Hospital-based violence intervention: Risk reduction resources that are essential for success
From the San Francisco General Hospital, University of California, San Francisco.
The journal of trauma and acute care surgery
04/2013; 74(4):976-82. DOI: 10.1097/TA.0b013e31828586c9
Hospital-based violence intervention programs (VIPs) aim to reduce violent injury and recidivism. The aim of this study was to determine the most significant risk reduction variables associated with success in our VIP. We hypothesized that our recidivism rate declined since VIP's inception and that we could identify risk reduction variables that were independent determinants of program success.
We analyzed our prospectively collected data for 2005-2011 from our VIP database. Success was defined as more than 50% needs met without recidivism or attrition. Impact and outcome evaluation was performed per a model promoted by the Centers for Disease Control. Rates of risk reduction and injury recidivism were calculated. Case management time spent per client (dose) was defined as low (0-1 hours per week), medium (1-3 hours per week), moderate (3-6 hours per week), and high (>6 hours per week). Correlation coefficients and logistic regression were used to examine associations between variables and success in the VIP.
Two hundred fifty-four clients received services. Meeting needs in mental health (odds ratio, 5.97; 95% confidence interval, 2.72-13.07) and employment (odds ratio, 4.41:95% confidence interval, 1.56-12.46) proved significantly associated with success (p < 0.005). The 6-year program recidivism rate was 4% versus historical control of 16% (p < 0.05). Moderate and high exposure to intensive case management in the first 3 months was also significantly associated with success (p < 0.05). Success in our VIP was not associated with age, gender, education level, previous incarceration, probation status, or length of time in program.
For 6 years, our recidivism rate has decreased fourfold compared with the rate before VIP inception. For startup and maintenance of a VIP, it is essential to know where to focus collaborative efforts in communities to target the most critical risk reduction resources. This study provides guidance-securing mental health care and employment for our clients appears to be predictive of success. The value of early "high-dose" intensive case management is also essential for reducing recidivism.
Care management study, level III.
Available from: ocean.kisti.re.kr
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ABSTRACT: Purpose: Clinical nurses are at high risk of incurring hospital violence during their working life. Hospital violence and its outcomes have an impact on the job satisfaction, the recruitment and retention of nurses as well as the quality of care delivered to patients. The purpose of this study was to identify coping styles toward hospital violence in clinical nurses using Q-methodology. Methods: Q-methodology, which analyzes the subjectivity of each type of attitude, and coping styles was used. The 40 selected Q-statements from each of 35 participants were classified into the shape of a normal distribution using a 9-point scale. The collected data were analyzed using the pc-QUANAL program. Results: The results revealed four discrete groups of clinical nurses toward hospital violence: take strong action and promote the recurrence prevention, appear psychosomatic symptoms, investigate the cause and focus on prevention, and request hospital assistance and keep up my duty. Conclusion: The findings indicate that development of nursing intervention program based on the four types could beneficially contribute to the violence prevention in hospital.
Available from: Theodore Corbin
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Traumatic event reexposure in injecting drug users is associated with increased drug use and potential for psychiatric symptoms. This is the first study to examine fixed and time-varying factors that are prospectively associated with new traumatic event reexposure in injecting drug users.
Injecting drug users registered in a syringe exchange program were enrolled in a 16-month parent study comparing strategies to increase drug abuse treatment enrollment. Participants (N = 162) completed baseline measures of demographics, psychiatric treatment history, and lifetime traumatic event exposure. Monthly follow-ups assessed past-month traumatic event exposure, days of heroin and cocaine use, criminal activity, and drug abuse treatment participation. Generalized Estimating Equations models tested the influence of fixed baseline and time-varying factors on traumatic event reexposure in the same month, the following month, and two months later.
Significant fixed risk factors for traumatic event reexposure include female gender and past psychiatric treatment. In addition, each past traumatic event exposure was associated with an increased likelihood of reexposure. After accounting for all other factors, each day of cocaine use was associated with a small but persistent increased risk of traumatic event reexposure. Reexposure to a traumatic event in the prior month more than doubled the risk of subsequent reexposure.
Injecting drug users experience a pattern in which drug use is associated with increased risk of subsequent traumatic event reexposure, and traumatic event reexposure is associated with further drug use and continued reexposure. Implications for addressing these concerns in injecting drug users are presented.
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