The physical and mental health of acute psychiatric ward staff, and its relationship to experience of physical violence.

To evaluate and describe the physical and mental health of staff on acute psychiatric wards and examine whether violence exposure is linked with health status. We undertook a cross-sectional survey with 564 nursing staff and healthcare assistants from 31 psychiatric wards in nine NHS Trusts using the SF-36, a reliable and valid measure of health status and compared summary scores with national normative data. Additional violence exposure data were collated simultaneously and also compared with health status.

Acceptability and use of coercive methods across differing service configurations with and without seclusion and/or psychiatric intensive care units.

Aims: The aim of this study was to compare across different service configurations the acceptability of containment methods to acute ward staff and the speed of initiation of manual restraint.

Background: One of the primary remits of acute inpatient psychiatric care is the reduction in risks. Where risks are higher than normal, patients can be transferred to a psychiatric intensive care unit or placed in seclusion.

Physical injury and workplace assault in UK mental health trusts: An analysis of formal reports.

Workplace violence is a significant problem for health service personnel, with National Health Service (NHS) workers subject to 68 683 physical assaults between 2013 and 2014. Almost 70% of assaults occur in the mental health sector, and although serious, non-fatal injury is rare, the individual and economic impact can be substantial. In the present study, we analysed mandatory incident reports from a national database to examine whether there were identifiable precursors to incidents leading to staff injury, and whether staff characteristics were associated with injury.

Predictors of effective de-escalation in acute inpatient psychiatric settings.

Aims And Objectives: To explore the factors that influence the use of de-escalation and its success in halting conflict in acute psychiatric inpatient setting.

Background: De-escalation is the use of verbal and nonverbal communication to reduce or eliminate aggression and violence during the escalation phase of a patient's behaviour. Although de-escalation is a first-line intervention in aggression management in acute psychiatric settings, little is known about the use or effectiveness of this technique.

Aggression on inpatient units: Clinical characteristics and consequences.

Aggression and violence are widespread in UK Mental Health Trusts, and are accompanied by negative psychological and physiological consequences for both staff and other patients. Patients who are younger, male, and have a history of substance use and psychosis diagnoses are more likely to display aggression; however, patient factors are not solely responsible for violence, and there are complex circumstances that lead to aggression. Indeed, patient-staff interactions lead to a sizeable portion of aggression and violence on inpatient units, thus they cannot be viewed without considering other forms of conflict and containment that occur before, during, and after the aggressive incident.

Nursing interventions for substance use during psychiatric hospital admissions: Clinical context and predictors.

Empirical information about how nurses manage substance use on psychiatric wards is lacking. The aims of the study were to identify the frequency and clinical features of incidents among a sample of inpatients over a 12-month period and how nursing staff intervened. Electronic, anonymized inpatient records were searched for incidents of substance use on 17 acute psychiatric wards in four hospitals in London.

Describing the precursors to and management of medication nonadherence on acute psychiatric wards.

Objective: This study aims to (a) describe what conflict (aggression, absconding etc.) and containment (de-escalation, restraining etc.) events occur before and after events of medication nonadherence on acute psychiatric wards and (b) identify which patient characteristics are associated with medication nonadherence.

Reducing conflict and containment rates on acute psychiatric wards: The Safewards cluster randomised controlled trial.

Background: Acute psychiatric wards manage patients whose actions may threaten safety (conflict). Staff act to avert or minimise harm (containment). The Safewards model enabled the identification of ten interventions to reduce the frequency of both.

Thematic analysis of psychiatric patients' perceptions of nursing staff.

Therapeutic and informal interactions with nurses are integral to the quality of care that psychiatric patients receive. How well these interactions are performed, and their impact on the experience and outcomes of inpatient care, have not been subject to systematic evaluation. The aim of the present study was to examine patients' perceptions of the personal and professional qualities of nursing staff and how these contribute to the ward environment.

Patients subject to high levels of coercion: staff's understanding.

Measures to keep staff and patients safe (containment) frequently involve coercion. A small proportion of patients is subject to a large proportion of containment use. To reduce the use of containment, we need a better understanding of the circumstances in which it is used and the understandings of patients and staff.

Identification of the "minimal triangle" and other common event-to-event transitions in conflict and containment incidents.

Although individual conflict and containment events among acute psychiatric inpatients have been studied in some detail, the relationship of these events to each other has not. In particular, little is known about the temporal order of events for individual patients. This study aimed to identify the most common pathways from event to event.

Measurement and monitoring of health care worker aggression exposure.

Aggression exposure is highly prevalent in healthcare workers, and is a complex problem that negatively impacts patient and worker safety and health. Typically only events of high severity (e.g.

Correlation between levels of conflict and containment on acute psychiatric wards: the city-128 study.

OBJECTIVE Attainment of safe, calm inpatient psychiatric wards that are conducive to positive therapeutic care is crucial. On such wards, rates of coerced medication, seclusion, manual restraint and other types of containment are comparatively low, and, usually, rates of conflict-for example, aggression, substance use, and absconding-are also low. Sometimes, however, wards maintain low rates of containment even when conflict rates are high.

Behavioural antecedents to pro re nata psychotropic medication administration on acute psychiatric wards.

This study examined the antecedents to administration of pro re nata (PRN) psychotropic medication on acute psychiatric wards, with a particular focus on its use in response to patient aggression and other conflict behaviours. A sample of 522 adult in-patients was recruited from 84 acute psychiatric wards in England. Data were collected from nursing and medical records for the first 2  weeks of admission.

Conflict and containment events in inpatient psychiatric units.

Aims And Objectives: To describe the types and frequency of conflict behaviours exhibited by patients during the first 2 weeks of admission to acute psychiatric units, the methods staff use to manage them and bring to the surface underlying common patterns.

Background: Many studies have investigated the prevalence and impact of psychiatric inpatient aggression. Much of the research to date has studied conflict and containment behaviours separately; however, some studies have reported relationships between certain behaviours suggesting that there are complex causal links between conflict and containment behaviours.

Self harm in adult inpatient psychiatric care: a national study of incident reports in the UK.

Background: We know little about the nature of self harming behaviour within inpatient psychiatric services. The few studies in this area have mainly investigated the correlates self harm, or have been restricted to forensic services, within single hospitals.

Objectives: To describe the demographic characteristics of those who self harm, and the characteristics of self harming behaviour within adult psychiatric wards across the UK.

Events preceding changes in conflict and containment rates on acute psychiatric wards.

Objective: The main objective of this study was to learn more about what increases or decreases the likelihood of patient conflict (such as verbal abuse, violence, and rule breaking) and containment (such as seclusion, manual restraint, and enforced medication) events in acute inpatient psychiatric wards.

Methods: Line graphs that mapped the total conflict and containment scores over two years on 16 acute inpatient psychiatric wards in the United Kingdom (London) were matched with chronological events that were documented in 120 qualitative semistructured interviews with ward managers and consultant psychiatrists during the same two-year period. Conflict and containment scores were derived from the validated Patient-Staff Conflict Checklist-Shift Report, which was completed by nurses at the end of each shift to log the frequency of conflict behaviors of patients and the staff containment measures.

Under the gaze of staff: special observation as surveillance.

Purpose: This study explores the relationship of special observation (SO) to a range of patient, staff, and ward variables.

Design And Methods: End-of-shift reports were completed by nurses on 136 acute mental health wards in England during 2004 and 2005.

Findings: Intermittent SO (patient checked at specified intervals) was used five times more frequently than constant SO (patient kept within sight or reach).

Managing risk and conflict behaviours in acute psychiatry: the dual role of constant special observation.

Aims:   This is a report of a study of events before and after the use of constant special observation on acute psychiatric wards, and the characteristics of patients who received it.

Background:   Constant special observation is a method of preventing acutely disturbed inpatients from harming themselves or others. It has been characterized as impersonal, intrusive and non-therapeutic.