Patient Violence in Psychiatric Residency: A Nationwide Survey

Park, Tricia L.; Schwartz, Thomas L.

doi:10.29046/jjp.016.1.001

Cited by 2 publications

(1 citation statement)

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“…Physical violence against staff can lead to low morale in the workplace and high employee turnover [2]. In a nationwide survey of psychiatric residents, it was found that 36% of residents have been assaulted, while 74% have been threatened [3]. These statistics illustrate the need for clinicians to be well equipped when faced with an agitated patient.…”

Section: Introductionmentioning

confidence: 99%

Avoiding the Chill Pill- Results from a Simulation-Based Verbal De-escalation Training for Psychiatry Residents in a Community Mental Health Center

Bodic

2023

J Intern Med Emerg Res.

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Background: Potentially dangerous encounters with uncooperative, belligerent, or even violent patients in the Emergency Department and Psychiatric Inpatient Units require skilled responses and timely management of episodes of acute agitation. Lack of training and knowledge in these scenarios could compromise the safety of both staff and patients. There have been improvements in knowledge and comfort when dealing with acutely agitated patients documented in previous studies that have used simulation training for junior psychiatry residents. Objectives: Understand the existing knowledge and skill gap and attempt to address it through simulation training. Methods: This is an IRB exempt quality improvement project, supported with funds from the Committee of Interns and Residents. The study was conducted over 3 years (2019-2022). All psychiatry residents (N=36) participated in an online module (4hrs, JCAHO and OMH accredited) and simulation training with 3 standardized patients (actors). All residents were blind to the clinical scenarios and observed by faculty. Each incoming class (2019-2022) has been trained yearly since. Pre and post intervention surveys asked questions about knowledge, comfort, perceived competence, prior training, verbal de-escalation skills (APSP-agitated patient simulation project survey) and the validated Management of Aggression and Violence Attitude Scale (MAVAS). Results: Data from pre- and post- intervention APSP responses were analyzed using the student’s paired t-test. Residents felt significantly more comfortable handling verbal de-escalation post training (score of 6 vs. 8, P<0.0001) and more competent evaluating and managing agitated patients (6 vs. 8, p<0.0001). They showed significant (p<0.05) changes in attitudes around seclusion and restrains and causes of agitation on MAVAS. The most used de-escalation interventions were: Explaining the situation and process, Summarizing the content, and Identifying patient’s feelings, wants and needs. Triggering behaviors included interrupting/ talking over the patient, not prioritizing patient’s needs, insisting on using medications. Conclusion: This project showed simulation-based training successfully addressed an important practice and knowledge gap and lent structure to the tailored protocol-based approach for managing agitated patients, especially in busy ER settings. Residents appreciated the simulation-based training with real life scenarios – they found it useful and engaging and they welcomed the interaction with standardized patients (SPs) during the training.

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Section: Introductionmentioning

confidence: 99%