BackgroundViolence is frequent towards nurses in forensic mental health hospitals. Implications of this high risk environment have not been systematically explored. This paper explores occurrence of symptoms on post traumatic stress and their relationship to professional quality of life.MethodsSelf report questionnaires assessing symptoms of post traumatic stress and professional quality of life were distributed among psychiatric nurses in a high security forensic psychiatric unit with high frequency of violent behaviour. Relationships between post traumatic stress symptoms, forensic nursing experience, type of ward and compassion satisfaction, burnout and compassion fatigue were explored.ResultsThe prevalence of post traumatic stress symptoms was low. Low scores were found on compassion satisfaction. Length of psychiatric nursing experience and low scores on compassion satisfaction were correlated to increased post traumatic stress symptoms.ConclusionAlthough high violence frequency, low rate of post traumatic stress symptoms and low compassion satisfaction scores was found. High staff/patient ratio and emotional distance between staff and patients are discussed as protective factors.
Short-to medium-term risk assessment in psychiatric hospitals is a topic of clinical relevance that deserves attention from the research community. In this paper, the Short Term Assessment of Risk and Treatability, or START (Webster, Martin, Brink, Nicholls, & Middleton, 2004), a new structured instrument for judgment of dynamic risk and treatment factors is briefly described. Internal reliability properties are analyzed and the predictive validity for severe violence in a Norwegian high secure psychiatric hospital is investigated. The results indicate that the START has promise as a valid tool for short-term violence risk assessment. The authors make an argument for the importance and relevance of dynamic risk and strength factors in the short to medium term.
Our objective was to describe and analyze the implementation process of the Short Term Assessment of Risk and Treatability in a forensic high secure unit in Norway. A stepwise implementation procedure was used and an educational package on practical use of the START in the clinic was developed. A questionnaire about START was given to the staff at the end of the first implementation phase and semi-structured qualitative interviews with staff on the content of security decision processes were carried out. Also, a log of the actual number of completed START scorings was made, including the number of ratings and the regularity of these ratings finished within this time frame. After six months' implementation the questionnaire showed that 74% of the staff agreed that the evaluations made on the basis of START were interdisciplinary. Seventy-three percent also agreed that START contributed significantly to a more systematic risk assessment and management, and 79% said the START was useful as a tool in risk assessments and treatment planning. Informants from the interview study described how the START structured their clinical judgement. At the same time, the START fulfilled their wish to address both the patients' strengths and risks. The START continued to be in regular use after the more intensive implementation process.Our results indicate that the implementation of START had led to interdisciplinary security decisions with a broader perspective of the patients' situation.
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