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Richardson Velmans S, Joseph C, Wood L, Billings J. A systematic review and thematic synthesis of inpatient nursing staff experiences of working with high-risk patient behaviours. J Psychiatr Ment Health Nurs 2024; 31:325-339. [PMID: 37874310 DOI: 10.1111/jpm.12987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. AIM The aim of the study was to examine nursing staff experiences of high-risk behaviours in inpatient mental health settings. METHODS Four electronic databases (CINAHL, Medline, PsycINFO, EMBASE) were searched. The protocol for this review was prospectively registered in PROSPERO (Ref: CRD42022334739). A meta-synthesis of nursing staff's experiences of high-risk behaviours in inpatient mental health settings was conducted. RESULTS We identified 30 eligible studies. Six themes were constructed from the meta-synthesis: the social contract of care; the function of risk behaviours; the expectation of risk; risk as a relational concept; navigating contradictions in care; the aftermath. DISCUSSION Nursing staff conceptualize risk as a meaningful behaviour shaped by patient, staff and environmental factors. Managing risk is an ethical dilemma for nursing staff and they require more training and support in ethical risk decision-making. IMPLICATIONS FOR PRACTICE Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours. RELEVANCE STATEMENT Nursing staff are frequently exposed to high-risk patient behaviours within inpatient health services, yet staff commonly report a lack of training and support in managing these behaviours. This systematic review offers insights into how high-risk behaviours are experienced by nursing staff and makes recommendations about how to improve the understanding and management of them. Inpatient mental healthcare services should formulate and manage risk as a relational concept comprising staff, patient and environmental factors. Future research and clinical practice should place further consideration on the varied experiences of different types of risk behaviours.
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Affiliation(s)
| | | | - Lisa Wood
- Division of Psychiatry, University College London, London, UK
| | - Jo Billings
- Division of Psychiatry, University College London, London, UK
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Quinn S, Rhynas S, Gowland S, Cameron L, Braid N, O Connor S. Risk for intellectual disability populations in inpatient forensic settings in the United Kingdom: A literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2022; 35:1267-1280. [PMID: 35995572 PMCID: PMC10087896 DOI: 10.1111/jar.13030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND People with an intellectual disability who commit a criminal offence can be detained, by a court, in a forensic inpatient facility. There is limited understanding of how inpatients with an intellectual disability and their nurses navigate risk in U.K. forensic services. METHODS A traditional literature review design was followed to map evidence (2000-2021) around the forensic and health and wellbeing risks faced by inpatients with an intellectual disability, nurses' perceptions of managing risk, and patient experiences of informing risk assessment and management. Papers were analysed thematically. RESULTS Findings suggest that restrictive measures to mitigate forensic risks (e.g., violence) can exacerbate the risk of poor health and wellbeing outcomes. There was some limited evidence of direct patient involvement in risk assessment and management. CONCLUSION Further research is required to explore how forensic inpatients with an intellectual disability can have input in care planning, risk assessment and management.
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Affiliation(s)
- Sam Quinn
- The University of Edinburgh, Edinburgh, Scotland
| | - Sarah Rhynas
- The University of Edinburgh, Edinburgh, Scotland
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Välimäki M, Lantta T, Lam YTJ, Cheung T, Cheng PYI, Ng T, Ip G, Bressington D. Perceptions of patient aggression in psychiatric hospitals: a qualitative study using focus groups with nurses, patients, and informal caregivers. BMC Psychiatry 2022; 22:344. [PMID: 35585520 PMCID: PMC9118596 DOI: 10.1186/s12888-022-03974-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Aggression in psychiatric hospitals has been of interest to researchers. Information on how different stakeholders perceive patient aggression remains equivocal. Even less is known about possible similarities or differences in stakeholders' perceptions of how aggressive behaviour is understood, managed and prevented in psychiatric hospitals. We aimed to explore multiple viewpoints on patient aggression, its possible causes and outcomes, and development ideas for prevention and management. METHODS A qualitative design was adopted. The data were collected using focus group interviews. A thematic approach was used for interpretation. The data were collected on 15 adult wards in two inpatient psychiatric settings in Hong Kong. Participants were nurses working on the psychiatric inpatient wards, patients admitted to the wards, and informal caregivers visiting inpatient wards (N = 94). RESULTS Commonalities between all groups were found on how patient aggression is perceived, and why it occurs. Patients and especially nurses described how patient aggression occurred with no clear reason or forewarning and how patients were physically controlled or restricted after aggressive events. Only nurses and patients expressed experiencing physical burden, while all groups considered psychological burden to be a consequence of aggression. All groups proposed that helpful attitudes among nurses, better communication, structural changes, and better self-management skills would prevent patient aggression. Risk assessment was proposed only by nurses and patients, while safety measures were proposed by nurses and informal caregivers only. The use of restrictive interventions to manage aggressive events was proposed by all groups. CONCLUSIONS Despite the complex diversity of perspectives in different stakeholder groups regarding patient aggression, the findings highlighted that it is possible to achieve some mutual understanding of aggression in psychiatric hospitals and identify areas to be developed. Staffs' attitudes and skills for engagement and communication with patients and informal caregivers should be improved. There is also still room to develop the therapeutic environment and culture toward meaningful activities during the treatment period.
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Affiliation(s)
- Maritta Välimäki
- Xiangya School of Nursing, Xiangya Center for Evidence-Based Practice & Healthcare Innovation, Central South University, 172 Tongzipo Road, Changsha, 410013, Hunan, China. .,Department of Nursing Science, ICT-city, University of Turku, 20014, Turku, Finland.
| | - Tella Lantta
- grid.1374.10000 0001 2097 1371Department of Nursing Science, ICT-city, University of Turku, 20014 Turku, Finland
| | - Yuen Ting Joyce Lam
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Teris Cheung
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong (SAR), China
| | - Po Yee Ivy Cheng
- grid.417134.40000 0004 1771 4093Community Psychiatric Services, 12/F, Block A, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Tony Ng
- grid.417134.40000 0004 1771 4093Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Glendy Ip
- grid.415585.80000 0004 0469 9664Central Nursing Division, Kwai Chung Hospital, Hospital Authority, Hong Kong (SAR), China
| | - Daniel Bressington
- grid.1043.60000 0001 2157 559XCollege of Nursing and Midwifery, Charles Darwin University, Ellengowan Drive, Casuarine, Darwin, NT 0909 Australia
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Conflict management: A qualitative study of mental health staff's perceptions of factors that may influence conflicts with forensic mental health inpatients. Arch Psychiatr Nurs 2021; 35:407-417. [PMID: 34561053 DOI: 10.1016/j.apnu.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 03/09/2021] [Accepted: 06/12/2021] [Indexed: 11/23/2022]
Abstract
Internationally, clinical services are under pressure to reduce their use of restrictive practices. The aim was to explore how mental health nurses and nursing assistants perceive conflict and their use of restrictive practices with mental health inpatients in forensic mental health care. A total of 24 semi-structured interviews with forensic mental health staff were conducted and analysed using thematic analysis. The findings propose a dynamic model that explains how tolerance of potential conflict situations changes depending on individual staff members' perceptions of patients and colleagues, and their relationships.
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Fletcher A, Crowe M, Manuel J, Foulds J. Comparison of patients' and staff's perspectives on the causes of violence and aggression in psychiatric inpatient settings: An integrative review. J Psychiatr Ment Health Nurs 2021; 28:924-939. [PMID: 33837640 DOI: 10.1111/jpm.12758] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/10/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Aggression and violence are persistent problems in psychiatric inpatient units. Violence preventive factors have been identified from both staff's and patients' perspectives. Violent and aggressive inpatient incidents have not been adequately explained in research and reviews to date. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This review is novel in that it provides a comparison of patients' and staff's perspectives and identified that these differ and were influenced by factors attributable to the inpatient culture. The one contributory factor both agreed upon was the role of staff's interpersonal skills in either exacerbating or de-escalating aggression and violence. The inpatient culture was found to engender differing perceptions of most contributory factors to violence and aggression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While staff's interpersonal skills were identified as a primary influence on whether their interaction with patients contributed to aggression and violence, this was shaped by the inpatient environment's culture. Patient-centred interactional skills need to focus on the patients' needs for respect and active participation rather than engendering feelings of disrespect or coercion. Patient-centred communication skills that demonstrate an understanding of the patient's experience in the inpatient environment need to be core skills for mental health nurses. ABSTRACT: Introduction High rates of aggression and violence are a persistent problem in inpatient mental health environments. A comparison of staff's and patients' perceptions of the causes may provide novel insights. Aim This review aimed to compare patients' and staff's perspectives on the causes of aggression and violence in inpatient environments. Method An integrative review of the literature was conducted with a search of Ovid (Medline, Embase, PsycINFO) databases and manual searching. Results Thirty articles met criteria for inclusion. Interactions prior to aggressive or violent incidents were characterized by patients as disrespectful and coercive, and by staff as indicative of the patient's mental state or personality. Both groups identified the importance of patient-centred communication skills. Discussion The review identified that patients and staff have differing perspectives on the causes of violence and aggression. There was an interactional dynamic between staff and patients that was shaped by the culture of the inpatient setting. Implications for Practice Understanding how the inpatient culture plays a role in shaping a dynamic between patients and staff and developing communication skills that acknowledge this may help reduce violence and aggression in inpatient settings.
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Affiliation(s)
- Alice Fletcher
- Forensicare, Victorian Institute of Forensic Mental Health, Melbourne, Vic., Australia
| | - Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jenni Manuel
- Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Bennett A, Hanna P. Exploring the Experiences of Male Forensic Inpatients' Relationships with Staff within Low, Medium and High Security Mental Health Settings. Issues Ment Health Nurs 2021; 42:929-941. [PMID: 33914668 DOI: 10.1080/01612840.2021.1913683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Therapeutic relationships within psychiatric settings are highlighted as important throughout the literature. However, research from the forensic inpatient perspective is limited. We address this gap by exploring the patient-staff relationships within forensic mental health inpatient services, from the patient's perspective. Thirty adult male forensic inpatients were interviewed about their experiences on the ward and their interactions with staff. Our analysis examines inpatients experiences of respectful and reciprocal relationships, relationships that empower, a disinterest in their patients' and authoritarian relationships. This study concludes by highlighting the need to prioritise the development of reciprocal relationships within forensic services.
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Affiliation(s)
- Alice Bennett
- Department of Psychological Interventions, University of Surrey, Guildford, UK
| | - Paul Hanna
- Department of Psychological Interventions, University of Surrey, Guildford, UK
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Lim E, Wynaden D, Heslop K. Using Q-methodology to explore mental health nurses' knowledge and skills to use recovery-focused care to reduce aggression in acute mental health settings. Int J Ment Health Nurs 2021; 30:413-426. [PMID: 33084220 DOI: 10.1111/inm.12802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/01/2022]
Abstract
When nurses practise recovery-focused care, they contribute positively to the consumer's mental health recovery journey and empower the person to be actively engaged in the management of their illness. While using recovery-focused care is endorsed in mental health policy, many health professionals remain uncertain about its application with consumers who have a risk for aggression during their admission to an acute mental health inpatient setting. This paper reports on Australian research using Q-methodology that examined the knowledge and skill components of recovery-focused care that nurses use to reduce the risk for aggression. The data from forty mental health nurses revealed five factors that when implemented as part of routine practice improved the recovery outcomes for consumers with risk of aggression in the acute mental health settings. These factors were as follows: (I) acknowledge the consumers' experience of hospitalization; (II) reassure consumers who are going through a difficult time; (III) interact to explore the impact of the consumer's negative lived experiences; (IV) support co-production to reduce triggers for aggression; and (V) encourage and support consumers to take ownership of their recovery journey. These findings provide nurses with a pragmatic approach to use recovery-focused care for consumers with risk for aggression and contribute positively to the consumers' personal recovery.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Mertens A, Vander Laenen F. Pains of Imprisonment Beyond Prison Walls: Qualitative Research With Females Labelled as Not Criminally Responsible. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2020; 64:1343-1363. [PMID: 31524000 DOI: 10.1177/0306624x19875579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research on the importation and deprivation models has focused almost exclusively on male inmates, and these models have not yet been studied in any setting other than prison. This research explores the importation and deprivation experiences of females labelled as not criminally responsible (FNCR). During the first part of the study, all the participants interviewed were in prison (n = 51). Follow-up interviews were carried out 18 months later, and while some participants were still in prison, others had been moved to (forensic or general) care. At that point, the study transcended the prison walls and extended its theoretical framework to forensic and general care facilities. In conclusion, the importation and deprivation framework, and the pains defined by Crewe, can be applied to FNCR in different types of setting. Most women were strongly affected by deprivations in prisons and in forensic care. Participants in forensic care sometimes felt more deprived than those in prison facilities.
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Affiliation(s)
- Anouk Mertens
- National Institute of Criminalistics and Criminology, Department of Criminology, Brussels, Belgium
| | - Freya Vander Laenen
- Ghent University, Department of Criminology, Penal Law and Social Law, Institute for International Research on Criminal Policy, Ghent, Belgium
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Thibaut B, Dewa LH, Ramtale SC, D'Lima D, Adam S, Ashrafian H, Darzi A, Archer S. Patient safety in inpatient mental health settings: a systematic review. BMJ Open 2019; 9:e030230. [PMID: 31874869 PMCID: PMC7008434 DOI: 10.1136/bmjopen-2019-030230] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Patients in inpatient mental health settings face similar risks (eg, medication errors) to those in other areas of healthcare. In addition, some unsafe behaviours associated with serious mental health problems (eg, self-harm), and the measures taken to address these (eg, restraint), may result in further risks to patient safety. The objective of this review is to identify and synthesise the literature on patient safety within inpatient mental health settings using robust systematic methodology. DESIGN Systematic review and meta-synthesis. Embase, Cumulative Index to Nursing and Allied Health Literature, Health Management Information Consortium, MEDLINE, PsycINFO and Web of Science were systematically searched from 1999 to 2019. Search terms were related to 'mental health', 'patient safety', 'inpatient setting' and 'research'. Study quality was assessed using the Hawker checklist. Data were extracted and grouped based on study focus and outcome. Safety incidents were meta-analysed where possible using a random-effects model. RESULTS Of the 57 637 article titles and abstracts, 364 met inclusion criteria. Included publications came from 31 countries and included data from over 150 000 participants. Study quality varied and statistical heterogeneity was high. Ten research categories were identified: interpersonal violence, coercive interventions, safety culture, harm to self, safety of the physical environment, medication safety, unauthorised leave, clinical decision making, falls and infection prevention and control. CONCLUSIONS Patient safety in inpatient mental health settings is under-researched in comparison to other non-mental health inpatient settings. Findings demonstrate that inpatient mental health settings pose unique challenges for patient safety, which require investment in research, policy development, and translation into clinical practice. PROSPERO REGISTRATION NUMBER CRD42016034057.
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Affiliation(s)
- Bethan Thibaut
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Lindsay Helen Dewa
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sonny Christian Ramtale
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Danielle D'Lima
- Centre for Behaviour Change, Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Sheila Adam
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Hutan Ashrafian
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Ara Darzi
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Stephanie Archer
- NIHR Imperial Patient Safety Tranlsational Research Centre, Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
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Tingleff EB, Hounsgaard L, Bradley SK, Gildberg FA. Forensic psychiatric patients' perceptions of situations associated with mechanical restraint: A qualitative interview study. Int J Ment Health Nurs 2019; 28:468-479. [PMID: 30341808 DOI: 10.1111/inm.12549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2018] [Indexed: 12/14/2022]
Abstract
To reduce the use and duration of mechanical restraint in forensic settings and ensure evidence-based patient care, we need more knowledge about patients' subjective experiences and perceptions. The aim was to investigate forensic psychiatric patients' perceptions of situations associated with the use of mechanical restraint and what they perceive as factors impacting the use and duration of mechanical restraint. Twenty participants were interviewed. Four themes were identified through a thematic analysis: 'overt protest reactions', 'silent protest reactions', 'illness-related behaviour', and 'genuinely calm', which together characterize patients' perceptions of their ways of acting and reacting during mechanical restraint episodes. These themes are linked together in two patterns in the process of mechanical restraint: 'pattern of protest' and 'pattern of illness'. Further research is needed to illuminate the associations between patients' perceptions of being subjected to mechanical restraint and ways of acting and reacting through the process of mechanical restraint.
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Affiliation(s)
- Ellen B Tingleff
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Department of Nursing, UCL University College, Vejle, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
| | - Lise Hounsgaard
- OPEN, Odense Patient data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, UCL University College, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark.,Institute of Nursing & Health Science, University of Greenland, Nuuk, Greenland
| | | | - Frederik A Gildberg
- Research & Development Unit, Department of Psychiatry Middelfart, Region of Southern Denmark, Middelfart, Denmark.,Center for Psychiatric Nursing and Health Research, Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Denmark
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Lim E, Wynaden D, Heslop K. Changing practice using recovery-focused care in acute mental health settings to reduce aggression: A qualitative study. Int J Ment Health Nurs 2019; 28:237-246. [PMID: 30027634 DOI: 10.1111/inm.12524] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 01/15/2023]
Abstract
Consumer aggression is common in acute mental health settings and can result in direct or vicarious psychological or physical impacts for both consumers and health professionals. Using recovery-focused care, nurses can implement a range of strategies to reduce aggression and empower consumers to self-regulate their behaviour, when faced with challenging situations, such as admission to the acute care setting. Currently, there is limited literature to direct nurses in the use of recovery-focused care and how it can be used to reduce consumer aggression. Twenty-seven mental health nurses participated in this study. The constructivist grounded theory method guided data collection and analysis to identify categories that accurately described participants' experiences. Five categories emerged that described how nurses can implement recovery-focused care clinically to reduce the risk of consumer aggression: (i) identify the reason for the behaviour before responding; (ii) being sensitive to the consumer's trigger for aggression; (iii) focus on the consumer's strengths and support, not risks; (iv) being attentive to the consumer's needs; and (v) reconceptualize aggression as a learning opportunity. As the importance of promoting consumer recovery is now embedded in mental health policies internationally, nurses need to prioritize the application of recovery-focused care clinically. Further research to provide evidence-based outcomes supporting the use of recovery-focused care is needed.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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12
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Dias MGPF, de Vargas D. Psychiatric Nurses' Attitudes Towards Violent Behaviour: A Brazilian Study. Issues Ment Health Nurs 2018; 39:687-692. [PMID: 29436881 DOI: 10.1080/01612840.2017.1422198] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This study examines nurses' attitudes towards violent behaviour and the management of aggressiveness. A convenience sample of 185 nurses working in psychiatric urgent care and emergency services in Brazil responded to the MAVAS-BR. The results show that nurses' attitudes are more reflective of the external and situational models of violent behaviour and the use of control methods to manage aggressiveness. The mapping of this phenomenon using the same tools in a different context from those traditionally studied while observing similar results suggests a pattern of attitudes towards violent behaviour and the management of aggressiveness among nurses around the world.
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Affiliation(s)
| | - Divane de Vargas
- a São Paulo University , Department of Maternal-Child and Psychiatric Nursing, School of Nursing , São Paulo , SP , Brazil
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Lim E, Wynaden D, Heslop K. Recovery-focussed care: How it can be utilized to reduce aggression in the acute mental health setting. Int J Ment Health Nurs 2017; 26:445-460. [PMID: 28960737 DOI: 10.1111/inm.12378] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2017] [Indexed: 12/19/2022]
Abstract
Consumer aggression is common in the acute mental health inpatient setting. Mental health nurses can utilize a range of interventions to prevent aggression or reduce its impact on the person and others who have witnessed the event. Incorporating recovery-focussed care into clinical practice is one intervention, as it fosters collaborative partnerships with consumers. It promotes their engagement in decisions about their care and encourages self-management of their presenting behaviours. It also allows the consumer to engage in their personal recovery as their mental health improve. Yet there is a paucity of literature on how nurses can utilize recovery-focussed care with consumers who are hospitalized and in the acute phase of their illness. In the present study, we report the findings of a scoping review of the literature to identify how recovery-focussed care can be utilized by nurses to reduce the risk of consumer aggression. Thirty-five papers met the inclusion criteria for review. Four components were identified as central to the use of recovery-focussed care with consumers at risk of becoming aggressive: (i) seeing the person and not just their presenting behaviour; (ii) interact, don't react; (iii) coproduction to achieve identified goals; and (iv) equipping the consumer as an active manager of their recovery. The components equip nurses with strategies to decrease the risk of aggression, while encouraging consumers to self-manage their challenging behaviours and embark on their personal recovery journey. Further research is required to evaluate the translation of these components clinically in the acute care setting.
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Affiliation(s)
- Eric Lim
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Dianne Wynaden
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Karen Heslop
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Lamanna D, Ninkovic D, Vijayaratnam V, Balderson K, Spivak H, Brook S, Robertson D. Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives. J Ment Health 2016; 25:536-542. [PMID: 27809615 DOI: 10.1080/09638237.2016.1207222] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND When the people hospitalized in psychiatric units demonstrate aggression, it harms individuals and creates legal and financial issues for hospitals. Aggression has been linked to inpatient, clinician and environmental characteristics. However, previous work primarily accessed clinicians' perspectives or administrative data and rarely incorporated inpatients' insights. This limits validity of findings and impedes comparisons of inpatient and clinician perspectives. AIMS This study explored and compared inpatient and clinician perspectives on the factors affecting verbal and physical aggression by psychiatric inpatients. METHODS This study used an interpretive theoretical framework. Fourteen inpatients and 10 clinicians were purposefully sampled and completed semi-structured interviews. Data were analyzed using inductive thematic analysis. RESULTS Six themes were identified at personal and organizational levels. The three person-level themes were major life stressors, experience of illness and interpersonal connections with clinicians. The three organization-level themes were physical confinement, behavioural restrictions and disengagement from treatment decisions. CONCLUSIONS Aggression is perceived to have a wide range of origins spanning personal experiences and organizational policies, suggesting that a wide range of prevention strategies are needed.
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Affiliation(s)
- Denise Lamanna
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada
| | - Danijela Ninkovic
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada
| | - Vinothini Vijayaratnam
- b Family and Community Medicine, St. Michael's Hospital , Toronto, Ontario , Canada , and
| | - Ken Balderson
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Harold Spivak
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - Shelley Brook
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
| | - David Robertson
- a Mental Health Service, St. Michael's Hospital , Toronto, Ontario , Canada.,c Department of Psychiatry, Faculty of Medicine , University of Toronto , Toronto, Ontario , Canada
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