Structured professional judgement and sequential redirections

Haque, Quazi; Webster, Christopher D.

doi:10.1002/cbm.1886

Cited by 13 publications

(6 citation statements)

References 33 publications

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“…The Historical, Clinical, Risk Management-20 (HCR-20) [58] is completed soon after admission and at six monthly intervals. Data were taken from those assessments completed prior to the study period for those already in hospital at the commencement date and within two weeks of admission for those admitted during the study period.…”

Section: Need For Therapeutic Security Risk Of Violencementioning

confidence: 99%

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

et al. 2020

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Background Prevention of violence due to severe mental disorders in psychiatric hospitals may require intrusive, restrictive and coercive therapeutic practices. Research concerning appropriate use of such interventions is limited by lack of a system for description and measurement. We set out to devise and validate a tool for clinicians and secure hospitals to assess necessity and proportionality between imminent violence and restrictive practices including de-escalation, seclusion, restraint, forced medication and others. Methods In this retrospective observational cohort study, 28 patients on a 12 bed male admissions unit in a secure psychiatric hospital were assessed daily for six months. Data on adverse incidents were collected from case notes, incident registers and legal registers. Using the functional assessment sequence of antecedents, behaviours and consequences (A, B, C) we devised and applied a multivariate framework of structured professional assessment tools, common adverse incidents and preventive clinical interventions to develop a tool to analyse clinical practice. We validated by testing assumptions regarding the use of restrictive and intrusive practices in the prevention of violence in hospital. We aimed to provide a system for measuring contextual and individual factors contributing to adverse events and to assess whether the measured seriousness of threating and violent behaviours is proportionate to the degree of restrictive interventions used. General Estimating Equations tested preliminary models of contexts, decisions and pathways to interventions. Results A system for measuring adverse behaviours and restrictive, intrusive interventions for prevention had good internal consistency. Interventions were proportionate to seriousness of harmful behaviours. A ‘Pareto’ group of patients (5/28) were responsible for the majority (80%) of adverse events, outcomes and interventions. The seriousness of the precipitating events correlated with the degree of restrictions utilised to safely manage or treat such behaviours. Conclusion Observational scales can be used for restrictive, intrusive or coercive practices in psychiatry even though these involve interrelated complex sequences of interactions. The DRILL tool has been validated to assess the necessity and demonstrate proportionality of restrictive practices. This tool will be of benefit to services when reviewing practices internally, for mandatory external reviewing bodies and for future clinical research paradigms.

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Section: Need For Therapeutic Security Risk Of Violencementioning

confidence: 99%

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

et al. 2020

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“…Ideally, risk formulation and risk management planning should be done in partnership with the patient (Wilson, 2011;Haque & Webster, 2013). This helps to facilitate an effective therapeutic alliance (De Vries Robbé et al 2012), to predict outcome across treatments (De Rubeis et al 2005), and to ensure that interventions are appropriate and agreed by the patient.…”

Section: Discussionmentioning

confidence: 98%

An audit of the quality of HCR-20 violence risk assessments in a low secure service

Sen¹,

Lindsey²,

Chatterjee³

et al. 2015

J. Psychiatr. Intensive Care

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“…Literatura przedmiotu wymienia wiele czynników ryzyka agresji ze strony pacjenta, tj. płeć męska, wiek pomiędzy 25-35 lat i powyżej 60. roku życia, zaburzenia psychiczne oraz wpływ substancji psychoaktywnych [6,7]. Agresja wobec personelu medycznego stanowi jednak bardziej złożony problem i aby zrozumieć skalę zjawiska nie można, jak już to wskazano wcześniej, szukać jej przyczyn wyłącznie w pacjencie.…”

Section: Wstępunclassified

Agresja wobec personelu medycznego w ocenie studentów pielęgniarstwa — propozycja narzędzia

Lickiewicz

Sałapa²,

Musiał³

et al. 2017

Problemy Pielęgniarstwa

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gresja wobec personelu medycznego w ocenie studentów pielęgniarstwa-propozycja narzędzia Aggression against medical personnel in perception of nursery students-tool suggestion STRESZCZENIE Wstęp. Agresja pacjentów i ich rodzin stanowi poważny problem w pracy personelu medycznego. Agresja powoduje wiele psychologicznych reakcji: od poczucia winy przez lęk do złości i wściekłości. Efekt długofalowy stanowi pogorszenie jakości opieki zdrowotnej powiązane z wypaleniem zawodowym personelu. Cel pracy. Celem pracy była adaptacja skali IMPACS, służącej do oceny konsekwencji agresji wobec pielęgniarek. Materiał i metody. Badaniem objęto 102 studentki III roku pielęgniarstwa. Narzędzie badawcze stanowiła adaptacja skali IMPACS. Wyniki. W celu uzyskania polskiej wersji narzędzia zastosowano metodę eksploracyjnej analizy czynnikowej. Przedstawiono dwa warianty analizy-trzy-i dwuczynnikowe. Wnioski. W badaniu wykazano różnice w rozbieżnościach pomiędzy oryginalną wersją skali i uzyskaną w badaniach. Wskazuje to na różnice w postrzeganiu agresji i jej konsekwencji w zależności od wpływu kultury i miejsca pracy.

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Structured professional judgement and sequential redirections

Abstract: Future developments in violence-reduction interventions will require improved integration between the worlds of research and clinical practice.

Cited by 13 publications

References 33 publications

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

An audit of the quality of HCR-20 violence risk assessments in a low secure service

Agresja wobec personelu medycznego w ocenie studentów pielęgniarstwa — propozycja narzędzia

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