dynamic Appraisal of Situational Aggression (DASAfr) and psychiatric nurses' perceptions of the clinical usefulness of the scale. The study was conducted in a 12-bed psychiatric intensive care unit in a large adult general psychiatric hospital. We found that the total score on the DASAfr has acceptable predictive accuracy for aggression against others and against staff and for seclusion with restraints; predictive accuracy was poorer for aggression against objects. Moreover, the nurses though the scale would be useful to their practice; and, indeed, the team still uses the DASAfr.
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30
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Yao X, Li Z, Arthur D, Hu L, Cheng G. The application of a violence risk assessment tool among Chinese psychiatric service users: a preliminary study. J Psychiatr Ment Health Nurs 2012; 19:438-45. [PMID: 22073978 DOI: 10.1111/j.1365-2850.2011.01821.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The Violence Risk Screening-10 (V-RISK-10) is one of the few instruments available for evaluating violence risk among general psychiatric service users. This naturalistic prospective study involved 376 inpatients in a general psychiatric hospital in Beijing and intended to determine whether this brief instrument could be applied to a sample of Chinese consumers and whether its predictive properties could be retained. Risk assessment at admission was compared to the record of aggression and violence during the first month of hospitalization. During the research period, 108 of the 376 consumers caused 265 incidences of aggression. Receiver operating characteristics for the V-RISK-10 Chinese version yielded an area under the curve of 0.63. Its sensitivity/specificity was 0.80/0.38 and the corresponding positive/negative predictive value was 0.34/0.82. Intraclass correlation coefficient for the whole instrument was 0.89. Compared to the results of the original V-RISK-10, its predictive accuracy was lower. However, with some modification, the V-RISK-10 still shows promise as an instrument for use in daily practice in Chinese clinical settings.
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Affiliation(s)
- X Yao
- School of Nursing, Peking Union Medical College, 33 Badachu Road, Shijingshan District, Beijing, China
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