ORCID Profile
0000-0002-8862-1527
Current Organisations
University of Northampton
,
Northumbria University
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Publisher: Wiley
Date: 08-2014
DOI: 10.1111/JAN.12495
Abstract: To explore mental health nurses' knowledge, attitudes and clinical judgement concerning medicines management in an inpatient setting with a view to enhancing training. Medicines management is a key role of mental health nurses, but little research has been conducted into their training needs. An exploratory mixed-methods design was used involving in idual interviews with participants to investigate their responses to hypothetical medicine administration scenarios. Interviews were held with a convenience s le of 50 Registered Nurses working in a specialist mental health hospital between November 2012-February 2013. Participants were presented with clinical vignettes describing eight scenarios they might encounter as part of their medicines management role and asked about how they would respond. Responses were assessed by two independent raters against ten quality standards underpinning the vignettes. The median number of responses that were judged to demonstrate adequate awareness of associated quality standards was 4 (range 1-7), indicating that many participants did not appear to be aware of, or compliant with, current UK medicines management guidance and local policy. Many would not report a 'near miss' or medicines administration error. There was a lack of awareness of guidance on verbal prescribing, consent to treatment rules and the administration of off-label/unlicensed drugs. Past year attendance on a medicines management course, time since registration and self-reported knowledge of national standards for medicines administration did not discriminate between total score on the 10 quality standards. The medicines management training needs of participants appeared not to be fully met by the existing learning sources. The use of vignettes to assess nurses' training needs requires evaluation in other settings.
Publisher: Wiley
Date: 23-06-2016
DOI: 10.1111/JOCN.13403
Publisher: Informa UK Limited
Date: 10-03-2017
Publisher: Elsevier BV
Date: 09-2023
Publisher: Wiley
Date: 12-02-2018
DOI: 10.1111/JPM.12450
Abstract: WHAT IS KNOWN ON THE SUBJECT?: It is generally felt that it is helpful for mental health nurses to control their emotions during their work. There are different approaches, but there is growing acceptance that different emotions may need different coping strategies. There is lots of evidence that nurses sometimes feel anger in a number of situations, but the research about anger in mental health nurses has never been examined as a whole. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: We have systematically identified all previous research where nurses completed measures that tried to measure their anger in certain situations, compared it to other people or investigated how it affected them or what its relationship was with their practice. Only a few studies have measured nurses' anger. However, it seems that while nurses are not generally angrier than any other group, they do often feel anger in relation to management of patient aggression and their job situation more generally. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Anger is the most commonly reported problematic emotion for mental health nurses. It may influence their practice and affect their well-being. This has implications for staff support and training. Introduction Emotional regulation is important in mental health nursing practice, but in idual emotions may require different regulation strategies. There is le evidence that nurses experience anger specifically during their work, for ex le when experiencing patient aggression. It is, therefore, important to consolidate what is known about how anger manifests in mental health nursing practice. We aimed to systematically identify, evaluate and synthesize results from studies about mental health nurses and anger, where anger was measured objectively. Systematic literature review based on PRISMA guidelines. We identified 12 studies. A range of validated and nonvalidated instruments was used. Mental health nurses may have lower levels of anger than normative s les, but anger is commonly reported as an issue for them. Anger was studied in relation to its links with (1) clinical management of patients, notably violence containment and (2) employment issues more generally, notably job motivation. Anger is related to nurses' attitudes about the acceptability of coercion, but there is no evidence that it results in more coercion. Nurses should be aware of the potential influence of anger on their practice. Anger, specifically, should be considered when supporting mental health nurses, for ex le in clinical supervision. Emotional regulation training should target anger.
Publisher: Elsevier BV
Date: 03-2013
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.PSYCHRES.2017.07.009
Abstract: The Short-Term Assessment of Risk and Treatability (START) assists risk assessment for seven risk outcomes based on scoring of risk and protective factors and assignment of clinically-informed risk levels. Its predictive validity for violence and self-harm has been established in males with schizophrenia, but accuracy across pathologically erse s les is unknown. Routine START assessments and 3-month risk outcome data of N = 527 adult, inpatients in a UK secure mental health facility were collected. The s le was ided into diagnostic groups predictive validity was established using receiver operating characteristics regression (rocreg) analysis in which potential covariates were controlled. In most single-diagnosis groups START risk factors ('vulnerabilities'), protective factors ('strengths'), and clinically-informed estimates predicted multiple risk outcomes with effect sizes similar to previous research. Self-harm was not predicted among patients with an organic diagnosis. The START risk estimates predicted physical aggression in all diagnostic groups, and verbal aggression, self-harm and self-neglect in most diagnostic groups. The START can assist assessment of aggressive, self-harm, and self-neglect across a range of diagnostic groups. Further research with larger s le sizes of those with multiple diagnoses is required.
Publisher: Cambridge University Press (CUP)
Date: 13-02-2014
DOI: 10.1017/S1352465813001124
Abstract: Background: Previous studies about the effectiveness of Dialectical Behaviour Therapy for the treatment of Borderline Personality Disorder have had promising results. However, no previous studies have examined its effectiveness when delivered in low secure inpatient services for women. Aims: To evaluate clinical outcomes during and after a 1-year period of admission within a low secure unit for women offering a Dialectical Behaviour Therapy programme. Method: A naturalistic, within subjects study of clinical data collected as part of routine practice was conducted. Participants were18 consecutively admitted women who met the diagnostic criteria for Borderline Personality Disorder and had completed at least 1 year of treatment. Measures covered: risk behaviours self-reported symptoms of Borderline Personality Disorder, and current mood and symptom experience staff reports of clinical problems, needs and social functioning. Scores were compared between admission and at 6 months and 1 year. Results: There was a statistically significant improvement on all 13 measures over the year's treatment. Most improvement was demonstrated between admission and 6 months. Conclusions: Engagement in1-year's treatment was associated with significant reduction in risk behaviours and both staff-rated and self-rated outcome measures. Some significant questions remain about which elements of the programme are most effective but the results are encouraging.
Publisher: Wiley
Date: 13-02-2015
DOI: 10.1111/JIR.12184
Abstract: People with intellectual disability (ID) account for a large proportion of aggressive incidents in secure and forensic psychiatric services. Although the Historical, Clinical, Risk Management 20 (HCR-20) has good predictive validity in inpatient settings, it does not perform equally in all groups and there is little evidence for its efficacy in those with ID. A pseudo-prospective cohort study of the predictive efficacy of the HCR-20 for those with ID (n = 109) was conducted in a UK secure mental health setting using routinely collected risk data. Performance of the HCR-20 in the ID group was compared with a comparison group of adult inpatients without an ID (n = 504). Analysis controlled for potential covariates including security level, length of stay, gender and diagnosis. The HCR-20 total score was a significant predictor of any aggression and of physical aggression for both groups, although the area under the curve values did not reach the threshold for a large effect size. The clinical subscale performed significantly better in those without an ID compared with those with. The ID group had a greater number of relevant historical and risk management items. The clinicians' summary judgment significantly predicted both types of aggressive outcomes in the ID group, but did not predict either in those without an ID. This study demonstrates that, after controlling for a range of potential covariates, the HCR-20 is a significant predictor of inpatient aggression in people with an ID and performs as well as for a comparison group of mentally disordered in iduals without ID. The potency of HCR-20 subscales and items varied between the ID and comparison groups suggesting important target areas for improved prediction and risk management interventions in those with ID.
Publisher: Elsevier BV
Date: 12-2020
Publisher: Wiley
Date: 21-06-2015
DOI: 10.1002/CBM.1967
Abstract: Violent and non-violent sexual behaviour is a fairly common problem among secure mental health service patients, but specialist sexual violence risk assessment is time-consuming and so performed infrequently. We aimed to establish whether a commonly used violence risk assessment tool, the Health Clinical Risk management 20(HCR-20), has predictive validity specifically for inappropriate sexual behaviour. A pseudo-prospective cohort design was used for a study in the adult wards of a large provider of specialist secure mental health services. Routine clinical team HCR-20 assessments were extracted from records, and incidents involving inappropriate sexual behaviour were recorded for the 3 months following assessment. Of 613 patients, 104 (17%) had engaged in at least one inappropriate sexual behaviour in 65 (10.6%), the sexual act was violent. HCR-20 total score, clinical and risk management subscales, predicted violent and non-violent sexual behaviour. The negative predictive value of the HCR-20 for inappropriate sexual behaviour was over 90%. Prediction of violent sexual behaviour may be regarded as well within the scope of the HCR-20 as a structured professional judgement tool to aid violence risk prediction, but we found that it also predicts behaviours that may be of concern but fall below the violence threshold. High negative predictive values suggest that HCR-20 scores may have some utility for screening out patients who do not require more specialist assessment for inappropriate sexual behaviour. Copyright © 2015 John Wiley & Sons, Ltd.
Publisher: Wiley
Date: 14-07-2004
Publisher: Informa UK Limited
Date: 10-2009
Publisher: Informa UK Limited
Date: 03-04-2015
Publisher: Wiley
Date: 10-10-2023
DOI: 10.1111/INM.13237
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.PSYCHRES.2014.07.080
Abstract: The Historical, Clinical and Risk Management Scales (HCR-20) may be a better predictor of inpatient aggression for selected demographic and clinical groups but homogeneity of study s les has prevented definitive conclusions. The aim of this study, therefore, was to test the predictive validity of the HCR-20 as a function of gender, diagnosis, age, and ethnicity while controlling for potential covariates. A pseudo-prospective cohort study (n=505) was conducted in a UK secure/forensic mental health setting using routinely collected data. The HCR-20 predicted aggression better for women than men, and for people with schizophrenia and/or personality disorder than for other diagnostic groups. In women, the presence of the risk management items (R5) was important while men׳s aggression was best predicted solely by current clinical features from the C5 scale. R5 items were better than C5 items for predicting aggression in people with organic and developmental diagnoses. Our data provide additional information on which HCR-20 raters can formulate overall summary judgements about risk for inpatient aggression based on important demographic and clinical characteristics.
Publisher: SAGE Publications
Date: 07-2007
Abstract: Reports of gender differences amongst arsonists at psychiatric assessment are not uncommon, however some are based on relatively small s les. A new retrospective study highlighting gender differences could help to confirm or refute the current state of knowledge. The aim of the current study was to examine gender differences amongst a s le of 167 adult arsonists (129 males and 38 females). Information was collected from clinical records on socio-demographic, family background and childhood factors adult adjustment fire setting history motives features of pyromania and other offending, from the case notes of a group of arsonists referred to the West Midlands Psychiatry Service over a 24-year period. Female arsonists were older than males and more likely to have a psychiatric diagnosis. Women more frequently had a history of sexual abuse, while men had a more varied criminal background and more substance abuse problems. Our findings largely support previous research, and are discussed in this context, whilst also bringing attention to a more recently developed theory (Action System Model). Significant gender differences amongst arsonists indicates that different emphases in the treatment of male and female arsonists may be advisable, though a reliable evidence base for treatment has yet to be established.
Publisher: Wiley
Date: 19-04-2021
DOI: 10.1111/JOCN.15780
Abstract: To evaluate and examine the utility of the Violence Prevention Climate scale by generalist healthcare professionals. Workplace violence in general hospital settings remains a challenge for healthcare organisations. High rates of violence are still being reported towards healthcare workers, despite organisational violence prevention strategies being implemented. There is a major challenge to healthcare organisation in the measurement of the effectiveness of these interventions, traditionally completed via the reporting and monitoring of workplace violent incidents. A novel approach to measuring workplace violence is by studying hospital atmosphere or climate. A cross‐sectional survey using the STARD guidelines was used. The Violence Prevention Climate scale was completed by 194 healthcare staff working in the emergency department, medical/surgical wards, respiratory/infectious disease, spinal care, renal unit, corrections health, and rehabilitation and community services of a major Australian tertiary referral hospital. The Violence Prevention Climate scale has previously been validated and used in mental health settings, but not general hospital settings. A content analysis of an open‐ended question on violence prevention management strategies was also conducted. Comprising of 14 items with two factors (patients and staff), the study revealed a 9‐item staff factor scale that can be used in the general hospital setting, the patient factor did not show adequate reliability. The content analysis revealed seven categories of staff identified violence prevention and management strategies. The use of the 9‐item scale across an organisation annually, or added to existing organisational workforce surveys, could prove to be practical way of measuring the social climate of violence in a general hospital setting. The results of which could guide clinical practice, workplace safety, policy and educational initiatives for the prevention and management of workplace violence.
Publisher: Informa UK Limited
Date: 12-2011
Publisher: Wiley
Date: 12-2001
DOI: 10.1046/J.1351-0126.2001.00426.X
Abstract: The need for accurate local information on the scale, nature and outcome of absconding or Absence Without Leave (AWOL) from an independent UK psychiatric hospital led to this 3-year (1997-1999) retrospective analysis of of AWOL data. One hundred and forty-eight AWOL incidents involving 88 patients were identified. Absconders were found to be significantly younger, more likely to be detained upon admission and more likely to be unmarried than a control group (n = 1378) of non-absconders. There were no significant differences for sex, length of admission or ethnicity. Descriptive data on the circumstances surrounding AWOL events are given, with at least 24 (16.2%) incidents having serious adverse outcomes. Baseline absconding rates are presented for the specialist clinical isions within the hospital. There is a need for more detailed studies of absconding by patients within the Adolescent Mental Health Service subgroup where the absconding rate was relatively high and engagement in risk activity whilst AWOL relatively frequent.
Publisher: Mark Allen Group
Date: 07-2008
DOI: 10.12968/BJON.2008.17.13.30528
Abstract: It is becoming increasingly clear that medication administration errors are common in routine clinical practice. I was co-investigator on a recent study (Haw et al, 2007) which found that errors occurred in one quarter of all administered doses in an inpatient psychiatric elderly unit. This is not an isolated result: error rates ranging from 3.5–27% of all prescribed doses have been reported in various medical and surgical settings (Barker et al, 2002 Prot et al, 2003 Tissot et al, 2003). In the most serious cases medication errors can have grave consequences for patients and clinicians.
Publisher: Wiley
Date: 02-2018
DOI: 10.1111/JCAP.12206
Abstract: Community-based mealtime management is an intensive, focused, and time-limited intervention for young people with an eating disorder which aims to support refeeding at home and thus prevent hospital admission. Little is known about clinicians' experiences of delivering this intervention. We aimed to explore mental health clinicians' perspectives on community mealtime management with children and adolescents diagnosed with an eating disorder. A qualitative design was used. Semistructured interviews were conducted with six mental health clinicians with experience of delivering or referral for the intervention. Interview recordings were transcribed and subjected to a thematic analysis. Analysis resulted in identification of three themes: (a) technical aspects of mealtime management, (b) emotional aspects of mealtime management, and (c) a mixed zone of uncertainty around the use of dietary supplements. Overall, participants believed mealtime management to be a valuable intervention. Findings highlight the perceived need for more formal training for clinicians undertaking mealtime management, and the positive impact this could potentially have on their practice. Clinicians' emotion regulation during intervention delivery was perceived to be important. There was a perceived need for greater adherence to protocols but an acceptance that flexibility was also required.
Publisher: Wiley
Date: 14-06-2021
DOI: 10.1002/NOP2.960
Abstract: There is a lack of clarity about the components which would signify appropriate psychological strengths among nursing student candidates. This study was conducted to identify such components from the viewpoint of the clinical nurses and nursing instructors. A qualitative study. This study comprised qualitative research using a conventional content analysis approach. Participants were 25 nurses and nursing instructors. Data were collected in audio‐recorded and transcribed semi‐structured interviews and were analysed using MAXQDA10 software. Analysis revealed four main categories including "anger management," "Stress/distress management," "self‐belief" and "aptitude for hard work." This study identified core components for future investigations into the psychological strengths of nursing applicants. This study provides specific testable hypotheses for future research endeavours. It is recommended that the researchers investigate the appropriateness of the components identified in this study to assess the psychological strength of the applicants in the longitudinal studies.
Publisher: American Physical Society (APS)
Date: 25-03-2022
Publisher: Elsevier BV
Date: 04-2019
Publisher: Wiley
Date: 29-03-2019
DOI: 10.1111/JOCN.14847
Abstract: To evaluate and explore mental health nurses' responses to and experience of an educational intervention to improve attitudes towards people with a diagnosis of borderline personality disorder (BPD). Report findings are concordant with relevant EQUATOR guidelines (STROBE and COREQ). Attitudes towards people with a diagnosis of BPD are poorer than for people with other diagnoses. There is limited evidence about what might improve this situation. One intervention with reportedly good effect uses an underlying biosocial model of BPD. No previous intervention has been co-produced with an expert by experience. We developed and delivered a 1-day intervention comprising these elements. A mixed-methods design was used comprising prospective within-subjects cohort intervention and qualitative elements. Participants were mental health nursing staff working in inpatient and community settings in one NHS Board in Scotland, UK. Measurement of cognitive and emotional attitudes to people with a diagnosis of BPD at pre- and postintervention (N = 28) and at 4-month follow-up. Focus groups were used to explore participants' experiences of the intervention (N = 11). Quantitative evaluation revealed some sustained changes consistent with expected attitudinal gains in relation to the perceived treatment characteristics of this group, the perception of their suicidal tendencies and negative attitudes in general. Qualitative findings revealed some hostility towards the underpinning biosocial model and positive appreciation for the involvement of an expert by experience. Sustained benefits of an educational intervention for people working with people diagnosed with BPD in some but not all areas. Participants provided contrasting messages about what they think will be useful. The study provides further evidence for incorporation of a biosocial model into staff training as well as the benefits of expert by experience co-production. Mental health nurses, however, believe that more well-resourced services are the key to improving care.
Publisher: Mark Allen Group
Date: 08-2008
DOI: 10.12968/IJTR.2008.15.8.30819
Abstract: Health-care professionals working in mental health settings are at risk of encountering violent and aggressive behaviour from patients, which can have a detrimental effect on their physical, psychological, emotional and spiritual well-being. Prevention and management of aggression and violence is therefore a priority. However, unlike their nursing colleagues, allied health professionals are not routinely taught such strategies in their pre-registration training. This article describes and critically explores violence prevention and management strategies under three headings: psychological, physical and pharmacological interventions. This is intended as a discussion article to introduce and update allied health-care professions in this area, assist them in identifying their own training needs, and allow them to have a greater role in multidisciplinary planning and discussion relating to aggression and violence in mental health settings. Focused and consistent training during pre-registration programmes, particularly in psychological interventions to de-escalate potentially violent scenarios could benefi t allied health professionals who go on to work in mental health settings. Future research should address the effi cacy of all types of interventions aimed at reducing aggression.
Publisher: RCN Publishing Ltd.
Date: 06-02-2008
DOI: 10.7748/NS2008.02.22.22.35.C6356
Abstract: To examine the delegation of medication administration, including the frequency of delegation, whether delegation was to a care worker or a registered nurse (RN) and whether care workers were directly supervised when administering medication. Administration of 1313 medication doses was observed on two inpatient psychiatric wards for older people. Administration was delegated by the nurse preparing the medication for four out of every five doses, usually to another registered nurse (78% of delegated doses), but also to care workers (22%). Care workers were more likely to administer medications to confused and aggressive patients than were registered nurses. Care workers who undertake delegated medication administration should receive regular training to ensure safety. Nurses remain accountable for delegated medication administration.
Publisher: Informa UK Limited
Date: 12-2007
Publisher: Royal College of Psychiatrists
Date: 03-2009
Abstract: The assessment of the future dangerousness of firesetters is problematical but psychiatrists may be requested to perform assessment of arsonists for the courts. We surveyed the views of psychiatrists and others ( n =54) on how 11 candidate historical variables might contribute to future dangerousness. Hierarchical cluster analysis indicated that variables fell into three groups related to level of perceived dangerousness. Apparent intention to endanger life and setting fire to an occupied building were the items thought by psychiatrists to most indicate highest future dangerousness. Having previously set fires that caused extensive damage, failure to extinguish previous fires or alert the authorities were perceived as indicating moderate future dangerousness. The study adds to what is known about how psychiatrists formulate assessments of future dangerousness.
Publisher: SAGE Publications
Date: 21-02-2011
Abstract: Objective: The terms used to refer to people who receive mental healthcare have been described as either potentially stigmatizing or empowering. This paper systematically reviews empirical studies of terminological usage in order to ascertain current knowledge. Methods: Multiple databases were searched using the terms ‘patient’, ‘client’, ‘service user’ and ‘consumer’. Empirical, English language studies were included where an aim was to measure outcome related to the various terms used to describe or refer to people who use mental health services. Studies were assessed (i) against a hierarchy of evidence and (ii) using a 12-item checklist of methodological quality. Results: The search resulted in the screening of 13,765 abstracts full text versions of 69 papers were examined and 11 studies that met the inclusion criteria were identified. All were cross-sectional surveys and all measured participant preference. Nine studies satisfied four or fewer quality markers. ‘Client’ and ‘patient’ were the terms preferred by study participants. Conclusions: Despite a stream of debate in editorial columns and letters pages, it is unclear whether terminological use is important to the people who use mental health services. Preference is the sole outcome investigated empirically. Methodological rigour of extant study findings is largely questionable. Generalization and interpretation from included studies should be approached very cautiously.
Publisher: Wiley
Date: 14-05-2015
DOI: 10.1111/INM.12136
Abstract: De-escalation is an important tool for preventing aggression in inpatient settings but definitions vary and there is no clear practice guideline. We aimed to identify how clinical staff define and conceptualize de-escalation, which de-escalation interventions they would use in aggressive scenarios, and their beliefs about the efficacy of de-escalation interventions. A questionnaire survey (n = 72) was conducted using open and closed questions additionally, clinical vignettes describing conflict events were presented for participants to describe their likely clinical response. Qualitative data were subject to thematic analysis. The major themes that de-escalation encompassed were communication, tactics, de-escalator qualities, assessment and risk, getting help, and containment measures. Different types of aggression were met with different interventions. Half of participants erroneously identified p.r.n. medication as a de-escalation intervention, and 15% wrongly stated that seclusion, restraint, and emergency i.m. medication could be de-escalation interventions. Those interventions seen as most effective were the most commonly used. Clinical staff's views about de-escalation, and their de-escalation practice, may differ from optimal practice. Use of containment measures and p.r.n. medication where de-escalation is more appropriate could have a negative impact work is needed to promote understanding and use of appropriate de-escalation interventions based on a clear guideline.
Publisher: Elsevier BV
Date: 11-2014
DOI: 10.1016/J.COMPPSYCH.2014.07.010
Abstract: Few instruments have been developed to assess the risk of self-harm by psychiatric patients and the evidence for their predictive validity is limited. Given that in iduals who self-harm may also engage in other-directed aggression, and that the behaviour can be a precursor to violence, we tested whether, and for which groups, the commonly used violence risk assessment HCR-20 demonstrated predictive validity for self-harm. A pseudo-prospective cohort study (N=504) was conducted in a UK secure/forensic mental health setting using routinely collected data. HCR-20 assessments were completed by the clinical team and incidents of self-harm during the 3months following assessment were coded from patient records. The HCR-20 total score, H10 and R5 subscales, and SJ for violence significantly predicted self-harm however, AUC values did not demonstrate large effect sizes (range .345 to .749). Personality disorder and impulsivity were the strongest predictors of self-harm, but the R5 scale contained the greatest proportion of relevant items. Predictive efficacy was superior for women compared with men and for those with schizophrenia or personality disorder compared with organic and developmental disorders. The HCR-20 appears to be a significant predictor of self-harm. It may be possible to supplement HCR-20 ratings with case specific knowledge and additional known risk factors for self-harm to make a valuable summary judgement about the behaviour and thus minimise the need for multiple assessment tools.
Publisher: Wiley
Date: 11-2018
DOI: 10.1111/JPM.12508
Publisher: Wiley
Date: 13-05-2015
DOI: 10.1111/INM.12130
Abstract: Despite evidence about the negative effects of verbal aggression in mental health wards there is little research about its prevalence or about the factors that predict the behaviour among inpatients. This study aimed to determine the prevalence of verbal aggression in a secure mental health service, and to examine the relationship of verbal aggression with risk factors for aggression in the risk assessment tool HCR-20 in order to establish whether, and with which factors, the behaviour can be predicted. Verbal aggression was measured using the Overt Aggression Scale (OAS) over a 3-month period across a heterogeneous patient group (n = 613). Over half the patients (n = 341, 56%) engaged in 1594 incidents of verbal aggression. The HCR-20 total, clinical, and risk management subscale scores predicted verbal aggression, though effect sizes were not large. Item-outcome analysis revealed that impulsivity, negative attitudes, and non-compliance with medication were the best predictors of verbal aggression and, therefore, should be targeted for intervention. There are key synergies between factors predicting verbal aggression and the core mental health nursing role. Nurses, therefore, are in a prime position to develop and implement interventions that may reduce verbal aggression in mental health inpatients.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/23779608221124291
Abstract: Quantification of the social climate of mental health care environments has received considerable attention. Investigations of the resulting measures indicate that social climate is associated with in idual outcomes including patient satisfaction and staff burnout. Interest has grown in developing interventions to improve social climate in anticipation of subsequent related benefits. This study aimed to identify and critically review research about the effectiveness of interventions for improving social climate in inpatient adult acute mental health settings. Systematic review reported in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive terms were used to search multiple electronic databases from inception to July 2019. Information about intervention type(s), complexity was extracted and study quality was assessed. Twenty-three papers met inclusion criteria of which 20 used a pretest–posttest study design and three employed randomized and/or controlled designs. Interventions were environmental/structural, operational rocess-oriented and developmental erson-oriented in nature and they ranged in complexity. The Ward Atmosphere Scale was the most common outcome measure used. Following quality assessment, six studies were judged to be sufficiently robust in terms of quality, theory-base, user-inclusion, and outcomes evaluation to contribute credibly to the evidence base. Of these, four complex person- and process-oriented intervention studies and two less complex structural/environmental intervention studies resulted in positive outcomes. There is limited strong evidence that interventions positively influence measures of ward social climate in acute adult mental health settings. Such measures should not be the sole criterion of success when evaluating change. Decisions about implementing change to improve social climate should be informed by meaningful proxy measures including the views and preferences of service users and other stakeholders. Studies using stronger designs are required to establish the ability of interventions to improve social climate.
Publisher: Oxford University Press (OUP)
Date: 10-06-2007
Abstract: Relatively little is known about medication administration errors in mental health settings. To investigate the frequency and nature of medication administration errors in old-age psychiatry. To assess the acceptability of the observational technique to nurse participants. Cross-sectional study technique using (i) direct observation, (ii) medication chart review and (iii) incident reports. Two elderly long-stay wards in an independent UK psychiatric hospital. Nine nurses administering medication at routine medication rounds. Frequency, type and severity of directly observed medication administration errors compared with errors detected by retrospective chart review and incident reports. Using direct observation 369 errors in 1423 opportunities for errors (25.9%) were detected vs. chart review detected 148 errors and incident reports none. Most errors were of doubtful or minor severity. The pharmacist intervened on four occasions to prevent an error causing patient harm. The commonest errors observed were unauthorized tablet crushing or capsule opening (111/369, 30.1%), omission without a valid reason (100/369, 27.1%) and failure to record administration (87/369, 23.6%). Among the nurses observed, the error rate varied widely from no errors to one error in every two doses administered. Of the seven nurses who completed the post-observation questionnaire, all said they would be willing to be observed again. Medication administration errors are common and mostly minor. Direct observation is a useful, sensitive method for detecting medication administration errors in psychiatry and detects many more errors than chart review or incident reports. The technique appeared to be acceptable to most of the nursing staff that were observed.
Publisher: American Psychiatric Association Publishing
Date: 12-2005
DOI: 10.1176/APPI.PS.56.12.1610
Abstract: A retrospective analysis of reports of medication administration errors over a period of three and a half years was carried out in a UK psychiatric hospital. A total of 112 errors and "near misses" were studied. The reporting rate increased over time. Psychotropic, intramuscular, and as-needed medications were overrepresented in the error reports. Fifteen percent of the errors had the potential to cause moderate or severe harm to patients. The two most common factors cited by nurses as contributing to error causation were a busy, noisy environment and personal factors, such as feeling tired or unsupported. Physicians were cited as having contributed to some errors.
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.PHYSIO.2012.12.009
Abstract: Osteoporosis is characterised by low bone mineral density (BMD) leading to an increased risk of fracture. Patients who have sustained a significant traumatic brain injury may have an increased risk of secondary reduced BMD as a result of immobility and other factors. To describe BMD in a cohort of patients recovering from traumatic brain injury, and to discuss the implications of the findings for physiotherapy practice. Prospective, observational. Specialist, residential unit providing care for in iduals with brain injury, many with a history of severe challenging behaviour. Current inpatients (n=51, 80% male) with the capacity to provide consent, as judged by their responsible clinician. The median age was 41 years (range 20 to 60 years), and the median time since the brain injury was sustained was 22 years (range 4 to 54 years). Participants' BMD was measured at the radius and tibia using quantitative ultrasound. Various clinical and demographic details were collected. Participants had suboptimal BMD measurements that were generally low for their age and gender. Nine (18%) participants met the criteria for osteopenia measured at the radius, and 26 (51%) participants met criteria for osteoporosis or osteopenia measured at the tibia. Some participants had reduced BMD, putting them at risk of fracture or of developing such risk in the future. This group is at particular risk because they frequently display challenging aggressive behaviours that may be met with responses including proportionate use of manual restraint. Physiotherapists should bear this increased risk in mind when devising exercise programmes assessing risk in neurobehavioural rehabilitation settings.
Publisher: Emerald
Date: 05-08-2014
Abstract: – Use of off-license medicines in forensic mental health settings is common and unlicensed drugs are sometimes prescribed. Despite their responsibility for administering medicines little is known about how mental health nurses view these practices. The paper aims to discuss these issues. – In total, 50 mental health nurses working in low and medium secure adolescent and adult mental health wards were presented with a clinical vignette about administration of unlicensed and off-license medicines. Semi-structured interviews about their likely clinical response to, and feelings about, this practice were conducted. Interview data were subject to a thematic analysis. – Analysis revealed six themes: status of unlicensed/off-label medicines legality of administering unlicensed medicines professional standards around administering unlicensed medicines finding out more about unlicensed medicines trusting medical colleagues and decision making in uncertain cases. – Forensic mental health nurses take a pragmatic approach to the practice of administering unlicensed medicines and most are aware of their professional responsibilities. – This study provides the first evidence to inform the development of training for forensic mental health nurses about an issue that is common in forensic mental health practice.
Publisher: Cambridge University Press (CUP)
Date: 22-08-2007
Publisher: Elsevier BV
Date: 04-2020
Publisher: Public Library of Science (PLoS)
Date: 05-10-2023
Publisher: Mark Allen Group
Date: 09-2008
DOI: 10.12968/BJON.2008.17.16.31073
Abstract: The portrayal of mental illness in the media can be negative and stigmatizing. Mental health nurses, therefore, need to be aware of the ways in which the media frame mental illness issues, and should be prepared to challenge inaccuracy. This article examines the changing nature of the UK press’s reporting of mental health issues by focusing on two areas. First, the changing terminology the press uses in their attempt to appear more sensitive, exemplified by recent growth in use of the term ‘suicide watch’. Secondly, the article examines the press’ reporting of the three English high-security special hospitals as an ex le of how the framing and personalization of stories is used to set the public agenda on mentally disordered offenders.
Publisher: Royal College of Psychiatrists
Date: 08-2009
Abstract: Modern mental healthcare providers must demonstrate service-level clinical effectiveness to key stakeholders. We introduced two performance indicators of clinical effectiveness based on outcome data from routinely collected Health of the Nation Outcome Scales (HoNOS) and HoNOS–secure assessments across St Andrew's Healthcare, a charity providing in-patient services in North ton and Essex. We present outcome data from the period 2004–2007. The indicators showed consistent 90-day improvement rates and increasing stability over time. the validity of results is supported by levels of change along predicted lines among different patient cohorts. It is possible and beneficial to use routine outcome measures to demonstrate clinical effectiveness at service level. the future of managing mental health outcomes will be in electronic health records systems.
Publisher: Elsevier BV
Date: 04-2016
DOI: 10.1016/J.IJNURSTU.2015.10.019
Abstract: There is some evidence that mental health nurses have poor attitudes towards people with a diagnosis of borderline personality disorder and that this might impact negatively on the development of helpful therapeutic relationships. We aimed to collate the current evidence about interventions that have been devised to improve the responses of mental health nurses towards this group of people. Systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. Comprehensive terms were used to search CINAHL, PsycINFO, Medline, Biomedical Reference Collection: Comprehensive, Web of Science, ASSIA, Cochrane Library, EMBASE, ProQuest [including Dissertations/Theses], and Google Scholar for relevant studies. Included studies were those that described an intervention whose aim was to improve attitudes towards, knowledge about or responses to people with a diagnosis of borderline personality disorder. The s le described had to include mental health nurses. Information about study characteristics, intervention content and mode of delivery was extracted. Study quality was assessed, and effect sizes of interventions and potential moderators of those interventions were extracted and converted to Cohen's d to aid comparison. The search strategy yielded a total of eight studies, half of which were judged to be methodologically weak with the remaining four studies judged to be of moderate quality. Only one study employed a control group. The largest effect sizes were found for changes related to cognitive attitudes including knowledge smaller effect sizes were found in relation to changes in affective outcomes. Self-reported behavioural change in the form of increased use of components of Dialectical Behaviour Therapy following training in this treatment was associated with moderate effect sizes. The largest effect sizes were found among those with poorer baseline attitudes and without previous training about borderline personality disorder. There is a dearth of high quality evidence about the attitudes of mental health nurses towards people with a diagnosis of borderline personality disorder. This is an important gap since nurses hold the poorest attitudes of professional disciplines involved in the care of this group. Further work is needed to ascertain the most effective elements of training programmes this should involve trials of interventions in s les that are compared against adequately matched control groups.
Publisher: Elsevier BV
Date: 03-2017
DOI: 10.1016/J.NEPR.2017.02.010
Abstract: The aim of this paper was to systematically review evidence about nursing and midwifery students' encounters with poor clinical care. We undertook a systematic review of English language empirical research using multiple databases from inception to April 2016. Hand searching was also undertaken. Included papers contained accounts of empirical research which reported on students' encounters with poor care. These were quality-assessed, information was extracted into tables, and study results were synthesized using thematic analysis. N = 14 papers met inclusion criteria study quality was moderate to good. Study synthesis revealed four themes: i) encounters with poor practice: students encounter poor practice that is likely to be worthy of professional sanction ii) while intention to report is high in hypothetical scenarios, this appears not always to translate to actual practice iii) a range of influencing factors impact the likelihood of reporting iv) the consequences of encountering and subsequently reporting poor practice appeared to have a lasting effect on students. Research is required to determine the frequency and nature of students' encounters with poor care, when and where they encounter it, how to increase the likelihood that they will report it, and how they can be supported in doing so.
Publisher: Informa UK Limited
Date: 04-03-2014
Publisher: SLACK, Inc.
Date: 04-2006
Publisher: Informa UK Limited
Date: 20-07-2020
Publisher: Elsevier BV
Date: 10-2015
DOI: 10.1016/J.COMPPSYCH.2015.07.009
Abstract: Periodic structured violence risk assessment is the principle method underlying treatment planning for mentally disordered offenders but little is known about how risk changes over time. We aimed to determine whether hospitalised patients underwent reliable clinical change in assessed risk. We used a pseudo-prospective longitudinal study design. Demographic, clinical and risk assessment data of adult inpatients (N=480) who had been routinely assessed with the HCR-20 on two to four occasions over a mean period of 17 months (SD=2) were collated. Linear mixed models regression was conducted to determine change over time on total, subscale, and in idual item scores, and relative change between clinical and demographic groups. The Reliable Change Index was calculated to examine whether change was greater than that expected by measurement error clinically significant change was defined as the extent to which HCR-20 scores reduced below previously reported scores for patients not requiring hospitalisation. HCR-20 total score (Estimate -0.42, 95% CI=-0.84, -0.01, p<.05 d=.20) and clinical score (Estimate=-0.42, 95% CI=-0.64, -0.20, p<.001 d=.36) reduced over assessments. Significant differences in change were evident between clinically and demographically defined groups. A maximum of 3% of in iduals showed clinically significant reliable reductions in HCR-20 total scores. The scores of patients whose overall level of risk was judged to have decreased did not reduce between assessments. Violence risk changes very little over the course of treatment although there is some variation between groups. Most change cannot be demonstrated to be reliable or clinically significant. Important clinical management decisions should not depend solely on evidence from changes in HCR-20 risk assessment.
Publisher: SAGE Publications
Date: 15-01-2013
Abstract: The growing worldwide use of pharmaceuticals is managed in some countries by a regulatory system which sharply ides legal use into licensed and unlicensed categories. We examine how for the range of psychotropics this simultaneously restricts the possible benefits to patients, prescribers and producers in some domains, while failing to manage the risks in others. A more flexible system, which shares at an earlier stage experience and evidence on benefits and risks in patients, previously marginalized on the grounds of age, diagnosis or comorbidity, would aid the development of safer, more effective ‘real-world prescribing’. Practical recommendations are made for a new model of research and prescribing governance, to enable more effective repurposing of these treatments.
Publisher: SAGE Publications
Date: 09-12-2013
Abstract: Relatively little effort has been made to develop and validate theories that explain firesetting. In this study, the first offense chain model of firesetting in mentally disordered offenders was developed. Twenty-three mentally disordered firesetters were interviewed about the affective, cognitive, behavioral, and contextual factors leading up to and surrounding one of their recorded firesetting offenses. Offense account interviews were analyzed using grounded theory. The resulting model consists of four main phases: (a) background, (b) early adulthood, (c) pre-offense period, and (d) offense and post-offense period. The model accounts for firesetting by male and female mentally disordered offenders and highlights the importance of early childhood experiences of fire and the onset of mental illness as precursors to firesetting within this population. Furthermore, the model is able to distinguish between different types of mentally disordered firesetters and their offense styles. The clinical implications and utility of the model are also discussed.
Publisher: Wiley
Date: 17-04-2022
DOI: 10.1111/INM.13006
Abstract: Self‐harm is common in mental health facilities, and coercive containment measures are sometimes used to manage it. Nurses' attitudes towards these measures have been investigated in relation to disturbed behaviour in general, but rarely to self‐harm specifically. We therefore investigated mental health nurses' use of and attitudes towards coercive measures (seclusion, restraint, intermittent and constant observations, forced intramuscular medication, and PRN medication) for self‐cutting management compared with for disturbed behaviours in general using a cross‐sectional, repeated measures survey design. Participants were N = 164 mental health nursing staff. Data collection was via a questionnaire comprising validated attitudinal measures. The study is reported in line with STROBE guidelines. Physical restraint (36.6%), forced intramuscular medication (32.3%) and seclusion (48.2%) had reportedly been used by in iduals for self‐cutting management. Respondents disapproved of using each coercive measure for self‐cutting more than they did for disturbed behaviour in general with the exception of PRN medication. Attitudes to coercive measures differed across target behaviours. Hence, nurses who had used each measure for managing self‐cutting disapproved of it less for that purpose than those who had not. Nurses who had used coercive techniques for self‐cutting management had less desirable attitudes to their use. We cannot say whether prior use of these techniques led to increased approval or whether greater approval led to an increased willingness to use them. Reducing the use of coercive techniques for self‐harm will require attitudes that support its use to be challenged. Less coercive techniques should be encouraged. Harm reduction techniques offer one such alternative.
Publisher: Wiley
Date: 05-12-2020
DOI: 10.1111/INM.12677
Abstract: Inpatient aggression on mental health wards is common and staff-patient interactions are frequently reported antecedents to aggression. However, relatively little is known about the precise relationship between aggression and these interactions, or their relationships with aggression and staff containment responses such as restraint and seclusion. This study aimed to determine the roles of anger and interpersonal style among mental health nurses and between nurses and patients in the occurrence of aggression and its containment. A correlational, pseudoprospective study design was employed. n = 85 inpatients and n = 65 nurses were recruited from adult, low- and medium-secure wards of a secure forensic mental health service. Participants completed validated self-report anger and transactional interpersonal style measures. Inpatient aggression and containment incident data for a 3-month follow-up period were extracted from clinical records. Dyadic nurse-patient relationships were anticomplementary. Patients' self-reported anger and staff-rated hostile interpersonal style were significantly positively correlated staff self-reported anger and patient-rated dominant interpersonal style were also positively correlated. Patient anger predicted aggression and their interpersonal style predicted being subject to containment in the form of restraint and seclusion. There were no statistically significant differences identified on measures between staff who were and were not involved in containment. More targeted intervention for patients' anger may have a positive impact on interpersonal style and lead to the reduction of incidents. Staff education and skills training programmes should emphasize the importance of interpersonal styles which could help to promote and enhance positive interactions.
Publisher: Springer Science and Business Media LLC
Date: 11-08-2021
DOI: 10.1186/S12911-021-01590-Y
Abstract: Data sparsity is a major limitation to estimating national and global dementia burden. Surveys with full diagnostic evaluations of dementia prevalence are prohibitively resource-intensive in many settings. However, validation s les from nationally representative surveys allow for the development of algorithms for the prediction of dementia prevalence nationally. Using cognitive testing data and data on functional limitations from Wave A (2001–2003) of the ADAMS study ( n = 744) and the 2000 wave of the HRS study ( n = 6358) we estimated a two-dimensional item response theory model to calculate cognition and function scores for all in iduals over 70. Based on diagnostic information from the formal clinical adjudication in ADAMS, we fit a logistic regression model for the classification of dementia status using cognition and function scores and applied this algorithm to the full HRS s le to calculate dementia prevalence by age and sex. Our algorithm had a cross-validated predictive accuracy of 88% (86–90), and an area under the curve of 0.97 (0.97–0.98) in ADAMS. Prevalence was higher in females than males and increased over age, with a prevalence of 4% (3–4) in in iduals 70–79, 11% (9–12) in in iduals 80–89 years old, and 28% (22–35) in those 90 and older. Our model had similar or better accuracy as compared to previously reviewed algorithms for the prediction of dementia prevalence in HRS, while utilizing more flexible methods. These methods could be more easily generalized and utilized to estimate dementia prevalence in other national surveys.
Publisher: American Psychological Association (APA)
Date: 09-2014
DOI: 10.1037/A0036794
Abstract: This article describes a systematic review of the psychometric properties of the Short-Term Assessment of Risk and Treatability (START) and a meta-analysis to assess its predictive efficacy for the 7 risk domains identified in the manual (violence to others, self-harm, suicide, substance abuse, victimization, unauthorized leave, and self-neglect) among institutionalized patients with mental disorder and/or personality disorder. Comprehensive terms were used to search 5 electronic databases up to January 2013. Additional articles were located by examining references lists and hand-searching. Twenty-three papers were selected to include in the narrative review of START's properties, whereas 9 studies involving 543 participants were included in the meta-analysis. Studies about the feasibility and utility of the tool had positive results but lacked comparators. START ratings demonstrated high internal consistency, interrater reliability, and convergent validity with other risk measures. There was a lack of information about the variability of START ratings over time. Its use in an intervention to reduce violence in forensic psychiatric outpatients was not better than standard care. START risk estimates demonstrated strong predictive validity for various aggressive outcomes and good predictive validity for self-harm. Predictive validity for self-neglect and victimization was no better than chance, whereas evidence for the remaining outcomes is derived from a single, small study. Only 3 of the studies included in the meta-analysis were rated to be at a low risk of bias. Future research should aim to investigate the predictive validity of the START for the full range of adverse outcomes, using well-designed methodologies, and validated outcome tools.
Publisher: SAGE Publications
Date: 2022
DOI: 10.1177/23779608221107278
Abstract: The Insomnia Severity Index (ISI) is a self-administrated questionnaire most frequently used to assess insomnia in clinical and non-clinical populations. To evaluate the psychometric properties of the Arabic ISI among patients diagnosed with chronic diseases. A cross-sectional and descriptive correlational design was used. A total of 1,005 patients with chronic diseases completed the seven items of the Arabic ISI version. The scale was assessed in terms of acceptability, internal consistency, and validity. Construct validity was explored with the use of principal factor analysis and confirmatory factor analysis, to examine the dimensional structure of the ISI. The Cronbach's alpha coefficient for the Arabic ISI was 0.82, which shows good reliability. The total ISI score did not have floor or ceiling effects. There was evidence of discriminate validity. The Principal Component Analysis (PCA) indicated two factors (four items loading on Factor I and three items loading on Factor II). The construct validity of PCA in terms of two factors was explored by confirmatory factor analysis to examine the dimensional structure of the ISI. The confirmatory factor analysis showed an absolute fit for the two-factor model. The results support the two-factor structure of ISI. The Arabic version of the ISI demonstrated good reliability and validity for assessing insomnia in patients diagnosed with chronic diseases.
Publisher: Mark Allen Group
Date: 08-2009
DOI: 10.12968/BJON.2009.18.15.43564
Abstract: Patient based outcomes tools such as Health of the Nation Outcome Scales can help users and providers to assess whether mental health services promote wellbeing, and can also inform research and clinical audit. With some exceptions, however, completion rates of routine outcomes ratings are poor, and some argue that current tools are not sufficiently service user-oriented. Concurrently, the recovery model as an approach to mental health care, emphasizing concepts such as hope, meaning and sense of self, has come to prominence. The emerging model creates a need to measure whether recovery-led services deliver positive outcomes. To answer this, it is necessary to first ask whether current routine outcomes tools are suitable measures of recovery-related concepts. This article examines the current state of outcomes measurement in UK mental health services in the age of the recovery model and proposes that a twin-track approach is required.
Publisher: SAGE Publications
Date: 07-2008
Abstract: We conducted a retrospective study of arsonists referred for psychiatric assessment and found that 88/202 (43.6%) had an IQ of 85 or below. The low IQ group showed more evidence of childhood temperamental disturbance, and a later pattern of internal problems rather than external factors expressing themselves as fire-setting. This study highlights the likelihood of lifelong, temperamental problems being apparent in childhood, and being predictive and possibly causative of fire setting in people with a low IQ. Better understanding of the distinct characteristics of lower IQ arsonists is essential for improved prevention, treatment and management.
Publisher: Elsevier BV
Date: 10-2017
DOI: 10.1016/J.IJNURSTU.2017.07.018
Abstract: Mental health nurses are exposed to patient aggression, and required to manage and de-escalate aggressive incidents coercive measures such as restraint and seclusion should only be used as a last resort. An improved understanding of links between nurses' exposure to aggression, attitudes to, and actual involvement in, coercive measures, and their emotions (anger, guilt, fear, fatigue, sadness), could inform preparation and education for prevention and management of violence. To identify relationships between mental health nurses' exposure to patient aggression, their emotions, their attitudes towards coercive containment measures, and their involvement in incidents involving seclusion and restraint. Cross-sectional, correlational, observational study. Low and medium secure wards for men and women with mental disorder in three secure mental health hospitals in England. N=Sixty eight mental health nurses who were designated keyworkers for patients enrolled into a related study. Participants completed a questionnaire battery comprising measures of their exposure to various types of aggression, their attitudes towards seclusion and restraint, and their emotions. Information about their involvement in restraint and/or restraint plus seclusion incidents was gathered for the three-month period pre- and post- their participation. Linear and logistic regression analyses were performed to test study hypotheses. Nurses who reported greater exposure to a related set of aggressive behaviours, mostly verbal in nature, which seemed personally derogatory, targeted, or humiliating, also reported higher levels of anger-related provocation. Exposure to mild and severe physical aggression was unrelated to nurses' emotions. Nurses' reported anger was significantly positively correlated with their endorsement of restraint as a management technique, but not with their actual involvement in restraint episodes. Significant differences in scores related to anger and fatigue, and to fatigue and guilt, between those involved/not involved in physical restraint and in physical restraint plus seclusion respectively were detected. In regression analyses, models comprising significant variables, but not the variables themselves, predicted involvement/non-involvement in coercive measures. Verbal aggression which appears targeted, demeaning or humiliating is associated with higher experienced anger provocation. Nurses may benefit from interventions which aim to improve their skills and coping strategies for dealing with this specific aggressive behaviour. Nurse-reported anger predicted approval of coercive violence management interventions this may have implications for staff deployment and support. However, anger did not predict actual involvement in such incidents. Possible explanations are that nurses experiencing anger are sufficiently self-aware to avoid involvement or that teams are successful in supporting colleagues who they perceive to be 'at risk'. Future research priorities are considered.
Publisher: Springer Science and Business Media LLC
Date: 26-04-2019
Publisher: Mark Allen Group
Date: 09-2010
DOI: 10.12968/BJHC.2010.16.9.78369
Abstract: St Andrew's Healthcare has pioneered the use of Health of the Nation Outcome Scales (HoNOS)data to power key performance indicators demonstrating change on global and risk-related outcome among a erse group of patients with mental disorders, neurodevelopmental and learning disabilities, and acquired brain injury. Performance indicators based on routinely collected outcomes data for 2008 and 2009 were calculated for six specialist services (at North ton men's, women's, adolescent, older adults secure services and our brain injury rehabilitation unit and in our low secure adult service in Essex) to demonstrate change. Mean 90-day changerates of +0.64% and +0.52% on the risk outcomes indicator, and of +0.78% and +0.66% on global outcomes measures were demonstrated for 2008 and 2009 respectively. Differentials in change ratesbetween services with highly specialised service-user needs reflected clinical realities. St Andrew's Healthcare has now published six years of performance data demonstrating continuouspositive change for our patient groups. These indicators should be viewed as valid and stable andshould be more widely adopted.
Publisher: Wiley
Date: 02-08-2015
DOI: 10.1111/JPM.12256
Publisher: Wiley
Date: 30-10-2018
DOI: 10.1111/JPM.12498
Abstract: WHAT IS KNOWN ON THE SUBJECT?: Nurses in mental health inpatient settings use a range of methods to try and help service users who self-harm Harm-reduction approaches are intended to help service users reduce the impact of their self-harm rather than simply to prevent them self-harming Harm-reduction techniques might be helpful for people who cut themselves because there are some clear ways harm can be minimized such as providing advice about cutting No one has previously tried to measure whether harm-reduction techniques are more or less acceptable to mental health practitioners and service users than traditional methods. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper describes the development of the Attitudes to Self-cutting Management scale. It met the criteria required of a good measurement tool. Each method of managing self-cutting has a unique acceptability profile Harm-reduction methods like advising on wound care and providing a first aid kit are endorsed by nurses and former service users Nurses providing sterile razors or remaining present during self-cutting attract more ergent opinions but are preferred to seclusion and restraint. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Nurses should talk through the approaches to management with service users and agree which techniques are preferred. ABSTRACT: Introduction Harm-reduction approaches for self-harm in mental health settings have been under-researched. Aim To develop a measure of the acceptability of management approaches for self-cutting in mental health inpatient settings. Methods Stage one: scale items were generated from relevant literature and staff/service user consultation. Stage two: A cross-sectional survey and statistical methods from classical test theory informed scale development. Results/Findings At stage one, N = 27 staff and service users participated. At stage two, N = 215 people (n = 175 current mental health practitioners and n = 40 people with experience of self-cutting as a UK mental health inpatient) completed surveys. Principal components analysis revealed a simple factor structure such that each method had a unique acceptability profile. Reliability, construct validity and internal consistency were acceptable. The harm-reduction approaches "advising on wound care" and "providing a first aid kit" were broadly endorsed "providing sterile razors" and "maintaining a supportive nursing presence during cutting" were less acceptable but more so than seclusion and restraint. Discussion The Attitudes to Self-cutting Management scale is a reliable and valid measure that could inform service design and development. Implications for practice Nurses should discuss different options for management of self-cutting with service users. Harm-reduction approaches may be more acceptable than coercive measures.
Publisher: Elsevier BV
Date: 11-2022
Publisher: Elsevier BV
Date: 06-2018
DOI: 10.1016/J.NEDT.2018.03.003
Abstract: There is increasing interest in the use of commercial movies in nursing education, or "cinenurducation". There is a need for educational interventions which target mental health nurses' attitudes towards people with borderline personality disorder. To investigate and evaluate the experience and effects of attendance at a screening of the movie Ida's Diary, a first-person account of living with borderline personality disorder. Mixed methods design comprising a within-subjects AB longitudinal survey, and a qualitative analysis of participant-generated data and researcher field notes from a World Café discussion group. One university in Scotland. N = 66 undergraduate and postgraduate mental health nursing and counselling students. Participants completed measures of cognitive and emotional attitudes towards, and knowledge about, people with borderline personality disorder before and after one of two film screenings. We conducted a World Café discussion group after the second screening. Resulting data were subject to a qualitative thematic analysis. Quantitative analysis revealed a five-factor cognitive and a single-factor emotional attitude structure. Cognitive-attitudinal items related to treatment deservingness and value of mixed treatment approaches improved across iterations. Total knowledge score did not change, but one item about borderline personality disorder as a precursor to schizophrenia received considerably more incorrect endorsement post-screening. Qualitative analysis revealed five themes: Facilitation and inhibition of learning promotion but not satiation of appetite for knowledge challenging existing understanding prompting creativity and anxiety and initiating thinking about the bigger picture. Participants found the film thought provoking it increased their appetite for knowledge. Findings suggest that screening should be delivered in conjunction with more didactic information about borderline personality disorder.
Publisher: Wiley
Date: 31-01-2023
DOI: 10.1111/JPM.12898
Abstract: ‘Leave’ is a common occurrence for patients detained in mental health settings. The term covers multiple scenarios, for ex le short periods to get off the ward through to extended periods at home prior to discharge. Despite the frequency and importance of leave, there is very little research about how it is implemented and whether, and in what circumstances, it is effective. While there is legislation about leave in the Mental Health Act (1983) mental health services are free to implement their own policies or not to implement one at all. The leave policies of NHS mental health services in England and Wales are highly inconsistent. The extent to which policies are consistent with guidance differs depending on which service is providing care. It is very likely that, because of inconsistencies between services and policies, practice also differs. Clinicians need to understand their responsibilities in the leave process to ensure that patients are supported in their recovery journey. Policymakers need to revisit leave policies in light of evidence from this study. Considerable guidance is available about the implementation of leave for detained patients, but in idual mental health services are free to determine their own policies. To determine how consistent leave policies of NHS mental health services in England and Wales are with relevant guidance and legislation. A national audit of NHS mental health services leave policies. Data were obtained through web searching and Freedom of Information requests. Policies were assessed against 65 criteria across four domains (administrative, Responsible Clinician, types of leave and nursing). Definitions of leave‐related terms were extracted and analysed. Fifty‐seven (91.9%) policies were obtained. There were considerable inconsistencies in how policies were informed by relevant guidance: Domain‐level consistency was 72.3% (administrative), 64.0% (Responsible Clinician), 44.7% (types of leave) and 41.9% (nursing). Definitions varied widely and commonly differed from those in relevant guidance. Mental health professionals are inconsistently supported by the policy in their leave‐related practice. This could potentially contribute to inconsistent practice and leave‐related patient outcomes. To ensure patients are treated fairly clinicians need to be aware of their responsibilities around leave. In some services, they will need to go beyond their organization's stated policy to ensure this occurs.
Publisher: Public Library of Science (PLoS)
Date: 03-11-2022
DOI: 10.1371/JOURNAL.PONE.0277062
Abstract: Psychological First Aid is a brief intervention based on international guidance from the World Health Organisation. Free to access online training in the intervention was introduced during the COVID-19 pandemic in UK. We aimed to determine the uptake of Psychological First Aid training among healthcare workers in care homes in the UK and to assess its effects on their wellbeing. This was a sequential mixed methods design. Healthcare workers (nurses and carers) working in care homes in the UK were surveyed about their uptake of Psychological First Aid, their stress, coping efficacy and the key concepts of Psychological First Aid (safety, calmness, hopefulness, connectedness, and accomplishment). Those that completed the Psychological First Aid training were asked to share their experiences via qualitative survey. Data collection was conducted between June and October 2021. Analyses included descriptive statistics and regression analysis. A six step thematic analysis was used to interpret the qualitative data. 388 participants responded to the survey. The uptake of Psychological First Aid training was 37 (9.5%). Psychological first aid was a significant predictor for coping efficacy ( β = 17.54, p = .001). Participants with a physical or mental health condition experienced higher stress and lower coping regardless of PFA training. Four themes were identified from the qualitative analysis: self-awareness and growth, relationships with others, overcoming stress and accessibility. While this study suggests some benefits to healthcare workers in care home settings undergoing PFA the poor uptake of the training warrants further investigation. Care home staff need psychological support. This gap remains as few completed PFA training. This is the first study in UK and worldwide to look at the effects of psychological first aid on stress and coping in this population and it warrants further investigation.
Publisher: Emerald
Date: 09-09-2014
Abstract: – The purpose of this paper is to assess the antecedent behaviours and consequences of firesetting for women in a secure psychiatric setting along with treatment engagement factors. To explore predictions made about emotionally expressive subtype firesetters by the multi-trajectory theory of adult firesetting (M-TTAF). – In total, 75 in idual firesetting episodes involving 25 female multiple firesetters were assessed using the St Andrew's Fire and Arson Risk Instrument. Assessments were made of treatment readiness, firesetting related self-efficacy, insight and barriers to change. – Findings support the relationship between reci ist firesetting and the psychological features of psychosis, personality disorder and substance misuse. The reported association of firesetting with suicidal thoughts, depression, interpersonal problems, anger/revenge motivation and lack of planning supports the view that behaviour is used to manage distressing life experience and as a “cry for help”. However, in a quarter of incidents there was an intention to harm others and evidence of premeditation in twelve percent. A small but significant minority lacked insight into their behaviour, were not ready for treatment and had low firesetting related self-efficacy. Predictions made by the M-TTAF about likely clinical features and motivators of emotionally expressive firesetters were largely supported. – The study highlights the importance of a detailed and specific risk assessment of firesetting that leads to identification of in idual risk factors and an in idualised treatment approach. This is of particular importance given the complex problems presented by women in secure settings and by the ersity of the conditions associated with fires set by each in idual.
Publisher: Elsevier BV
Date: 05-2015
DOI: 10.1016/J.IJNURSTU.2015.02.007
Abstract: Risk assessment and management is central to the nursing role in forensic mental health settings. The Short Term Assessment of Risk and Treatability (START) aims to support assessment through identification of risk and protective factors. It has demonstrated predictive validity for aggression it also aims to aid risk assessment for unauthorised leave and substance abuse where its performance is relatively untested. To test the predictive validity of the START for unauthorised leave and substance abuse. A naturalistic, pseudo-prospective cohort study. Four centres of a large UK provider of secure inpatient mental health services. Inpatients resident between May 2011 and October 2013 who remained in the service for 3-months following assessment with the START by their clinical team. Exclusion criteria were missing assessment data in excess of prorating guidelines. Of 900 eligible patients 73 were excluded leaving a final s le size of n=827 (response rate 91.9%). Mean age was 38.5 years (SD=16.7) most participants (72.2%) were male common diagnoses were schizophrenia-type disorders, personality disorders, organic disorders, developmental disorders and intellectual disability. Routinely conducted START assessments were gathered. Subsequent incidents of substance abuse and unauthorised leave were coded independently. Positive and negative predictive values of low and elevated risk were calculated. Receiver Operating Characteristic analysis was conducted to ascertain the predictive accuracy of the assessments based on their sensitivity and specificity. Patient-based rates of unauthorised leave (2.4%) and substance abuse (1.6%) were low. The positive and negative predictive values for unauthorised leave were 5.9% and 98.4% and for substance abuse 8.1% and 99.0%. The START specific risk estimate for unauthorised leave predicted its associated outcome (Area under the curve=.659, p<.05, 95% CI .531, .786) the substance abuse risk estimate predicted its outcome with a large effect size (Area under the curve=.723, p<.01, 95% CI .568, .879). The study provides limited support for the START by demonstrating the predictive validity of its specific risk estimates for substance abuse and unauthorised leave. High negative predictive values suggest the tool may be of most utility in screening out low risk in iduals from unnecessary restrictive interventions very low positive predictive values suggest caution before implementing restrictive interventions in those rated at elevated risk. Researchers should investigate how multidisciplinary teams formulate risk assessments for these outcomes since they outperform the quantitative element of this tool.
Publisher: Wiley
Date: 05-05-2005
DOI: 10.1111/J.1365-2850.2005.00836.X
Abstract: The working environment is an important determinant of employee well-being. Previous UK studies report registered nurses' perception of the working environment using the Work Environment Scale (WES), but surprisingly few include data for nurses working in mental health or learning disability settings. One hundred and sixty-one (58.8%) registered nurses working day shifts in five specialist isions (forensic adult mental health, adolescent mental health, elderly continuing care, adult and adolescent learning disability and brain injury rehabilitation) of a large charitable hospital comprising mostly secure (i.e. 'locked') wards completed the WES. Nurses working in separate clinical isions differed only on the 'physical comfort' subscale. These results are discussed in the context of previous UK research: this s le of nurses scored differently on a number of subscales, with the working environment characterized by relatively high levels of support, cohesion and managerial control and slightly lower levels of autonomy. It is unclear whether the differences reflect the organizational (i.e. non-NHS) context, or a secure environment effect. Previous studies of mental health nurses are now 10 years old and we present data that may provide a benchmark of perceptions of the working environment held by nurses working in mental health and learning disability settings.
Publisher: Wiley
Date: 02-03-2011
DOI: 10.1111/J.1365-2850.2011.01707.X
Abstract: Aggression is a consequence of acquired brain injury that may necessitate admission to neurobehavioural services. The 'Overt Aggression Scale - Modified for Neurorehabilitation' (OAS-MNR) is a valid, reliable means of capturing this. A criticism of observational rating scales is they do not reflect factors like intent to harm which results in recording anomalies. 'Attacks' has been proposed as a measure which achieves this within psychiatric settings. Principal goals of this study are to determine the usefulness of measuring similar concepts in neurobehavioural services and further validating both scales. A total of 1066 physical assaults were recorded in 6 weeks by 25 patients in an inpatient neurobehavioural programme using the OAS-MNR. Fifty incidents were also rated on Attacks. Convergent validity for using both measures in neurobehavioural services was found. Modifying OAS-MNR severity scores using one of two factors found to underlie Attacks produced an index that successfully discriminated incidents whose risk necessitated more intrusive intervention, which was not evident otherwise. Modifying scores that objectively reflect severity of physical assaults using measures of perceived intent should be a feature of observational recording scales such as the OAS-MNR. Ensuring robust inter-rater reliability will be essential in any development work.
Publisher: Emerald
Date: 08-05-2017
Abstract: The purpose of this paper is to explore how raters combine constituent components of Historical Clinical Risk-20 (HCR-20) risk assessment, and how relevant they rate the tool to different diagnostic and demographic groups. A cross-sectional survey design of n =45 mental health clinicians (psychiatrists, psychologists, and others) working in a secure hospital responded to an online survey about their risk assessment practice. HCR-20 Historical and Clinical subscales were rated the most relevant to violence prediction but four of the five items rated most relevant were Historical items. A recent history of violence was rated more important for risk formulation than Historical and Risk management items, but not more important than Clinical items. While almost all respondents believed predictive accuracy would differ by gender, the tool was rated similarly in terms of its relevance for their client group by people working with men and women, respectively. This was an exploratory survey and results should be verified using larger s les. Clinicians judge recent violence and Clinical items most important in inpatient violence risk assessment but may overvalue historical factors. They believe that recent violent behaviour is important in risk formulation however, while recent violence is an important predictor of future violence, the role it should play in SPJ schemes is poorly codified. It is important that risk assessment is accurate in order to both protect the public and to protect patients from overly lengthy and restrictive detention. Despite the vast number of studies examining the predictive validity of tools like HCR-20 very little research has examined the actual processes and decision-making behind formulation in clinical practice.
Publisher: Cold Spring Harbor Laboratory
Date: 20-10-2023
Publisher: Wiley
Date: 15-06-2010
Publisher: Elsevier BV
Date: 06-2016
Publisher: Elsevier BV
Date: 10-2020
Publisher: Wiley
Date: 20-03-2014
DOI: 10.1111/JPM.12143
Abstract: Medication administration errors and near misses are common including in mental health settings. Nurses should report all errors and near misses so that lessons can be learned and future mistakes avoided. We interviewed 50 nurses to find out if they would report an error that a colleague had made or if they would report a near-miss that they had. Less than half of nurses said they would report an error made by a colleague or a near-miss involving themselves. Nurses commonly said they would not report the errors or near misses because there was a good excuse for the error/near miss, because they lacked knowledge about whether it was an error/near miss or how to report it, because they feared the consequences of reporting it, or because reporting it was too much work. Mental health nurses mostly report similar reasons for not reporting errors and near misses as nurses working in general medical settings. We have not seen another study where nurses would not report an error or near miss because they thought there was a good excuse for it. Training programmes and policies should address all the reasons that prevent reporting of errors and near misses. Medication errors are a common and preventable cause of patient harm. Guidance for nurses indicates that all errors and near misses should be immediately reported in order to facilitate the development of a learning culture. However, medication errors and near misses have been under-researched in mental health settings. This study explored the reasons given by psychiatric nurses for not reporting a medication error made by a colleague, and the perceived barriers to near-miss reporting. We presented 50 nurses with clinical vignettes about error and near-miss reporting and interviewed them about their likely actions and about their views and perceptions. Less than half of participants would report an error made by a colleague (48%) or a near-miss involving themselves (40%). Thematic analysis revealed common themes for both not reporting an error or a near-miss were knowledge, fear, burden of work, and excusing the error. The first three themes are similar to results obtained from research in general medical settings, but the fourth appears to be novel. Many mental health nurses are not yet fully convinced of the need to report all errors and near misses, and that improvements could be made by increasing knowledge while reducing fear, burden of work, and excusing of errors.
Publisher: Elsevier BV
Date: 09-2014
Publisher: Wiley
Date: 21-11-2012
DOI: 10.1111/J.1447-0349.2012.00888.X
Abstract: Nurses' attitudes about the causes and management of aggression affects their choice of intervention. We aimed to compare the attitudes held by patients and staff in a forensic mental health service with the Management of Aggression and Violence Attitudes Scale, and examine the factor validity of the tool in this setting by conducting a prospective comparative questionnaire survey. Staff (n = 72) and patient (n = 98) attitudes differed to a limited extent. Confirmatory factor analysis refuted the previously reported structure of the tool. Exploratory factor analysis suggested three underlying factors related to modifiability of aggression, hands on management, and hands off management. Patients were more optimistic than nurses about the modifiability of aggressive behaviour. Male patients and those with diagnoses other than personality disorder were significantly more likely to agree about modifiability than controls. Forensic inpatients recognize the need for the use of a range of techniques to prevent and manage aggression and violence, but selected groups are most likely to believe that aggression is modifiable. Prevention and management of aggression training should emphasize the modifiability of aggressive behaviour. The development of measures of modifiability and management style would assist in the evaluation of training and would offer new avenues for research.
Publisher: Wiley
Date: 23-06-2023
DOI: 10.1111/JPM.12946
Abstract: Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but some nurses see it as a ‘tick the box’ exercise. Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. Mental health nurses' attitudes towards risk assessment are erse with regard to its legitimacy, conduct and value. This study provides an organised framework to help understand the areas in which these different attitudes occur. Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. Understanding nurses' attitudes towards risk assessment could inform education and practice improvements. To explore mental health nurses' attitudes towards risk assessment. An integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis quantitative data were integrated with emerging themes. Eighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation) use of structured approaches (technical orientation) value of intuition (intuitive orientation) and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses. Mental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment. This review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes.
Publisher: Royal College of Psychiatrists
Date: 02-2007
Abstract: The Human Rights Act was incorporated into UK law in 2000, but little is known about how it is implemented in psychiatric care. We explored the understanding of multidisciplinary teams of the restriction and protection of patients' human rights using an open-response questionnaire. Content analysis was employed to summarise written, narrative data about the human rights of 102 patients in secure psychiatric care. Our clinical teams considered human rights to be protected through risk assessment and management, ongoing monitoring, local policy and existing UK mental health legislation. Understanding of the proper and proportionate restriction of ‘qualified’ rights (such as article 5 liberty) and the positive enablement and promotion of human rights (such as article 8 family and private life) appeared to be limited. A cultural shift in focus is required in mental health services to understand and ensure positive promotion of human rights. Clinicians should directly address the human rights of their patients and articulate the rationale for proportionate restrictions of qualified rights. Clinical policy, training and audit should explicitly embody the protection of human rights.
Publisher: Oxford University PressOxford
Date: 30-06-2007
DOI: 10.1093/ACPROF:OSO/9780198567066.003.0010
Abstract: Previous work found that tree turnover, biomass, and large liana densities increased in mature tropical forests in the late 20th century, indicating a concerted shift in forest ecological processes. However, the findings have proved controversial. Here, regional-scale patterns of tree turnover are characterized, using improved datasets available for Amazonia that span the last twenty-five years. The main findings include: trees at least 10 cm in diameter recruit and die twice as fast on the richer soils of western Amazonia compared to trees on the poorer soils of eastern Amazonia turnover rates have increased throughout Amazonia over the last two decades mortality and recruitment rates have tended to increase in every region and environmental zone recruitment rates consistently exceed mortality rates and increases in recruitment and mortality rates are greatest in western Amazonia. These patterns and trends are not caused by obvious artefacts in the data or the analyses, and cannot be directly driven by a mortality driver such as increased drought because the biomass in these forests has simultaneously increased. Apparently, therefore, widespread environmental changes are stimulating the growth and productivity of Amazon forests.
Publisher: Oxford University PressOxford
Date: 30-06-2007
DOI: 10.1093/ACPROF:OSO/9780198567066.003.0011
Abstract: This chapter discusses a previous study by Phillips et al. (1998) on biomass changes in Amazonian permanent s le plots which has been used to infer the presence of a regional carbon sink, generating vigorous debate about s ling and methodological issues. A new analysis of biomass change in old-growth Amazonian forest plots is presented here using new inventory data. It has been found that across fifty-nine sites, the above-ground dry biomass in trees of more than 10 cm in diameter has increased since plot establishment by about 1.22 Mg per hectare per year, or about 0.98 Mg per hectare per year if in idual plot values are weighted by the number of hectare years of monitoring. This significant increase is not confounded by spatial or temporal variation in wood specific gravity, nor does it depend on the allometric equation used to estimate biomass. Overall, these results suggest a slightly greater rate of net stand-level change than reported in 1998, and indicate the presence of a significant regional-scale carbon sink in old-growth Amazonian forests during the past two decades.
Publisher: Cambridge University Press (CUP)
Date: 02-2012
Abstract: Mental Health Recovery Star is a multifaceted 10-item outcomes measure and key-working tool that has been widely adopted by service providers in the UK. We aimed to explore its factorial validity, internal consistency and responsiveness. Recovery Star readings were conducted twice with 203 working-age adults with moderate to severe mental health problems attending a range of mental health services, and a third time with 113 of these in iduals. Mental Health Recovery Star had high internal consistency and appeared to measure an underlying recovery-oriented construct. Results supported a valid two-factor structure which explained 48% of variance in Recovery Star ratings data. Two Recovery Star items (‘relationships’ and ‘addictive behaviour’) did not load onto either factor. There was good statistically significant item responsiveness, and no obvious item redundancy. Data for a small number of variables were not normally distributed and the implications of this are discussed. Recovery Star has been received enthusiastically by both mental health service providers and service users. This study provides further evidence for its adoption in recovery-focused mental health services and indicates that items relating to addictive behaviour, responsibilities and work could be further developed in future.
Publisher: Elsevier BV
Date: 12-2018
DOI: 10.1016/J.IJNURSTU.2018.09.002
Abstract: Violence and aggression are common in inpatient mental health hospital settings and cause problems for staff, patients and organisations. An important factor in treatment efficacy is ward atmosphere, and one element of this is the violence prevention climate. To develop and test the psychometric properties of a new scale to measure perceptions of the violence prevention climate among staff and patients in mental health inpatient settings. Scale development and cross-sectional validation study. Three hospital sites within an independent sector provider of secure mental health care. Participants were patients and staff residing in/working on wards in the adult male and female mental health care pathways. The study was conducted in three stages: scale development, pilot testing and psychometric evaluation. The scale items were developed from systematic literature review, informant interviews (staff) and focus groups (patients) and expert review. The resulting scale was subject to pilot testing with staff and patients (n = 58 and n = 25). The reliability and validity of the scale was examined by administering it to 326 staff and 95 patients. Exploratory factor analysis was used to establish construct validity, and this was further assessed with Rasch modelling. Internal consistency was assessed by calculation of Cronbach's alpha coefficients. Convergent and discriminant validity were measured by comparing results with existing validated instruments. Temporal stability of the items was assessed using test-retest reliability coefficients. The VPC-14 is a 14-item scale demonstrating good psychometric properties. Exploratory factor analysis revealed two subscales, staff actions and patient actions, each demonstrating good internal consistency (Cronbach's alpha .89 and .76). All items demonstrated good temporal stability. Rasch modelling confirmed the unidimensionality of the two subscales, and items demonstrated high construct validity. Moderate correlations were found between subscales of the VPC-14 and the EssenCES, whilst no correlations were found with items in the ACMQ, thus demonstrating good convergent and discriminant validity. The VPC-14 is currently the most robust available measure of the inpatient violence prevention climate. It is quick and easy to administer, considers views of both staff and patients and thus can be introduced as standard practice in a ward setting. Potential uses include tracking the violence prevention climate longitudinally and in evaluation of new policy and procedural interventions.
Publisher: Elsevier BV
Date: 09-2009
DOI: 10.1016/J.PHYSIO.2009.04.005
Abstract: There is a lack of empirical research about physical assault by patients against physiotherapists who work in mental health settings. This study aimed to ascertain the lifetime prevalence and 12-month incidence of assault by patients against physiotherapists in UK mental health settings. This research will inform the development of pre- and post-registration training programmes for physiotherapists. Postal questionnaire survey. Members of the Chartered Society of Physiotherapists' special interest group for physiotherapists working in the field of psychiatry. Self-reported experience of physical assault by patients. Secondary outcome was self-reported training received to manage violent and aggressive patients. Questionnaires were returned by 116/178 (65%) special interest group members. Fifty-one percent (59/116) reported that they had been assaulted at work during their career, and 24% (28/116) had been assaulted by a patient in the previous 12 months. Physiotherapists in mental health settings appear to be at greater risk of assault by patients than other non-nursing clinicians. Physiotherapists who work in mental health are at similar risk of physical assault by patients as their nursing colleagues, who are required by the UK Nursing and Midwifery Council to receive education and training in the prevention and management of aggression and violence in their pre-registration training. The authors recommend that appropriate training should be included in pre-registration programmes for physiotherapists.
Publisher: Wiley
Date: 23-02-2022
DOI: 10.1111/JPM.12826
Abstract: Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person‐oriented (for ex le groups of people with a similar mental health diagnosis) or practice‐oriented (for ex le practices such as seclusion or restraint). It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory‐informed approaches to attitudinal research. By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets—indicated by large proportions of respondents who appraise negatively—concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice. There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments. Training programmes that focus on attitudinal change need to be more rigorously evaluated. Attitudes are considered integral to mental health nursing practice. To comprehensively describe the (i) measured attitudes of UK mental health nurses towards people and practice (ii) effectiveness of interventions to change attitudes and (iii) relationships between their attitudes, other variables/constructs and practice. Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK‐based mental health nurses' attitudes with multi‐item scales. Studies were quality appraised, mean (SD) attitudinal data were standardized, and other results converted to standardized effect sizes. N = 42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude‐practice links. This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice. Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co‐morbidity. Addressing disparities between nurses' attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude‐practice links.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Emerald
Date: 02-08-2013
Publisher: Elsevier BV
Date: 03-2017
Publisher: Wiley
Date: 06-2018
DOI: 10.1002/CBM.2036
Abstract: Structured risk assessment is commonly used in secure settings to aid prediction and prevention of risky behaviours the expected benefits have rarely been investigated. The aim of the study is to determine whether adverse outcomes (physical and verbal aggression, self-harm, victimisation, self-neglect, unauthorised leave and substance abuse) reduced after patients were assessed with the Short-term Assessment of Risk and Treatability (START). In a naturalistic study, anonymised demographic and clinical information was collected from 50 male patients. Data included START assessment and frequency of target behaviour for 3 months before and after first assessment. Chi-square and linear mixed models analyses were used to determine whether there was any change in the behaviours of interest. There were no significant changes in physical or verbal aggression over time, although a tendency towards fewer incidents was apparent. Other adverse behaviours were very infrequent at baseline, precluding adequate analysis. In this small s le, START did not achieve its primary purpose of significant reduction in adverse behaviours. Although our s le size was informed by a power calculation, we may have over-estimated the size of anticipated change. Further, the 3-month comparison periods before and after the assessment follow-up period were rather short. Accordingly, we recommend more research on the value of this tool in practice rather than discontinuing its use. Copyright © 2017 John Wiley & Sons, Ltd.
Publisher: Unpublished
Date: 2012
Publisher: Wiley
Date: 09-09-2019
DOI: 10.1111/INM.12649
Abstract: Mental health nurses have traditionally lagged in terms of physical healthcare skills and have been found to have poorer cultural safety-related attitudes relative to other nurses. Organizational culture, including safety-related culture, is associated with important aspects of care quality. The aim of the current study was to examine the relationships between safety-related attitudes, physical healthcare-related knowledge and organizational culture among mental health nurses. By doing so, the intention was to inform decisions about interventions to improve attitudes and care related to severe physiological deterioration among mental health nurses. The study design was cross-sectional and correlational. The safety-related attitudes of N = 133 nurses from the inpatient mental health services of one Local Health District in New South Wales, Australia, were examined in terms of a range of potential predictor variables of safety attitudes (Safety Attitudes Questionnaire) including in idual organizational-perceiver type (Organisational Climate Assessment Inventory), knowledge of emergency medical healthcare (Lambeth In situ Training Questionnaire), use and perception of medical emergency teams (purpose-designed questionnaire) and a range of demographic variables. Regression analyses revealed that those who perceived the organization to have a primarily market-oriented culture had poorer safety-related attitudes than those who perceived a more clan-type culture. Number of years qualified was negatively associated with safety attitudes. To our knowledge, this is the first study in mental health which demonstrates a link between organizational culture-perception and safety attitudes related to physical healthcare. Results suggest that, among nurses, in iduals have quite different perceptions of the organizational culture. In turn, this suggests that the 'one-size fits all' approach to changing organizational culture may be inappropriate.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Wiley
Date: 28-06-2015
DOI: 10.1111/JPM.12232
Abstract: The Short-Term Assessment of Risk and Treatability (START) is a tool used in some mental health services to assess patients to see if they are at risk of violence, self-harm, self-neglect or victimization. The recommended time between assessments is 3 months but there is currently no evidence to show that this is best practice. We have investigated whether assessing at 1- or 2-month intervals would be more accurate and therefore facilitate more in idualized risk management interventions. We found that many patients who were rated as low risk had been involved in risk behaviours before 3 months had passed some patients who were rated at increased risk did not get involved in risk behaviours at all. Results are mixed for different outcomes but on balance, we think that the recommendation to conduct START assessment every 3 months is supported by the evidence. However, reassessment should be considered if risk behaviours are not prevented and teams should always consider whether risk management practices are too restrictive. The Short-Term Assessment of Risk and Treatability (START) guides assessment of potential adverse outcomes. Assessment is recommended every 3 months but there is no evidence for this interval. We aimed to inform whether earlier reassessment was warranted. We collated START assessments for N = 217 adults in a secure mental health hospital, and subsequent aggressive, self-harm, self-neglect and victimization incidents. We used receiver operating characteristic analysis to assess predictive validity survival function analysis to examine differences between low-, medium-, and high-risk groups and hazard function analysis to determine the optimum interval for reassessment. The START predicted aggression and self-harm at 1, 2 and 3 months. At-risk in iduals engaged in adverse outcomes earlier than low-risk patients. About half warranted reassessment before 3 months due to engagement in risk behaviour before that point despite a low-risk rating, or because of non-engagement by that point despite an elevated risk rating. Risk assessment should occur at appropriate intervals so that management strategies can be in idually tailored. Assessment at 3-month intervals is supported by the evidence. START assessments should be revisited earlier if risk behaviours are not prevented teams should constantly re-evaluate the need for restrictive practices.
Publisher: Wiley
Date: 21-01-2020
DOI: 10.1111/JOCN.15126
Abstract: To capture the experiences of nurses in relation to the acutely physiologically deteriorating consumer. Improving the physical health care of consumers with mental illness has been widely adopted as a priority for mental health nursing. Much of the effort thus far has focused on routine screening, prevention and treatment of common comorbidities including cardiovascular disease, diabetes mellitus and cancer. There has been less focus on the acutely physiologically deteriorating consumer in the mental health setting. Further study is warranted since this issue poses a set of highly complex challenges for nurses within the inpatient setting. An exploratory, descriptive study was employed using focus groups to gather narrative data, which was then subject to qualitative analysis. Eleven mental health inpatient wards within a local health district in Sydney, Australia, were studied, comprising ward-based nurses (n = 64) and nurse unit managers (n = 8). This paper follows the COREQ guidelines for reporting qualitative health research. Qualitative data analysis revealed three themes central to the nurses' experience: (a) lack of clarity (subthemes: procedures and leadership accountability) (b) confidence in the workforce (subthemes: knowledge and skills, training needs, relevant experience, collaboration with emergency and medical teams, stigmatising attitudes) and (c) complexity (subthemes: complexity as the new norm and suitability of the mental health environment). The themes found in this study can be used to guide and inform healthcare policy, protocols, education and processes around building a more confident nurse workforce for the acutely physiologically deteriorating consumer. Findings provide a rich data set for the generation of measurement tools and protocols to guide physical health care and evaluate performance.
Publisher: Elsevier BV
Date: 10-2020
Publisher: Cambridge University Press (CUP)
Date: 05-2012
DOI: 10.1192/PB.36.5.194A
Publisher: Springer Science and Business Media LLC
Date: 30-03-2021
Publisher: Mark Allen Group
Date: 05-2008
DOI: 10.12968/BJON.2008.17.10.29483
Abstract: The Human Rights Act is sometimes misunderstood as being an obstruction to the provision of safe and effective mental health care, allowing patients to cry ‘human rights abuse’ too easily. In reality, however, little is known about how human rights are protected and promoted in psychiatric care. This article provides an overview, for nurses, of how human rights are currently understood to be protected in mental health care and steps that could improve the protection of rights. Additionally, an overview of the relevant case law is presented to enable nurses to understand how human rights law is ever-evolving, how cases may be interpreted, and the implications that this has for mental health nursing practice.
Publisher: Wiley
Date: 20-07-2020
DOI: 10.1111/INM.12762
Publisher: Wiley
Date: 17-10-2014
DOI: 10.1111/INM.12088
Abstract: Little is known about the experiences of male patients in secure mental health and intellectual disability units during environmental transition. We interviewed patients before (n = 9) and after (n = 8) a side-to-side security transition from medium-secure wards in an older building to new wards in a purpose-built building. We inquired about transitional experiences in general and about this transition specifically. We examined interview transcripts and field notes using thematic analysis, and collated routine outcome data to gauge whether transition had obvious positive or negative effects. Qualitative analysis indicated three major themes (information, transition, and behaviour) and five overlapping subthemes (positive information sharing and consultation, concerns and anxieties about lack of information, life change and opportunity, home and sense of belonging, and potential conflict). Outcome data indicated little obvious change between first and second interviews. Expressed concerns of patients about transition were largely about tangible and practical issues, including changes to rules, including smoking and prohibited items. The results highlight the need for the development of supportive patient-inclusion strategies, consistent and transparent communication processes, and a published timeframe during the planning and implementation phases of all types of transitional moves, including the side-to-side transfer of residents between accommodation buildings.
Publisher: Springer Science and Business Media LLC
Date: 07-10-2016
Publisher: Emerald
Date: 09-11-2010
Publisher: Wiley
Date: 10-11-2005
DOI: 10.1111/J.1365-2850.2005.00892.X
Abstract: Smoking in a forensic psychiatric service: a survey of inpatients' views Very little is known concerning the views and beliefs of psychiatric inpatients about smoking in hospital. We conducted a survey of inpatients from the forensic wards of a large independent psychiatric hospital using a structured interview to collect data about their views on smoking. Of 102 patients eligible to participate, 45 (44.1%) agreed to do so. Most participants (34, 75.6%) were current smokers. Most smokers thought it was just too difficult to give up smoking (25, 73.5%). They cited seeing staff and other patients smoking, as well as the smoky atmosphere on the ward, as barriers to quitting. The majority of participants (35, 77.8%) thought that staff should be allowed to smoke with patients. Smokers held more liberal views about smoking than non-smokers. A smaller proportion of non-smokers than smokers were happy with the hospital smoking policy, as reflected in the ward rules about smoking. The results of this survey suggest that a change in attitude and culture towards smoking may be needed in psychiatric units. Smokers should be regularly offered help and encouragement to quit. Psychiatric care staff should carefully consider whether their own smoking behaviour undermines their patients' attempts to stop smoking. More attention should be given to the views and needs of non-smokers.
Publisher: BMJ
Date: 30-11-2002
Publisher: Informa UK Limited
Date: 31-08-2010
Publisher: Wiley
Date: 05-11-2023
DOI: 10.1111/JPM.12881
Abstract: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse‐delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing‐specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta‐Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse‐delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. Outcomes from 348 between‐group comparisons were extracted from K = 51 studies ( N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. Trial evidence of effective mental health nurse‐delivered interventions is limited. Many studies produced few or no measurable benefits none demonstrated improvements related to personal recovery. Mental health nurses should look beyond gold standard RCT evidence, and to evidence‐based interventions that have not been trialled with mental health nurse delivery.
Publisher: Wiley
Date: 31-05-2013
DOI: 10.1111/JPM.12088
Abstract: People with mental disorder account for a disproportionately large amount of smokers, and the problem is greatest in inpatient settings. 'Stop smoking' services should be tailored to the needs of in idual patient groups. It is important therefore to investigate factors relevant to different groups in order to inform future quit smoking interventions. We compared 50 patients and 50 staff in a secure mental health hospital on measures of smoking and smoking motives, nicotine dependence, craving, previous cessation attempts, motivation to quit and quit smoking-related self-efficacy. Patients were significantly more dependent on nicotine with higher levels of craving were more likely to smoke to cope with stress, for something to do when bored, for enjoyment and pleasure and reported significantly less readiness to quit smoking. Staff were more likely to cite health concerns as reasons for quitting. Future pre-intervention work with inpatients should focus on increasing their readiness to quit smoking. Once motivation is increased, interventions should include advice on reducing cravings, finding alternative methods for coping with stress and boredom and achieving enjoyment and pleasure from alternative sources.
Publisher: Wiley
Date: 19-07-2016
DOI: 10.1111/INM.12238
Abstract: This paper describes an audit of prevention and management of violence and aggression care plans and incident reporting forms which aimed to: (i) report the compliance rate of completion of care plans (ii) identify the extent to which patients contribute to and agree with their care plan (iii) describe de-escalation methods documented in care plans and (iv) ascertain the extent to which the de-escalation methods described in the care plan are recorded as having been attempted in the event of an incident. Care plans and incident report forms were examined for all patients in men's and women's mental health care pathways who were involved in aggressive incidents between May and October 2012. In total, 539 incidents were examined, involving 147 patients and 121 care plans. There was no care plan in place at the time of 151 incidents giving a compliance rate of 72%. It was documented that 40% of patients had contributed to their care plans. Thematic analysis of de-escalation methods documented in the care plans revealed five de-escalation themes: staff interventions, interactions, space/quiet, activities and patient strategies/skills. A sixth category, coercive strategies, was also documented. Evidence of adherence to de-escalation elements of the care plan was documented in 58% of incidents. The reasons for the low compliance rate and very low documentation of patient involvement need further investigation. The inclusion of coercive strategies within de-escalation documentation suggests that some staff fundamentally misunderstand de-escalation.
Publisher: Springer Science and Business Media LLC
Date: 27-02-2014
DOI: 10.1007/S11065-014-9254-9
Abstract: A body of work has developed over the last 20 years that explores facial emotion perception in Borderline Personality Disorder (BPD). We identified 25 behavioural and functional imaging studies that tested facial emotion processing differences between patients with BPD and healthy controls through a database literature search. Despite methodological differences there is consistent evidence supporting a negative response bias to neutral and ambiguous facial expressions in patients. Findings for negative emotions are mixed with evidence from in idual studies of an enhanced sensitivity to fearful expressions and impaired facial emotion recognition of disgust, while meta-analysis revealed no significant recognition impairments between BPD and healthy controls for any negative emotion. Mentalizing studies indicate that BPD patients are accurate at attributing mental states to complex social stimuli. Functional neuroimaging data suggest that the underlying neural substrate involves hyperactivation in the amygdala to affective facial stimuli, and altered activation in the anterior cingulate, inferior frontal gyrus and the superior temporal sulcus particularly during social emotion processing tasks. Future studies must address methodological inconsistencies, particularly variations in patients' key clinical characteristics and in the testing paradigms deployed.
Publisher: Oxford University Press (OUP)
Date: 20-02-2012
Publisher: SAGE Publications
Date: 04-12-2021
DOI: 10.1177/10998004211055866
Abstract: The new coronavirus disease (COVID-19) carries a high risk of infection and has spread rapidly around the world. However, there are limited data about the clinical symptoms globally. The purpose of this systematic review and meta-analysis is to identify the prevalence of the clinical symptoms of patient with COVID-19. A systematic review and meta-analysis were carried out. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, medRxiv, and Google Scholar, from December 1st, 2019 to January 1st, 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I 2 ) statistics. A total of 215 studies, involving 132,647 COVID-19 patients, met the inclusion criteria. The pooled prevalence of the four most common symptoms were fever 76.2% ( n = 214 95% CI 73.9–78.5) coughing 60.4% ( n = 215 95% CI 58.6–62.1) fatigue 33.6% ( n = 175 95% CI 31.2–36.1) and dyspnea 26.2% ( n = 195 95% CI 24.1–28.5). Other symptoms from highest to lowest in terms of prevalence include expectorant (22.2%), anorexia (21.6%), myalgias (17.5%), chills (15%), sore throat (14.1%), headache (11.7%), nausea or vomiting (8.7%), rhinorrhea (8.2%), and hemoptysis (3.3%). In subgroup analyses by continent, it was found that four symptoms have a slight prevalence variation—fever, coughing, fatigue, and diarrhea. This meta-analysis found the most prevalent symptoms of COVID-19 patients were fever, coughing, fatigue, and dyspnea. This knowledge might be beneficial for the effective treatment and control of the COVID-19 outbreak. Additional studies are required to distinguish between symptoms during and after, in patients with COVID-19.
Publisher: Informa UK Limited
Date: 26-03-2019
Publisher: Informa UK Limited
Date: 28-08-2015
Publisher: Hindawi Limited
Date: 22-11-2020
DOI: 10.1111/JONM.13205
Publisher: SAGE Publications
Date: 27-02-2015
Abstract: The Short-Term Assessment of Risk and Treatability (START) aims to assist mental health practitioners to estimate an in idual’s short-term risk for a range of adverse outcomes via structured consideration of their risk (“Vulnerabilities”) and protective factors (“Strengths”) in 20 areas. It has demonstrated predictive validity for aggression but this is less established for other outcomes. We collated START assessments for N = 200 adults in a secure mental health hospital and ascertained 3-month risk event incidence using the START Outcomes Scale. The specific risk estimates, which are the tool developers’ suggested method of overall assessment, predicted aggression, self-harm/suicidality, and victimization, and had incremental validity over the Strength and Vulnerability scales for these outcomes. The Strength scale had incremental validity over the Vulnerability scale for aggressive outcomes therefore, consideration of protective factors had demonstrable value in their prediction. Further evidence is required to support use of the START for the full range of outcomes it aims to predict.
Publisher: American Psychological Association (APA)
Date: 06-2016
DOI: 10.1111/CPSP.12146
Publisher: Wiley
Date: 13-06-2020
DOI: 10.1111/INM.12750
Publisher: Informa UK Limited
Date: 11-09-2017
DOI: 10.1080/09638288.2017.1375030
Abstract: The in idual recovery outcomes counter is a 12-item personal recovery self-assessment tool for adults with mental health problems. Although widely used across Scotland, limited research into its psychometric properties has been conducted. We tested its' measurement properties to ascertain the suitability of the tool for continued use in its' present form. Anonymised data from the assessments of 1743 adults using mental health services in Scotland were subject to tests based on principles of Rasch measurement theory, principal components analysis and confirmatory factor analysis. Rasch analysis revealed that the six-point response structure of the in idual recovery outcomes counter (I.ROC) was problematic. Re-scoring on a four-point scale revealed well-ordered items that measure a single, recovery-related construct, and has acceptable fit statistics. Confirmatory factor analysis supported this. Scale items covered around 75% of the recovery continuum those in iduals least far along the continuum were least well addressed. A modified tool worked well for many, but not all, service users. The study suggests specific developments are required if the I.ROC is to maximise its' utility for service users and provide meaningful data for service providers. Implications for Rehabilitation Agencies and services working with people with mental health problems aim to help them with their recovery. The in idual recovery outcomes counter has been developed and is used widely in Scotland to help service users track their progress to recovery. Using a large s le of routinely collected data we have demonstrated that a number of modifications are needed if the tool is to adequately measure recovery. This will involve consideration of the scoring system, item content and inclusion, and theoretical basis of the tool.
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Geoffrey Dickens.