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ABSTRACT: Aggression during psychiatric hospitalization is frequent, problematic, and a major challenge for nurses and mental health services more generally. The strength of the therapeutic alliance between nursing staff and patients has been posited as an important protective factor that can limit the likelihood of aggression. This study examined the relationship between interpersonal style, perceived coercion, and psychiatric symptoms on the therapeutic alliance between patients and staff, and how each, in turn, is related to aggression. Participants in this study were 79 patients admitted to an acute psychiatric hospital. Each participant was interviewed to determine perceived coercion, symptoms of psychiatric illness, interpersonal style, and therapeutic alliance. Incidents of aggression were recorded at discharge through a review of incident forms, file review, and interviews with unit nursing staff. The results showed that a hostile-dominant interpersonal style and symptoms of paranoia predicted poor therapeutic alliance, contributing 14% of the variance in therapeutic alliance scores. A dominant interpersonal style predicted aggression towards staff. Therapeutic alliance, perceived coercion, and symptoms of psychiatric illness did not predict aggression. Implications for engagement in treatment and the prevention of aggression are discussed.
International journal of mental health nursing 08/2011; 21(1):20-9. · 1.07 Impact Factor
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ABSTRACT: The aim of this study was to evaluate the impact of a two-pronged, letter intervention strategy to improve the follow-up after referral (FAR) rate to general practitioners of patients referred for a psychiatric assessment.
The FAR rate of patients referred to the Inner South East Primary Mental Health Team (PMHT) between June 2007 and June 2008 was examined via telephone call, before and after the implementation of a process sending letters to patients and practice managers advising them to make an appointment to discuss recommendations resulting from the psychiatric assessment.
A statistically significant improvement (χ² (1, n = 44) = 5.81, p = 0.016) in FAR rate was observed for patients post-intervention, with 11/25 (44%) pre-intervention patients not returning to their referring general practitioner within 1 month of assessment, compared to 2/19 (10.5%) patients post-intervention.
The implementation of two simple and inexpensive measures resulted in a fourfold improvement in the return rate of patients to their referring general practitioner post-psychiatric assessment.
Australasian Psychiatry 06/2011; 19(3):236-9. · 0.86 Impact Factor
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ABSTRACT: Interpersonal style, a key component of personality and personality disorder, has emerged as an important characteristic that is relevant to aggressive behavior by patients in psychiatric hospitals. However, studies examining the relationship between interpersonal style and aggression have thus far only been conducted with patients with personality disorder and/or mild and stable symptoms of mental illness. This study explored the relative importance of patients' interpersonal style, psychiatric symptoms, and perceptions of staff coercion on aggression and self-harm during acute psychiatric hospitalization. One hundred and fifty-two patients (M = 38.32 years, SD = 12.06; 56.8% males and 43.2% females) admitted for short-term assessment and treatment to the acute units of a civil and a forensic psychiatric hospital were administered the Brief Psychiatric Rating Scale, Impact Message Inventory, and MacArthur Admission Experience Survey. Participants' files were reviewed and nursing staff were interviewed at the end of each patient's hospital stay to determine whether participants had self-harmed or acted aggressively towards others. Initial univariate analyses showed that thought disorder and dominant and hostile-dominant interpersonal styles predicted aggression. Using multiple regression and controlling for gender and age, only a hostile-dominant interpersonal style predicted aggression (β = .258, p < .05). No factors were significantly related to self-harm. These results suggest that measures of interpersonal style are sensitive to those aspects of interpersonal functioning that are critical to patient's responses to the demands of psychiatric in-patient treatment. Procedures to assess risk and engage and manage potentially aggressive patients, including limit-setting styles and de-escalation strategies, should take into account the interpersonal style of patients and the interpersonal behavior of staff.
Psychiatry Interpersonal & Biological Processes 01/2010; 73(4):365-81. · 3.16 Impact Factor
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Australasian Psychiatry 07/2009; 17(3):247-8. · 0.86 Impact Factor
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ABSTRACT: The aim of this study was to investigate the preferences of general practitioners (GPs) in reply letters for patients referred for a one-off psychiatric assessment.
A sample of GPs referring to a primary mental health team service were mailed a questionnaire inquiring into the usefulness of 21 different letter items.
The response rate was 51%. Many of the items in our routine reply letters were rated highly, but others such as developmental history, supplementary information and a comprehensive report were not. Sending a copy of the letter to the patient was rated as useful by only 42.5%.
The Royal Australian and New Zealand College of Psychiatrists' guidelines for reply letters are endorsed. There are, however, some additional items that GPs may find useful.
Australasian Psychiatry 01/2009; 17(5):385-8. · 0.86 Impact Factor
