Adverse Incidents, Patient Flow and Nursing Workforce Variables on Acute                 Psychiatric Wards: The Tompkins Acute Ward Study

Bowers, Len; Allan, Teresa; Simpson, Alan; Nijman, Henk; Warren, Jonathan

doi:10.1177/0020764007075011

Cited by 62 publications

(61 citation statements)

References 21 publications

(23 reference statements)

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“…Our previous work has shown an inverse relationship between the presence of regular nursing staff and violent incidents (Bowers, Allan, Simpson, Nijman, & Warren 2005a;Bowers, Nijman, Allan, Simpson, Warren, & Turner 2005c), as has that of others (Chou, Lu, & Mao 2002;Lanza et al 1994), and in surveys of staff or patients larger numbers are often seen as necessary to reduce levels of violence (FaganPryor et al 2003;Kumar, Guite, & Thornicroft 2001). However one other study has also reported a positive association between staffing numbers and patient aggression (Owen et al 1998).…”

Section: Discussionmentioning

confidence: 89%

“…Adverse events can also cause significant distress for staff (and sometimes injuries) and are thought to contribute to low morale, high sickness, high staff turnover and high vacancy rates (Garcia et al 2005;Needham et al 2005b). Poor staffing levels result in more adverse incidents (Bowers et al 2005a) and the consequent reliance on temporary staff is expensive and linked with lower standards of care (Audit Commission 2001).…”

Section: Introductionmentioning

confidence: 99%

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Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Bowers

Allan

Simpson

et al. 2009

Issues in Mental Health Nursing

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127

152

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This is the accepted version of the paper.This version of the publication may differ from the final published version. to ascertain those factors most strongly associated with verbal aggression, aggression towards objects and physical aggression against others. High levels of aggression were associated with a high proportion of patients formally detained under mental health legislation, high patient turnover, alcohol use by patients, ward doors being locked, and higher staffing numbers (especially qualified nurses). The findings suggest that the imposition of restrictions on patients exacerbates the problem of violence, and that alcohol management strategies may be a productive intervention. Permanent repository linkInsufficient evidence is available to draw conclusions about the nature of the link between staffing numbers and violence.3

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Section: Discussionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Bowers

Allan

Simpson

et al. 2009

Issues in Mental Health Nursing

Self Cite

127

152

View full text Add to dashboard Cite

show abstract

“…The delivery of nidotherapy within secure settings, gaining the support of fl uctuating staff teams with regime and policy imperatives, was particularly challenging: this is clearly crucial, as many of this patient groups will fi nd themselves in secure settings, often for extensive periods of time. When staff in such units frequently change or are relatively uninvolved in the therapeutic care of those with antisocial behaviour, aggressive episodes tend to increase (Bowers et al, 2007): this is both a complication for, and a driver of, the adoption of nidotherapy, not only for patient benefi t, but as a vehicle for more meaningful engagement of staff in facilitative and collaborative treatment in inpatient settings.…”

Section: Discussionmentioning

confidence: 99%

Integration of Nidotherapy Into the Management of Mental Illness and Antisocial Personality: a Qualitative Study

Spencer

Rutter

Tyrer

2009

Int J Soc Psychiatry

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Nidotherapy is an acceptable form of management and was perceived in this study to have largely positive results for both patients and clinical teams as it offered intervention beyond that provided by conventional teams. It was felt to require more than six months of treatment and was less successful when there was inadequate communication between the nidotherapist and clinical teams and when the philosophy of care was not congruent.

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“…An analysis of single and repeat incidents of self-harm showed that therapist contact (performing a psychosocial assessment) was associated with a significantly decreased risk for a repeat incident, suggesting that the therapist-patient relationship has a moderating influence on repeat self-harming incidents (15). Further, we know from adult psychiatric literature that an increased risk for suicide has been associated with the discontinuity of care from a significant professional (16,17). Children and adolescents are dependent on a stable therapist-patient relationship (18,19) for a positive treatment outcome.…”

Section: Introductionmentioning

confidence: 99%

Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings

Ulke

Klein

Klitzing

2014

International Journal of Adolescent Medicine and Health

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This study examined whether relational stressors such as psychosocial stressors, the therapist's absence and a change of therapist are associated with repeat aggressive or self-harming incidents in child and adolescent psychiatric inpatient care. The study data were derived from critical incident reports and chart reviews of 107 inpatients. In multinomial regression analysis, patients with repeat aggressive or self-harming incidents were compared with patients with single incidents. Results suggested that a higher number of psychosocial stressors and a change of therapist, but not the therapist's absence are predictors for repeat aggressive and self-harming incidents. There was a high prevalence of therapist's absence during both, single and repeat, incidents. Repeat aggressive incidents were common in male children and adolescents with disruptive behavior disorders. Repeat self-harming incidents were common in adolescent females with trauma-related disorders. Patients with repeat aggressive or self-harming incidents had a higher number of abnormal intrafamilial relationships and acute life events than patients with single incidents. Interventions to reduce a change of therapist should in particular target children and adolescents with a higher number of psychosocial stressors and/or a known history of traumatic relational experiences. After a first incident, patients should have a psychosocial assessment to evaluate whether additional relational support is needed.

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Adverse Incidents, Patient Flow and Nursing Workforce Variables on Acute Psychiatric Wards: The Tompkins Acute Ward Study

Abstract: This is the accepted version of the paper.This version of the publication may differ from the final published version. Permanent

Cited by 62 publications

References 21 publications

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric Wards

Integration of Nidotherapy Into the Management of Mental Illness and Antisocial Personality: a Qualitative Study

Relational stressors as predictors for repeat aggressive and self-harming incidents in child and adolescent psychiatric inpatient settings

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