Risk assessments for acute violence to third parties: a review of the literature

Exploring the safe environment provided by nurses in inpatient psychiatric wards: A mixed-methods study

INTRODUCTION

Previous research has indicated that community-based mental health services in Iran are restricted, leading to overcrowding in psychiatric wards. This overcrowding has been linked to a range of problems, such as violence, suicide and medical errors. Despite the abundance of research on patient safety, there is still a lack of understanding regarding how mental health nurses (MHNs) create a secure environment within these wards.

AIM

This study focused on exploring a safe environment provided by MHNs in inpatient psychiatric wards at Farshchian (Sina) Hospital, Hamadan, Iran.

METHOD

An explanatory mixed-methods study was conducted. Initially, the Safe Environment Scale was distributed to all MHNs (n = 48) working in three wards at Farshchian (Sina) Hospital to evaluate the current status. The scale measured two dimensions, and descriptive statistics were used to analyse the collected data. Subsequently, 20 MHNs were selected for semi-structured interviews using purposeful sampling at the same hospital to interpret and fill gaps in the quantitative findings. The data collected from the interviews were analysed using conventional content analysis.

RESULTS

The perception and engagement of MHNs in creating a safe environment in the inpatient psychiatric wards were found to be at a medium level, according to the Safe Environment Scale (mean ± SD, 14.67 ± 4.18 and 85.27 ± 17.57, respectively). The qualitative study identified several categories in the results, including 'Hyper-vigilance to safety and security environment', 'Therapeutic communication gap', 'Nurse burnout', 'Staff safety and security need' and 'Environmental safety hazards'.

DISCUSSION

MHNs employ a hyper-vigilant strategy to guarantee a secure atmosphere within psychiatric wards. However, this approach may inadvertently impede the establishment of a safe environment and even diminish MHNs' perception and involvement in its maintenance.

IMPLICATIONS FOR MENTAL HEALTH NURSING

According to our research, it appears that MHNs need to improve their education and training in order to successfully implement the vigilance strategy for establishing a secure environment. Additionally, it is essential for them to prioritize therapeutic communication with patients, as this plays a vital role in promoting a safe environment within inpatient psychiatric wards.

Safety and security procedures in psychiatric acute admission wards

Violence and assaultive behaviour is a serious and growing problem in psychiatric services across the world. Despite many concerns about violence and assault in healthcare, there is an alarming lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals.

This paper describes the safety and security measures in psychiatric acute admission wards in the Republic of Ireland and may be considered to be representative of acute psychiatric settings in other jurisdictions. A population study was undertaken, which included all psychiatric acute admission wards in the Republic. A descriptive survey research design was adopted, with the use of a questionnaire for data collection. The questionnaire was analysed using SPSS (version 11) and descriptive statistics were used to present the results.

There was wide variation in safety and security practices across the wards. Measures aimed at ensuring staff security were also lacking, with no overall acceptable minimal standards discernible. It may be concluded that there is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards. One has to ask to what extent the disparate practices in safety and security revealed in the results of the study account for the escalation in violent episodes and assaultive behaviour in psychiatric services in recent years.

The Diagnostic Efficiency of the Extended German Brøset Violence Checklist to Assess the Risk of Violence

Background and Purpose: The prevention of aggression and violence of patients is part of the challenge for the psychiatric inpatient care. Resources needed are a systematic risk assessment and taking preventive measures according to the risk. The extended Brøset Violence Checklist (BVC-CH) is an assessment instrument for the short-term assessment of the risk of violence for physical attacks toward medical staff and other patients. Until now, the instrument was only validated in the context of the development phase of the instrument. The aim of this study was to investigate how valid the BVC-CH scale is for adult psychiatry in acute inpatient care facilities. Methods: In a prospective cohort study, 232 consecutively admitted patients were assessed using the BVC-CH. The calculation of the predictive values was based on a contingency table. The discriminatory power of the instrument and the determination of the cutoff point were done using the receiver operating characteristic (ROC) curve analysis. Physical attacks were registered with the Staff Observation of Aggression Scale–Revised (SOAS-R). Results: The sensitivity was 58.8% and the specificity was 96.8% by a cutoff point of ≥7. By choosing a cutoff point of ≥6, the sensitivity was 64.7% and the specificity was 95.1%. A value of .93 was determined for the area under the curve receiver operating characteristic (AUCROC). Conclusions: Overall, the BVC-CH is a valid instrument for the short-term prediction of physical attacks. Further research of the BVC-CH is recommended but in particular for the cutoff point.

Safety and security in acute admission psychiatric wards in Ireland and London: a comparative study

AIMS AND OBJECTIVES

The comparative element of this study is to describe safety and security measures in psychiatric acute admission wards in the Republic of Ireland and London; to describe differences and similarities in terms of safety and security patterns in the Republic of Ireland and London; and to make recommendations on safety and security to mental health services management and psychiatric nurses.

BACKGROUND

Violence is a serious problem in psychiatric services and staff experience significant psychological reactions to being assaulted. Health and Safety Authorities in the UK and Ireland have expressed concern about violence and assault in healthcare, however, there remains a lack of clarity on matters of procedure and policy pertaining to safety and security in psychiatric hospitals.

DESIGN

A descriptive survey research design was employed.

METHODS

Questionnaires were circulated to all acute wards in London and in Ireland and the resulting data compared.

RESULTS

A total of 124 psychiatric wards from London and 43 wards from Ireland were included in this study and response rates of 70% (London) and 86% (Ireland) were obtained. Differences and similarities in safety and security practices were identified between London and Ireland, with Irish wards having generally higher and more intensive levels of security.

CONCLUSIONS

There is a lack of coherent policy and procedure in safety and security measures across psychiatric acute admission wards in the Republic of Ireland and London. Given the trends in European Union (EU) regulation, there is a strong argument for the publication of acceptable minimum guidelines for safety and security in mental health services across the EU.

RELEVANCE TO CLINICAL PRACTICE

There must be a concerted effort to ensure that all policy and procedure in safety and security is founded on evidence and best practice. Mental health managers must establish a review of work safety and security procedures and practices. Risk assessment and environmental audits of all mental health clinical environments should be mandatory.

Pediatric nurses: advocates against youth violence

ISSUES AND PURPOSE

This article examines the issues of youth violence and the role of the pediatric nurse in addressing youth at risk for violence. An example of a school-based violence prevention program is included.

CONCLUSIONS

Black adolescent males from lower socioeconomic backgrounds and violent communities tend to be at highest risk. However, the profile of risk for violence is expanding to include youth in rural and middle-class suburban settings.

PRACTICE IMPLICATIONS

Pediatric nurses play a vital role in the identification of at-risk youth and in the planning and evaluation of interventions for youth violence prevention.

Clinician safety

Clinician safety is a serious concern for health care professionals because of the great risk of violence in health care workplaces, especially emergency and mental health departments. Assaults on mental health staff are often encountered from patients who are intoxicated with, or suffering withdrawal symptoms from, substances. Additionally, violence toward mental health professionals is frequently encountered from patients diagnosed with paranoid schizophrenia, personality disorders, learning disabilities, and mental retardation. Incidents of assault are often ignored by victims and administrators. Administrators must implement several measures to prevent clinician assault.