Phil Woods

The Brøset Violence Checklist Sensitivity, Specificity, and Interrater Reliability

The Brøset Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects as either present or absent. It is hypothesized that an individual displaying two or more of these behaviors is more likely to be violent in the next 24-hour period. All 109 consecutive referrals to four psychiatric inpatient acute units during a 2-month period were included in the study. Ratings were performed at the time of admission and three times a day for each patient—once for each working shift. Interrater reliability was adequate. Thirty-four separate incidences of violence occurred. Comparisons between ratings performed in the 24-hour interval before the incident and all other ratings suggested moderate sensitivity and good specificity of the instrument. It is concluded that the BVC is a useful instrument in predicting violence within the next 24-hour period and that the psychometric properties of the instrument are satisfactory.The Broset Violence Checklist (BVC) assesses confusion, irritability, boisterousness, verbal threats, physical threats, and attacks on objects as either present or absent. It is hypothesized that an individual displaying two or more of these behaviors is more likely to be violent in the next 24-hour period. All 109 consecutive referrals to four psychiatric inpatient acute units during a 2-month period were included in the study. Ratings were performed at the time of admission and three times a day for each patient—once for each working shift. Interrater reliability was adequate. Thirty-four separate incidences of violence occurred. Comparisons between ratings performed in the 24-hour interval before the incident and all other ratings suggested moderate sensitivity and good specificity of the instrument. It is concluded that the BVC is a useful instrument in predicting violence within the next 24-hour period and that the psychometric properties of the instrument are satisfactory.

Mapping nursing activity in acute inpatient mental healthcare settings

Background: The quality of care on acute inpatient mental health units is a matter of national and international concern. A major determinant of the quality of care experienced by service users is the use of nursing time. Aims: To map, classify and compare the patterns of activities for qualified and unqualified nursing staff in three acute inpatient mental health wards in three UK NHS-provider organizations, and to compare the proportions of time dedicated to user-centred and non user-centred activities. Method: Open interviews with staff undertaken hourly during five, three-day data collection periods per ward. Results: A total of 505 hours of nursing activity were assessed. Half of all activity reported was staff-user contact, however, the majority was during containment activities. Qualified staff were responsible for ward administration, unqualified staff for the majority of staff-user interaction. Unqualified staff reported higher satisfaction with their work, positively correlated with patient contact time. Conclusions: Working practices built on highly prescriptive nursing routines need to be reconfigured in order to allow qualified staff more time to engage with patients and unqualified staff to use their time with service users more constructively. Declaration of interest: This study was funded by three mental health trusts in the North West United Kingdom. We know of no financial relationship that may pose a conflict of interest.

Risk assessment and management in mental health nursing

Chapter 1: Introduction. Chapter 2: Risk Assessment and Management. Chapter 3: The Theory of Risk. Chapter 4: Instrumentation. Chapter 5: Risk to Others. Chapter 6: Risk to Self. Chapter 7: Risk of Substance Misuse. Chapter 8: Conculsions

Assessing living skills in forensic mental health care with the behavioural status index: A European network study

Abstract Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare. The goal of this study was to compare a norm-based psychometric assessment battery (the Behavioural Status [BEST] Index) with known valid instruments. Parallel cohort studies were undertaken in four European countries. Inpatients from 24 forensic psychiatric clinics were assessed three times using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Positive clinical changes were noted in insight, empathy, and some behaviors related to communication and living skills, with little change in violence risk, which was low to medium for most patients. Clinical congruence was observed between logically cognate items of the BEST Index and comparison instruments. Evidence for the scientific and clinical utility of the BEST Index as an effective tool for forensic psychiatric practice is discussed.

Selecting and Monitoring Living Skills in Forensic Mental Health Care: Cross-Border Validation of the BEST-Index

Background: Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare.Aim: We cross-validate a norm-based psychometric assessment battery (the Behavioral Status Index [BEST-Index]) against known valid instruments. Method: Parallel cohort studies were undertaken in five European countries. Inpatients (N = 231) from 24 forensic psychiatric clinics were assessed three times, using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Results: Positive clinical changes were noted in communication and living skills, with little change in violence risk, which was low to medium for 90 percent of patients. Clinical congruence was observed between logically cognate items of cross-validators and the BEST-Index. Discussion: Evidence for the scientific and clinical utility of the BEST-Index as an effective guideline for treatment priorities and outcomes is discussed.

RELATIONSHIPS AMONG RISK, AND COMMUNICATION AND SOCIAL SKILLS IN A HIGH SECURITY FORENSIC SETTING

The Behavioural Status Index was developed for risk assessment within forensic care. This paper reports data analysis for the Behavioural Status Index and its subscales. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals in the UK. Results are reported for inter-item correlations, factor analysis, and differences among independent groups of patients, categorized by Mental Health Act 1983 classification, patient ward dependency, and patient gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of behaviours.