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Inpatient Units (inpatient + unit)

Distribution by Scientific Domains

Medical Sciences	86%
Psychology	13%

Distribution within Medical Sciences

Nursing General	27%
Psychiatry	12%
11 Other Subdomains	61%

Kinds of Inpatient Units

psychiatric inpatient unit

Selected Abstracts

An examination of frequent nursing interventions and outcomes in an adolescent psychiatric inpatient unit

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2009
Candace Bobier
ABSTRACT:, Little is known about which nursing interventions used in adolescent psychiatric inpatient treatment demonstrate improvements in outcome in the ,real world' setting, despite an increase in external outcomes reporting requirements. This paper examines nursing and other multidisciplinary interventions commonly used at the Youth Inpatient Unit, Christchurch, New Zealand, in relation to improvements in outcomes as measured by the Health of the Nation Outcome Scales for Children and Adolescents, utilizing data gathered prospectively as part of an ongoing quality assurance and outcomes project. We found the majority of interventions investigated were utilized equally across diagnostic groups, although stress management and problem-solving education was used more for patients with mixed affective disorders. Further, the results contribute to growing evidence toward the value of providing medication and problem-solving education to this population. Mental health nurses working with children and adolescents should be supported to utilize and develop their unique skill set to offer targeted interventions and to examine their practice to identify the most valuable interventions for their patients within this developmental context. [source]

Group Psychotherapy with Children on an Inpatient Unit: The MEGA Group Model

JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING, Issue 1 2006
Jay Reeve PhD
TOPIC:,Psychotherapy group intervention with children based on the use of community meeting. PURPOSE:,To describe a model group intervention that is based on developmental level and applicable across a broad spectrum of behavioral and psychiatric disorders. The purpose of this paper is to discuss the development of this model on one inpatient unit, the benefits of the model and implication for future research, including a simple model of the stages of group development. SOURCES:,A review of the literature and the author's experience in the development of a model group intervention. CONCLUSION:,The model is a flexible and broadly applicable one, which may be utilized by a variety of staff, including relatively inexperienced line workers. [source]

Clinical characteristics of inpatient adolescents with severe obsessive,compulsive disorder

DEPRESSION AND ANXIETY, Issue 2 2006
Gal Shoval M.D.
Abstract Obsessive,compulsive disorder (OCD) is a common disorder in adolescents, usually treated in the outpatient setting. Our aim in this study was to evaluate the clinical characteristics of adolescents with severe OCD that required hospitalization. A total of 342 patients consecutively admitted to a psychiatric adolescent inpatient unit and 87 healthy volunteers were assessed by a semistructured interview for clinical diagnosis, suicide risk factors, aggression, ego defense mechanisms, and intelligence. Patients with OCD (n=40) were compared to other four diagnostic patient groups with psychotic, affective, conduct, and eating disorders, as well as to normal controls. Adolescent inpatients with OCD experienced less separation anxiety than all the other psychiatric groups (P < .01) and were less impulsive than controls (P < .001). They differed in aggressive/impulsive traits and hospital-related behaviors from other diagnostic groups. Adolescent inpatients with OCD consist of a unique subgroup in the inpatient unit in terms of their clinical characteristics and risk factors for suicide. These characteristics should be taken into account when developing a treatment plan for these difficult-to-treat inpatients. Depression and Anxiety 23:62,70, 2006. © 2006 Wiley-Liss, Inc. [source]

The development of the Recovery and Prevention of Psychosis Service in Melbourne, Australia

EARLY INTERVENTION IN PSYCHIATRY, Issue 2 2009
Brendan P. Murphy
Abstract Aim: To describe the establishment of a multicomponent, phase-specific, early intervention service for young people experiencing psychosis. Methods: The Recovery and Prevention of Psychosis Service commenced streamed clinical service delivery in November 2004, providing comprehensive case management for up to 3 years within Victoria's largest metropolitan health service. It delivers phase-oriented treatment focusing on early detection, recovery and relapse prevention, and minimizing disability and secondary comorbidity. The combined programme covers training and professional development, data collection and evaluation, specialist intervention services, group programme work and community development. Results: Of the first 151 clients, 70.2% were male, the average age at first presentation was 20.9 years, 15% were under 18 at first contact and 67% required inpatient admission at least once. Mean age at first contact was 20.84 years for those requiring inpatient services and 70% admitted were male. The average length of stay was 25.69 days and 23% were secluded, with an average of 2.1 seclusions. A large percentage of Recovery and Prevention of Psychosis Service clients (81%) required involuntary treatment, a significantly greater proportion of admitted patients were on Community Treatment Orders compared to those never admitted (22.5% cf. 4.1%; P = 0.04) and 92% of those admitted subsequently relapsed compared to 8% of those not admitted (P = 0.02). Conclusions: Recovery and Prevention of Psychosis Service is successfully developing a fully integrated first episode service. Recent developments include expanding the period of care up to 5 years for selected patients, the recruitment of a health promotions officer and planning for the development of a youth inpatient unit. [source]

One-year outcome of an early intervention in psychosis service: a naturalistic evaluation

EARLY INTERVENTION IN PSYCHIATRY, Issue 3 2007
Swaran P. Singh
Abstract Aim: We conducted a 1-year prospective evaluation of an early intervention in psychosis service (Early Treatment and Home-based Outreach Service (ETHOS)) during its first 3 years of operation in South-west London, UK. Methods: All patients referred to ETHOS underwent structured assessments at baseline and at 1-year follow-up. In addition, hospitalization rates of ETHOS patients (intervention group) were compared with a non-randomized parallel cohort (comparison group) of first-episode patients treated by community mental health teams. Results: The Early Treatment and Home-based Outreach Servicepatients experienced significant improvements in symptomatic and functional outcomes, especially vocational recovery. The service received only a quarter of eligible patients from referring teams. ETHOS patients did not differ from the comparison group in number of admissions, inpatient days or detention rates. Although number of referrals increased over time, there was no evidence that patients were being referred earlier. Conclusions: There is now robust evidence for the effectiveness of specialist early intervention services. However, such services must be adequate resourced, including an early detection team and provision of their own inpatient unit. [source]

Eating disorder not otherwise specified in an inpatient unit: the impact of altering the DSM-IV criteria for anorexia and bulimia nervosa

EUROPEAN EATING DISORDERS REVIEW, Issue 5 2007
Riccardo Dalle Grave
Abstract Objective To evaluate (1) the Eating Disorder Not Otherwise Specified (EDNOS) prevalence in an eating disorder inpatient unit; (2) the impact of altering the diagnostic criteria for anorexia nervosa and bulimia nervosa on the prevalence of EDNOS. Method One hundred and eighty six eating disorder patients consecutively hospitalised were included in the study. The prevalence of anorexia nervosa, bulimia nervosa and EDNOS was evaluated with the Eating Disorder Examination (EDE). The EDNOS prevalence was recalculated after the alteration of three diagnostic criteria for anorexia nervosa and one for bulimia nervosa. Results Seventy eight patients (41.9%) met the diagnostic criteria for anorexia nervosa, 33 (17.8%) for bulimia nervosa and 75 (40.3%) for EDNOS. The alteration of the DSM-IV diagnostic criteria reduced the prevalence of EDNOS to 28 cases (15%). Conclusion EDNOS is a very frequent diagnostic category in an inpatient setting. Altering the diagnostic criteria for anorexia nervosa and bulimia nervosa reduced significantly the prevalence of EDNOS. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

Risk factors for falling in a psychogeriatric unit

INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 8 2001
A. John de Carle
Abstract Objective To identify risk factors associated with falls in a psychogeriatric inpatient population. Design Retrospective cohort study. Setting A psychogeriatric inpatient unit in a Brown University affiliated psychiatric hospital. Participants A total of 1834 men and women who represented all admissions to the psychogeriatric inpatient unit between January 1992 and December 1995. Results Over the study period a total of 175 falls were recorded, giving a fall rate of 9.5%. Using a logistic regression model, six variables were found to be independently associated with an increased risk of falling: female gender, electroconvulsive therapy (ECT), mood stabilizers, cardiac arrhythmias, Parkinson's syndrome and dementias. Falls and ECT were associated with longer hospital stay, when adjusted for confounders including ECT. Conclusions These findings support previous results and identify ECT as a possible risk factor for falling in a hospital setting. Copyright © 2001 John Wiley & Sons, Ltd. [source]

An examination of frequent nursing interventions and outcomes in an adolescent psychiatric inpatient unit

Group Psychotherapy with Children on an Inpatient Unit: The MEGA Group Model

Integrating pediatric hospitalists in the academic health science center: Practice and perceptions in a canadian center,,

JOURNAL OF HOSPITAL MEDICINE, Issue 4 2010
FRCPC, Sanjay Mahant MD
Abstract BACKGROUND: The integration of hospitalists in academic settings has been identified as a challenge to the hospitalist movement. The Division of Pediatric Medicine, Hospital for Sick Children, Toronto, was established in 1981, providing a rich resource to examine this field in the academic context and inform academic program development. OBJECTIVES: To explore the characteristics, practice, perceptions, and contributions of pediatric hospital medicine in an academic health science center (AHSC). METHODS: A cross-sectional survey of physicians attending on the pediatric medicine inpatient unit (PMIU) (n = 20). RESULTS: Clinical activity included attending on the PMIU, consultation and comanagement outside the PMIU, and outpatient care of "hospital intense" patients. There was a high level of engagement in research, education, and quality improvement activities. Perceived advantages to a career as a hospitalist included: working in a team; generalist approach to care; stability relative to community practice; intellectually stimulating and rewarding work; and growing area for scholarship. Perceived disadvantages to a career as a hospitalist included: burnout; recognition and respect; and lack of long-term relationships with patients. Themes regarding barriers to establishing a career as a hospitalist in an AHSC were as follows: burnout; time and skills to develop an academic niche; balance between clinical and academic priorities; and system for career advancement. CONCLUSIONS: The contributions of pediatric hospitalists to the academic mission were diverse. Fellowship training, faculty development, and balance between time allocated to direct patient care and academic pursuits should be defined. This will help ensure career development, viability, and realization of excellence in the academic context. Journal of Hospital Medicine 2010;5:228,233. © 2010 Society of Hospital Medicine. [source]

Toto, I don't think we're on the adult inpatient unit anymore

JOURNAL OF HOSPITAL MEDICINE, Issue 3 2009
Jack M. Percelay MD
[source]

Psychiatric inpatient care for adults with intellectual disabilities: generic or specialist units?

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2004
K. Xenitidis
Abstract Background When adults with intellectual disabilities (ID) require a psychiatric admission, general adult mental health units are often used. Specialist units have emerged recently as a care option but there is only limited evidence of their effectiveness. Thus this study aims to describe and evaluate the effectiveness of a specialist inpatient unit and report on the utilization of generic and specialist inpatient services. Method All patients admitted to a specialist ID psychiatric unit were evaluated on admission and immediately after discharge on a number of outcome measures. In addition, they were compared with those admitted to general adult mental health units covering the same catchment area. Results Significant improvements were demonstrated within the specialist unit cohort on measures including psychopathology, global level of functioning, behavioural impairment and severity of mental illness. The specialist unit patients had a longer length of inpatient stay but were less likely to be discharged to out-of-area residential placement. Conclusions Specialist units are an effective care option for this group of people. [source]

Patients' and their parents' satisfaction levels about the treatment in a child and adolescent mental health inpatient unit

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 9 2010
F. VAROL TAS md
Accessible summary ,,The views of patients and their relatives regarding the treatment are extremely important in mental health as well as in other medical disciplines. ,,In our study, consistent with the literature, the satisfaction levels of young people and their families regarding the service they got during their stay in the unit were determined to be high. ,,The questionnaire used in the survey was designed to allow for five domain-based subscales which were admission process, staff, environment/services, treatment interventions and treatment outcome. ,,The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that; the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. ,,The results of such studies help to improve the quality of treatment and the mental health service that children and adolescents and their families receive. Abstract The aim of this study is to demonstrate the feedback and the satisfaction levels of the adolescents and their parents who received treatment in the newly opened inpatient unit. The results of the questionnaire evaluating the quality of the mental health service provided by the inpatient unit were examined retrospectively. The participants were the adolescents and their parents who received treatment and were discharged between January 2006 and May 2007. They were asked to give feedback on their observations and perceptions about the treatment they received, starting from the admission assessment until the time they were discharged. The satisfaction level of young people and their families regarding the service they received during their stay in the unit were determined to be high. The results of the questionnaires completed by adolescents and parents showed that the availability and the helpfulness of the staff, the admission process was given the highest satisfaction scores. Information about the adolescents' and their parents' experience of the treatment they received is essential and valuable in terms of promoting the quality of service and better treatment outcomes of an inpatient unit. [source]

Serum 6-Beta-Naltrexol Levels Are Related to Alcohol Responses in Heavy Drinkers

ALCOHOLISM, Issue 9 2000
Mary E. McCaul
Background: There is strong evidence for the role of the endogenous opioid system in alcohol reinforcement and consumption; however, recent human laboratory studies and clinical trials have reported mixed effects of naltrexone (a nonselective opioid antagonist) on alcohol-related behaviors. This paper reports a secondary data analysis of a human laboratory study that examines the relationship between serum levels of 6-beta-naltrexol, the major, biologically active metabolite of naltrexone, and subjective effects of alcohol. Methods: The study used a within-subjects design to examine the effects of naltrexone (0, 50, and 100 mg/day) on subjective responses to alcohol (none, moderate, and high dose) in heavy drinkers (n= 23). Each subject received three doses of naltrexone in random order; each naltrexone dose was administered over an 8 day period on an inpatient unit, with a 1 week outpatient washout between doses. After stabilization at each of the naltrexone doses, subjects participated in three alcohol challenge sessions (none, moderate, and high dose) in random order; thus, each subject participated in a total of nine alcohol administration sessions. Results: Doubling the naltrexone dose (50 vs. 100 mg/day) doubled the mean serum 6-beta-naltrexol levels. At each naltrexone dose, there was a 4-fold range in 6-beta-naltrexol levels across subjects. Before alcohol administration, higher 6-beta-naltrexol levels were associated with higher ratings of sedation. After high-dose alcohol administration, higher 6-beta-naltrexol levels were associated with significantly lower ratings of liking and best effects. Conclusions: These findings provide further evidence of the involvement of the opioid system in the modulation of alcohol effects and suggest that serum 6-beta-naltrexol concentrations may be important in predicting therapeutic response to naltrexone. [source]

Service provision for men with antisocial personality disorder who make contact with mental health services

PERSONALITY AND MENTAL HEALTH, Issue 3 2009
Mike J. Crawford
Concerns have been raised about the quality of health services for people with antisocial personality disorder (ASPD). As part of a randomized trial of cognitive behaviour therapy for men with ASPD, we collected prospective data on service utilization over a 12-month period. Among the 52 men that participated, 96% had evidence of anxiety disorder and 64% met criteria for probable alcohol misuse. Almost half the sample presented to emergency medical services and 21% were admitted to a mental health inpatient unit during the following year. Despite this, only 11 (21%) were provided with follow-up care from mental health services. Levels of alcohol and drug misuse were lower among those that were given follow-up (27.3% compared with 63.4%, p < 0.05). Although services for people with personality disorder in Britain have expanded, most men with ASPD do not receive follow-up care from mental health services. Copyright © 2009 John Wiley & Sons, Ltd. [source]

Borderline personality disorder and sensory processing impairment

PROGRESS IN NEUROLOGY AND PSYCHIATRY, Issue 4 2009
Stephen Brown FRCPsych
Sensory processing disorder (SPD) is a term advocated by some occupational therapists to describe a range of problems that might be amenable to particular treatment strategies, and has mainly been applied within the fields of paediatrics and learning disability. In this article,the authors investigate whether there could be a common ground between borderline personality disorder (BPD) and SPD and describe an extension of the treatment strategies for SPD to those with BPD in their acute inpatient unit. Copyright © 2009 Wiley Interface Ltd [source]

Dextromethorphan and Quinidine Combination for Heroin Detoxification

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2008
Evaristo Akerele MD
Dextromethorphan (DM) is a low-affinity, non-competitive NMDA receptor antagonist that has shown promise in preclinical and preliminary clinical studies for the reduction of opioid withdrawal symptoms, but when used at higher doses, it is associated with deleterious side effects attributed to its metabolite, dextrorphan. A clinical trial was therefore conducted to test the withdrawal-suppressant effect of a combination of dextromethorphan with quinidine (DM/Q). Quinidine inhibits the metabolism of dextromethorphan, reducing dextrorphan levels. Opioid-dependent patients were admitted to an inpatient unit, stabilized for three days on morphine (25 mg, sc, every six hours), and randomly assigned on day 2 to DM/Q (30 mg/30 mg, twice a day) (n = 22) or matching placebo (n = 9) prior to the discontinuation of morphine on day 4. Withdrawal symptoms, measured with the Modified Himmelsbach Opioid Withdrawal Scale (MHOWS), increased significantly on days 4 and 5 (Z = 3.70, p = .0002), and by day 6, 90% of the sample (28/31) had dropped out of the study. There were no differences between treatment groups on either outcome measure. The combination of dextromethorphan and quinidine appears ineffective as a primary treatment for opioid withdrawal. Future studies should examine dextromethorphan as an adjunct to other anti-withdrawal medications and focus more on the relationship between dextrorphan levels and withdrawal suppression. [source]

The Opportunity Loss of Boarding Admitted Patients in the Emergency Department

ACADEMIC EMERGENCY MEDICINE, Issue 4 2007
Thomas Falvo DO
Abstract Objectives: Boarding admitted patients in emergency department (ED) treatment beds has been recognized as a major cause of ED crowding and ambulance diversions. When process delays impede the transfer of admitted patients from the ED to inpatient units, the department's capacity to accept new arrivals and to generate revenue from additional patient services is restricted. The objective of this study was to determine the amount of functional ED treatment capacity that was used to board inpatients during 12 months of operations at a community hospital and to estimate the value of that lost treatment capacity. Methods: Historical data from 62,588 patient visits to the ED of a 450-bed nonprofit community teaching hospital in south central Pennsylvania between July 2004 and June 2005 were used to determine the amount of treatment bed occupancy lost to inpatient holding and the revenue potential of utilizing that blocked production capacity for additional patient visits. Results: Transferring admitted patients from the ED to an inpatient unit within 120 minutes would have increased the functional treatment capacity of the ED by 10,397 hours during the 12 months of this study. By reducing admission process delays, the hospital could potentially have accommodated another 3,175 patient encounters in its existing treatment spaces. Providing emergency services to new patients in ED beds formerly used to board inpatients could have generated $3,960,264 in additional net revenue for the hospital. Conclusions: Significantly higher operational revenues could be generated by reducing output delays that restrict optimal utilization of existing ED treatment capacity. [source]

User satisfaction with services in a randomised controlled trial of adolescent anorexia nervosa

EUROPEAN EATING DISORDERS REVIEW, Issue 5 2009
Peter Roots
Abstract Background User satisfaction is a neglected outcome in adolescent anorexia nervosa especially since the relative effectiveness of different treatments is unclear. It may also affect clinical outcome. Aims To assess young person's and parents' satisfaction with CAMHS outpatient, specialist outpatient and inpatient treatment received in a large randomised controlled trial. Method Quantitative and qualitative analysis of questionnaire data from 215 young people and their parents followed by focus groups to further explore emerging themes. Results High levels of satisfaction were reported, more amongst parents than young people and with specialist services. Both young people and carers strongly valued clinical relationships that involved being listened to and understood. They valued the expertise of specialist rather than generic CAMHS services. There were polarised views on the influence of other young people in inpatient units. Parents in particular valued support for themselves, both from professionals and other parents and felt this, and sibling support was lacking. Conclusions All comprehensive CAMH services are able to provide the good generic psychotherapeutic skills that parents and young people value so highly. However, generic CAMHS struggle to provide the demanded level of expertise and more specialised individual and family therapeutic interventions. Copyright © 2009 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

The inpatient management of physical activity in young people with anorexia nervosa

EUROPEAN EATING DISORDERS REVIEW, Issue 5 2008
Sarah Davies
Abstract This study investigates the management of physical activity in young inpatients with anorexia nervosa. Through telephone interviews and postal surveys inpatient units across the UK were asked about written documents regarding physical activity management, how they viewed healthy exercise, how they assessed physical fitness to engage in activity, the management approaches taken, provision of education and support around this issue and range of activities provided. Results indicated that a variety of approaches were taken, with little consensus between units, although the majority of approaches did involve some form of restriction, frequently determined by weight criteria. There were few substantial written documents to guide practice and a range of interpretations of healthy exercise. The findings are discussed and suggestions made for research to explore this area further and to inform the development of effective interventions. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source]

An exploratory study of resilience and job satisfaction among psychiatric nurses working in inpatient units

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 5 2010
Patricia S. Matos
ABSTRACT The present exploratory study was designed to examine the relationship between resilience and job satisfaction in psychiatric nurses working in inpatient units in a large, urban medical centre. The long range goal was to understand the dimensions of job satisfaction in this inpatient environment in order to implement nurse retention programmes specifically targeted toward teaching nurses skills in developing resilience. The nurses (n = 32) reported a high level of resilience and high job satisfaction. The job satisfaction subscale of professional status had the highest mean rating among these nurses, and the physician,nurse interaction subscale had the lowest mean score. Implications for future practice and research are addressed. [source]

Mental health nurses establishing psychosocial interventions within acute inpatient settings

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2009
Antony Mullen
ABSTRACT Acute inpatient units provide care for the most acutely unwell people experiencing a mental illness. As a result, the focus for care is on the containment of difficult behaviour and the management of those considered to be ,at high risk' of harm. Subsequently, recovery-based philosophies are being eroded, and psychosocial interventions are not being provided. Despite the pivotal role that mental health nurses play in the treatment process in the acute inpatient setting, a review of the literature indicates that mental health nursing practice is too custodial, and essentially operates within an observational framework without actively providing psychosocial interventions. This paper will discuss the problems with mental health nursing practice in acute inpatient units highlighted in the current literature. It will then put forward the argument for routine use of psychosocial interventions as a means of addressing some of these problems. [source]

Occupational violence and assault in mental health nursing: A scoping project for a Victorian Mental Health Service

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 1 2008
Brett McKinnon
ABSTRACT:, The present study aimed to examine the prevalence of occupational assault against nurses at a Victorian Mental Health Service, including inpatient units and community teams. The results of this study will assist in developing strategies to minimize the occurrence of occupational assault and, more importantly, its impact for nursing staff. A survey methodology was used. All nurses from two adult acute psychiatric inpatient units as well as those from the community-based teams were invited to participate in a single survey (n = 90). The sample group for this research included all nursing staff from both inpatient units and community services. High levels of occupational violence against nurses overall and in the past year, underreporting of incidents, and high levels of staff fear are prominent findings of this study. There needs to be a total review of all policy relating to occupational violence with special focus given to the results of this study. The areas of risk management, training, sanctioning, and incident reporting should head the list, as well as addressing staff culture. Universally adopting a zero tolerance approach to occupational violence suggests that it is far from being part of the job. Further, management should consider a comprehensive orientation package that informs patients and their significant others about the role of the treating team. Communicating adequately with patients and their significant others is needed to clarify expectations and to avoid frustration and angry outbursts. [source]

Staff gender ratio and aggression in a forensic psychiatric hospital

INTERNATIONAL JOURNAL OF MENTAL HEALTH NURSING, Issue 2 2006
Michael Daffern
ABSTRACT:, Gender balance in acute psychiatric inpatient units remains a contentious issue. In terms of maintaining staff and patient safety, ,balance' is often considered by ensuring there are ,sufficient' male nurses present on each shift. In an ongoing programme of research into aggression, the authors investigated reported incidents of patient aggression and examined the gender ratio on each shift over a 6-month period. Contrary to the popular notion that a particular gender ratio might have some relationship with the likelihood of aggressive incidents, there was no statistically significant difference in the proportion of male staff working on the shifts when there was an aggressive incident compared with the shifts when there was no aggressive incident. Further, when an incident did occur, the severity of the incident bore no relationship with the proportion of male staff working on the shift. Nor did the gender of the shift leader have an impact on the decision to seclude the patient or the likelihood of completing an incident form following an aggressive incident. Staff confidence in managing aggression may be influenced by the presence of male staff. Further, aspects of prevention and management may be influenced by staff gender. However, results suggest there is no evidence that the frequency or severity of aggression is influenced by staff gender ratio. [source]

Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality

JOURNAL OF ADVANCED NURSING, Issue 6 2007
Lynn Unruh
Abstract Title.,Nurse absenteeism and workload: negative effect on restraint use, incident reports and mortality Aim., This paper is a report of a study to assess the impact of nurse absenteeism on the quality of patient care. Background., Nurse absenteeism is a growing management concern. It can contribute to understaffed units, staffing instability, and other factors that could have a negative impact on patient care. The impacts of absenteeism on the quality of nursing care have rarely been studied. Method., Retrospective monthly data from incident reports and staffing records in six inpatient units for 2004 were analysed. Dependent variables were the numbers of restraints, alternatives to restraints, incident reports, deaths, and length of stay. Explanatory variables were nurse absenteeism hours, patient days per nursing staff, and interaction between these variables. Controls were patient acuity and unit characteristics. Fixed effects regressions were analysed as regular or negative binomial models. Findings., Neither high Registered Nurse absenteeism nor high patient load was related to restraint use when taken separately. However, high Registered Nurse absenteeism was related to restraint use when patient load was high. Registered Nurse absenteeism was related to a lower use of alternatives to restraints. Incident reports were increased by high patient load, but not absenteeism, or absenteeism given patient load. When both patient load and absenteeism were high, deaths were higher also. Conclusion., Absenteeism alone may not be a strong factor in lowering quality, but the combination of high Registered Nurse absenteeism and high patient load could be a factor. Staffing and absenteeism may be part of a vicious cycle in which low staffing contributes to unit absenteeism, which contributes to low staffing, and so on. [source]

Are Patient Preferences for Life-Sustaining Treatment Really a Barrier to Hospice Enrollment for Older Adults with Serious Illness?

JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 3 2006
David Casarett MD
OBJECTIVES: To determine whether patient preferences are a barrier to hospice enrollment. DESIGN: Prospective cohort study. SETTING: Fifteen ambulatory primary care and specialty clinics and three general medicine inpatient units. PARTICIPANTS: Two hundred three seriously ill patients with cancer (n=65, 32%), congestive heart failure (n=77, 38%), and chronic obstructive pulmonary disease (n=61, 30%) completed multiple interviews over a period of up to 24 months. MEASUREMENTS: Preferences for high- and low-burden life-sustaining treatment and site of death and concern about being kept alive by machines. RESULTS: Patients were more likely to enroll in hospice after interviews at which they said that they did not want low-burden treatment (3 patients enrolled/16 interviews at which patients did not want low-burden treatment vs 47 patients enrolled/841 interviews at which patients wanted low-burden treatment; relative risk (RR)=3.36, 95% confidence interval (CI)=1.17,9.66), as were interviews at which patients said they would not want high-burden treatment (5/28 vs 45/826; RR=3.28, 95% CI=1.14,7.62), although most patients whose preferences were consistent with hospice did not enroll before the next interview. In multivariable Cox regression models, patients with noncancer diagnoses who desired low-burden treatment (hazard ratio (HR)=0.46, 95% CI=0.33,0.68) were less likely to enroll in hospice, and those who were concerned that they would be kept alive by machines were more likely to enroll (HR=5.46, 95% CI=1.86,15.88), although in patients with cancer, neither preferences nor concerns about receiving excessive treatment were associated with hospice enrollment. Preference for site of death was not associated with hospice enrollment. CONCLUSION: Overall, few patients had treatment preferences that would make them eligible for hospice, although even in patients whose preferences were consistent with hospice, few enrolled. Efforts to improve end-of-life care should offer alternatives to hospice that do not require patients to give up life-sustaining treatment, as well as interventions to improve communication about patients' preferences. [source]

A psychometric evaluation of the Chinese version of the stage of change-readiness and treatment-eagerness scale

JOURNAL OF CLINICAL NURSING, Issue 17 2009
Mei-Yu Yeh
Aims., The present study analysed the psychometric properties of a Chinese version of the stage of change-readiness and treatment-eagerness scale among alcohol-dependent patients and investigated whether a three-factor structure fit the data. Background., The stage of change-readiness and treatment-eagerness scale is a 19-item instrument designed to measure alcohol-dependent patients' motivation for change. However, this instrument had not been translated and validated for use in Taiwan. Design., Survey. Methods., A sample of 161 alcohol-dependent patients receiving alcohol-related treatment in psychiatric hospital outpatient and inpatient units was included. Confirmatory factor analyses were conducted on three-factor measurement models of the stage of change-readiness and treatment-eagerness scale. Results., Confirmatory factor analyses supported the presence of a three-factor modified model (ambivalence, recognition and taking steps) among alcohol-dependent patients. Higher internal item consistency was found for the recognition and taking step factors, while the ambivalence factor was shown to have lower internal consistency. Convergent, discriminant and concurrent validity were obtained for the assessment of severity of alcohol dependence. Conclusions., The results indicated that the 11-item, three-factor modified Chinese version of the stage of change readiness and treatment eagerness scale provided best goodness of fit for the data in this study. This study demonstrated that the Chinese version of the stage of change readiness and treatment eagerness scale is a reliable and valid self-report measure for the assessment of changing motivation in alcohol-dependent patients. Relevance to clinical practice., The Chinese version of stage of change readiness and treatment eagerness scale is applicable for use in clinical treatment and research, predicting motivation for change and evaluating intervention outcomes in Taiwan. [source]

Staff survey results and characteristics that predict assault and injury to personnel working in mental health facilities

AGGRESSIVE BEHAVIOR, Issue 1 2003
Julie Cunningham
Abstract The purpose of this study was to complete a mental health staff opinion survey to identify patient and staff characteristics associated with staff assault and injury in psychiatric treatment settings and to develop a model of prediction for staff assault and injury utilizing these survey variables. The data consisted of opinion surveys sent to staff of 15 child, adolescent, and adult psychiatry inpatient units in the United States. Multivariate logistic regression was used to determine the level of assault and staff-reported injury prediction that could be obtained from the staff-completed opinion survey. Responses indicated a high prevalence of reported aggression, with 62.3% of staff endorsing verbal and physical aggression, property destruction, and self-injurious behavior as being prevalent at their site, whereas only 4.1% rated none of these as prevalent. Staff working with children and adolescents in settings with high rates of psychiatric diagnoses reported increased frequency of assault and injury compared with those working with adults. Younger, less experienced staff reported higher rates of assault and injury. Staff working with female patients reported similar rates of assault and injury to those working with males. A logistic regression analysis using staff-reported survey results of both staff and patient characteristics predicted assault correctly 73.7% of the time and injury 66.1% of the time. Resources for violence prevention and staff training programs in violence prevention are needed in child and adolescent psychiatry wards. Results are consistent with theories emphasizing the importance of negative emotions and affects, impulsivity, and frustration in goal-directed activities in human aggression. Aggr. Behav. 29:31,40, 2003. © 2003 Wiley-Liss, Inc. [source]

General psychiatric services for adults with intellectual disability and mental illness

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 1 2004
R. Chaplin
Abstract Background Adults with intellectual disability (ID) and mental illness may use general or specialist psychiatric services. This review aims to assess if there is evidence for a difference in outcome between them. Methods A literature review was conducted using a variety of electronic databases and hand-search strategies to identify all studies evaluating the outcome of people with ID and mental illness using general psychiatric services. Results There is no conclusive evidence to favour the use of general or specialist psychiatric services. People with ID stay less time on general psychiatric than specialist inpatient units. People with severe ID appear not to be well served in general services. Older studies of inpatient samples suggest a worse outcome for people with ID. Novel specialist services generally improve upon pre-existing general services. Assertive outreach in general services may preferentially benefit those with ID. Recent studies suggest similar lengths of stay in general psychiatric beds for people with and without ID. Conclusions Although 27 studies were located, only two were randomized controlled trials. The evidence is poor quality therefore further evaluation of services employing a variety of designs need to be employed to give more robust evidence as to which services are preferred. [source]

Offenders with intellectual disability: the size of the problem and therapeutic outcomes

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2002
P. Barron
Abstract Background People with intellectual disability (ID) who offend may be subject to a variety of disposals within the criminal justice system, or via diversion to health and social services in inpatient units or in community ID teams. Offenders with ID are a group with complex needs who may pose a recurrent risk to the public. Despite the significant number of offenders with ID, there is limited evidence on treatment effectiveness and outcomes. Methods A literature search of all electronic databases was undertaken, and journals were hand-searched for clinical trials or case studies of interventions for offenders with ID. The main outcome was recidivism rates. Results There were no published clinical trials of offenders with ID. A series of small-scale group cognitive-behavioural treatments for sex offenders offers the most persuasive evidence of success in reducing recidivism. Conclusion Offenders with ID often receive inadequate services as a result of poor identification through the criminal justice system and research into effective treatments is rudimentary. Further studies are necessary in order to improve treatment efficacy and service provision for a complex group of individuals. [source]