Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives

Lamanna, Denise; Ninkovic, Danijela; Vijayaratnam, Vinothini; Balderson, Ken; Spivak, Harold; Brook, Shelley; Robertson, David W.

doi:10.1080/09638237.2016.1207222

Cited by 29 publications

(57 citation statements)

References 30 publications

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“…() studies show that patient characteristics such as symptoms (including drug or alcohol use), personality traits and demographic factors can give rise to aggressive/violent behaviour. However, results from this review suggest that patients did not emphasize symptoms of mental illness as significant for their aggressive/violent behaviour, which is consistent with results from other qualitative studies (Ilkiw‐Lavalle & Grenyer, ; Lamanna et al., ).…”

Section: Discussionsupporting

confidence: 89%

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

Tingleff

Bradley²,

Gildberg

et al. 2017

Psychiatric Ment Health Nurs

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Introduction There is a lack of research into psychiatric patients' perceptions of coercion that discriminates between different types of coercive measures, while also investigating patients' perceptions of undergoing coercion as a process. This knowledge is required to improve our understanding and provide a foundation for improving clinical practice. Aims To review existing research literature in order to investigate adult psychiatric patients' reported perceptions of situations before, during and after specific and defined types of coercive measures, and to investigate what patients perceive as moderating factors, in regard to the use of these coercive measures. Method A systematic review and thematic analysis of 26 peer-reviewed studies was undertaken. Results The analysis identified six themes and additional subthemes, where "interactions with professionals" and "communication" were predominant themes across the timeline of coercion. Altogether, themes were associated with either "positive or negative patient-perceived impact." Implications for practice Increased sensitivity to patients' views of the situation at each point in the process is desirable in order to respond to the patients' individual needs. Professionals also need to articulate concern and empathy towards the patient and to improve communication skills before, during and after a coercive incident. Use of de-escalation and noncoercive strategies is required. Relevance statement Coercion within psychiatric/mental health care remains controversial, and repeated international calls have recommended a reduction of their use. This review indicates that greater attention to how patients perceive the use of coercive measures (before, during, and after incidents) needs to be considered in order to improve the evidence-based and clinical practice.

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Section: Discussionsupporting

confidence: 89%

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

Tingleff

Bradley²,

Gildberg

et al. 2017

Psychiatric Ment Health Nurs

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“…Interestingly, several people indicated that the app helped with boredom or getting through the day during their involuntary stay at the hospital. This is consistent with other findings that the treatment environment is a major contributor to aggression, especially when there is a lack of activity or variation in activity [ 42 , 43 ]. We know from the literature that periods of inactivity and boredom are consistent with an increased likelihood of aggression and violence [ 43 ]; therefore, this study reinforces the idea that interventions that alleviate boredom could conceivably be used to reduce aggression in future research, as in the following cases:…”

Section: Resultssupporting

confidence: 93%

Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study

Mistler¹,

Ben‐Zeev²,

Carpenter‐Song³

et al. 2017

JMIR Ment Health

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BackgroundAggression and violence on acute psychiatric inpatient units is extensive and leads to negative sequelae for staff and patients. With increasingly acute inpatient milieus due to shorter lengths of stay, inpatient staff is limited in training and time to be able to provide treatments. Mobile technology provides a new platform for offering treatment on such units, but it has not been tested for feasibility or usability in this particular setting.ObjectiveThe aim of this study was to examine the feasibility, usability, and acceptability of a brief mindfulness meditation mobile phone app intended to reduce anger and aggression in acute psychiatric inpatients with schizophrenia, schizoaffective disorder, or bipolar disorder, and a history of violence.MethodsParticipants were recruited between November 1, 2015 and June 1, 2016. A total of 13 inpatients at an acute care state hospital carried mobile phones for 1 week and were asked to try a commercially available mindfulness app called Headspace. The participants completed a usability questionnaire and engaged in a qualitative interview upon completion of the 7 days. In addition, measures of mindfulness, state and trait anger, and cognitive ability were administered before and after the intervention.ResultsOf the 13 enrolled participants, 10 used the app for the 7 days of the study and completed all measures. Two additional participants used the app for fewer than 7 days and completed all measures. All participants found the app to be engaging and easy to use. Most (10/12, 83%) felt comfortable using Headspace and 83% (10/12) would recommend it to others. All participants made some effort to try the app, with 6 participants (6/12, 50%) completing the first 10 10-minute “foundation” guided meditations.ConclusionsThis is the first known study of the use of a commercially available app as an intervention on acute psychiatric inpatient units. Acutely ill psychiatric inpatients at a state hospital found the Headspace app easy to use, were able to complete a series of meditations, and felt the app helped with anxiety, sleep, and boredom on the unit. There were no instances of an increase in psychotic symptoms reported and there were no episodes of aggression or violence noted in the record.

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“…Twenty-seven studies explored violent and aggressive incident experiences in staff,81–96 patients,97–99 mixed groups100–106 and patient family members 27. Five studies explored the risk factors associated with verbal and physical aggression 35 37 107–109. Three studies explored mental health nurses’ perspectives on the response to violent situations in high secure environments: one on the psychological impact of physical assault on staff,110 one on making violence risk assessments in imminent violent situations111 and one on the decline of incident reports 112.…”

Section: Resultsmentioning

confidence: 99%

Patient safety in inpatient mental health settings: a systematic review

et al. 2019

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ObjectivesPatients 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.DesignSystematic 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.ResultsOf 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.ConclusionsPatient 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 numberCRD42016034057.

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Aggression in psychiatric hospitalizations: a qualitative study of patient and provider perspectives

Abstract: 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.

Cited by 29 publications

References 30 publications

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

“Treat me with respect”. A systematic review and thematic analysis of psychiatric patients’ reported perceptions of the situations associated with the process of coercion

Mobile Mindfulness Intervention on an Acute Psychiatric Unit: Feasibility and Acceptability Study

Patient safety in inpatient mental health settings: a systematic review

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