Violence and Aggression in Psychiatric Units

Department of Psychological Medicine, University of Sydney and Canberra Hospital, Woden, New South Wales, Australia.
Psychiatric Services (Impact Factor: 2.41). 12/1998; 49(11):1452-7. DOI: 10.1176/ps.49.11.1452
Source: PubMed


To help predict aggressive and violent behaviors, the frequency and types of these behaviors in acute psychiatric inpatient settings were examined, and potential interactions between staffing and patient mix and rates of the behaviors were explored.
Data on violent incidents were gathered prospectively in three adult acute psychiatric units in a general hospital and two units in a primary psychiatric hospital in Sydney, Australia. Staff recorded violent and aggressive incidents, which were ranked on an 8-level scale. They also completed weekly reports of staffing levels and patient mix. Poisson regression analysis was used to calculate relative rates, 95 percent confidence intervals, and p values.
A total of 1,289 violent incidents were recorded over a seven-month period. Based on the scale, 58 percent of the incidents were serious. Seventy-eight percent were directed toward nursing staff. Complex relationships between staffing, patient mix, and violence were found. Relative risk increased with more nursing staff (of either sex), more nonnursing staff on planned leave, more patients known to instigate violence, a greater number of disoriented patients, more patients detained compulsorily, and more use of seclusion. The relative risk decreased with more young staff (under 30 years old), more nursing staff with unplanned absenteeism, more admissions, and more patients with substance abuse or physical illness. In total these factors accounted for 62 percent of the variance in violence.
Violent incidents in psychiatric settings are a frequent and serious problem. Incidents appear to be underreported, and the seriousness of an incident does not guarantee it will be reported.

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    • "serious and 78% are directed towards nursing staff (Owen et al. 1998). Additional evidence also points to a particular subset of individuals perpetrating this violence. "
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    • "Other positive findings have been associations between higher staffing levels and amore therapeutic wards (Moos, 1972); intensive staffing and lower lengths of stay (Becker, 1969); and lower rates of violent incidents (Chou et al., 2002; Lanza et al., 1994). However other research has found no connection between staff/patient ratios and outcomes (Ellsworth et al., 1979); more staff and more violence (Owen et al., 1998); and more staff and increased interaction between them, rather than between staff and patients (Sandford et al., 1990). Finally, in a study utlising 22 wards, although high staffing levels were associated with lower readmission rates, substantially better predictions of care outcomes could be made when the amount of attention patients received from staff was taken into account (Coleman and Paul, 2001). "
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