Theo Dassen

Frequency and severity of aggressive incidents in acute psychiatric wards in Switzerland

BackgroundAggression and violence and negative consequences thereof are a major concern in acute psychiatric inpatient care globally. Variations in study designs, settings, populations, and data collection methods render comparisons of the incidence of aggressive behaviour in high risk settings difficult.ObjectiveTo describe the frequency and severity of aggressive incidents in acute psychiatric wards in the German speaking part of Switzerland.MethodsWe conducted a prospective multicentre study on 24 acute admission wards in 12 psychiatric hospitals in the German speaking part of Switzerland. Aggressive incidents were recorded by the revised Staff Observation Aggression Scale (SOAS-R) and we checked the data collection for underreporting. Our sample comprised 2344 treatment episodes of 2017 patients and a total of 41560 treatment days.ResultsA total of 760 aggressive incidents were registered. We found incidence rates per 100 treatment days between 0.60 (95% CI 0.10–1.78) for physical attacks and 1.83 (1.70–1.97) for all aggressive incidents (including purely verbal aggression). The mean severity was 8.80 ± 4.88 points on the 22-point SOAS-R-severity measure; 46% of the purely verbally aggression was classified as severe (≥ 9 pts.). 53% of the aggressive incidents were followed by a coercive measure, mostly seclusion or seclusion accompanied by medication. In 13% of the patients, one ore more incidents were registered, and 6.9% of the patients were involved in one ore more physical attack. Involuntary admission (OR 2.2; 1.6–2.9), longer length of stay (OR 2.7; 2.0–3.8), and a diagnosis of schizophrenia (ICH-10 F2) (OR 2.1; 1.5–2.9) was associated with a higher risk for aggressive incidents, but no such association was found for age and gender. 38% of the incidents were registered within the first 7 days after admission.ConclusionAggressive incidents in acute admission wards are a frequent and serious problem. Due to the study design we consider the incidence rates as robust and representative for acute wards in German speaking Switzerland, and thus useful as reference for comparative and interventional research. Implications for clinical practice include the recommendation to extend the systematic risk assessment beyond the first days after admission. The study confirms the necessity to differentiate between types of aggressive behaviour when reporting and comparing incidence-data.

Perception of aggression among psychiatric nurses in Switzerland

Objective:u2002 To identify principal components and patterns in the perception of aggression by psychiatric nurses and to explore relationships between the perception of aggression and personal and workplace characteristics.

Nurses’ knowledge and practice about urinary incontinence in nursing home care

BACKGROUNDnAn important barrier in the implementation of effective incontinence treatments is the level of knowledge of the nurses concerning assessment and treatment of urinary incontinence. Therefore, it is important to assess current nurses knowledge and practice in urinary incontinence care so that nurses can receive adequate training and education.nnnAIMS AND OBJECTIVESnThis article reports on the development and testing of the Urinary Incontinence Practice and Knowledge Scale as well as the results of nurses practice and knowledge about urinary incontinence.nnnMETHODSnA cross-sectional design with a convenience sample of nurses and nurse assistants was used.nnnRESULTSnNurses answer two-thirds of the questions correctly. The level of knowledge of the nurse assistants is lower than that of nurses. Education and experience in the field are associated with the level of knowledge. Nurses and nurse assistants perform continence-related actions only sometimes or often at best. Both groups have best results in the subscale Support and they have most deficits in Documentation.nnnCONCLUSIONnNurses and nurse assistants need more education and training in urinary incontinence care. Special focus should lie on documentation. The results give information towards adequate education and training for nurses as well as nurse assistants.

Predicting inpatient violence using an extended version of the Broset-Violence-Checklist: instrument development and clinical application.

BackgroundPatient aggression is a common problem in acute psychiatric wards and calls for preventive measures. The timely use of preventive measures presupposes a preceded risk assessment. The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments suited for short-time prediction of violence of psychiatric inpatients in routine care. Aims of our study were to improve the accuracy of the short-term prediction of violence in acute inpatient settings by combining the Brøset-Violence-Checklist (BVC) with an overall subjective clinical risk-assessment and to test the application of the combined measure in daily practice.MethodWe conducted a prospective cohort study with two samples of newly admitted psychiatric patients for instrument development (219 patients) and clinical application (300 patients). Risk of physical attacks was assessed by combining the 6-item BVC and a 6-point score derived from a Visual Analog Scale. Incidents were registered with the Staff Observation of Aggression Scale-Revised SOAS-R. Test accuracy was described as the area under the receiver operating characteristic curve (AUCROC).ResultsThe AUCROC of the new VAS-complemented BVC-version (BVC-VAS) was 0.95 in and 0.89 in the derivation and validation study respectively.ConclusionThe BVC-VAS is an easy to use and accurate instrument for systematic short-term prediction of violent attacks in acute psychiatric wards. The inclusion of the VAS-derived data did not change the accuracy of the original BVC.

Using the nursing minimum data set for the Netherlands (NMDSN) to illustrate differences in patient populations and variations in nursing activities

RATIONALEnA nursing minimum data set (NMDS) provides data that are useful to legitimate nurses contribution to healthcare. In Belgium and the US, such NMDS are operational, other countries are developing it, among which is the Netherlands.nnnOBJECTIVEnTo evaluate whether the nursing minimum data set for the Netherlands (NMDSN) is suitable to describe the diversity of patient populations and the variability of nursing care.nnnMETHODOLOGYnUsing the NMDSN data collection forms, patient data were collected from 15 different hospital wards. During one week, nurses manually completed the NMDSN list for every patient. The data analysis methodology from the Belgian MVG was used, including ridit analysis and graphs.nnnRESULTSnThe NMDSN includes items related to hospital, patient demographics, medical condition, nursing process, nursing phenomena, nursing interventions, outcomes of nursing care, and complexity of care. There were 686 individual patients in the study, while for the data analysis their 2090 patient days in the hospital were used. Frequencies of nursing phenomena, nursing activities and results of care were calculated, transformed into ridit scores, and presented graphically as fingerprints.nnnCONCLUSIONnThe set of NMDSN items allows illustrating the diversity of patient populations, and variation in nursing care by means of fingerprints.

A comparison of surgical patients’ and nurses’ perceptions of patients’ autonomy, privacy and informed consent in nursing interventions

Abstract Objective: To investigate and compare Greek patients’ and nurses’ perceptions of the realisation of autonomy, informed consent and privacy in surgical nursing care. Design and setting: The study used a non-experimental comparative descriptive design and the data were collected from a convenience sample of 275 surgical patients and 222 nurses of six hospitals using two parallel self-completed questionnaires. Results: Nurses perceived that information-giving was realised more than any other concept and that they had given patients an opportunity to decide on alternative treatments, length of stay, eating and drinking, pain relief, sleeping pills, bladder and bowel function, hygiene and wound care. Nurses believed more than patients that patients’ privacy was protected, while neither patients nor nurses perceived the provision of informed consent. Patients who had never been operated on previously and had a planned admission felt more that they were offered the opportunity to make decisions. Those with a planned admission who had been offered informed consent believed that they had received information, their privacy had been protected and they had given informed consent. Nurses with training on ethics believed more strongly that patients had received information and informed consent. Conclusion: Nurses perceived autonomy, informed consent, and privacy were more often realised than the patients perceived.

Predictors of care dependency in Alzheimer's disease after a two-year period.

This paper presents the results from a panel study in the Netherlands of 68 female in-patients with Alzheimers disease. The main focus of this study was to investigate longitudinal changes and differences in care dependency. Descriptive statistics indicated an increase in almost all 15 features of dependency in a two-year period. A stepwise regression procedure revealed that the loss of social relationships, the loss of the ability to communicate, and the degree of care dependency at entry to the study were the strongest predictors of the follow-up ratings. The pattern of findings reveals that the Care Dependency Scale is sensitive to care dependency increase after a two-year period, and that the scale has utility in establishing longitudinal patterns of care dependency.

Pflegeabhängigkeit im Pflegeheim--eine psychometrische Studie

Zusammenfassung.nEin niederländischesnInstrument zur Erfassungnder Pflegeabhängigkeit wurdenins Deutsche übersetzt undnhinsichtlich verschiedener Gütekriteriennüberprüft. Es wurdenngute Ergebnisse erzielt für die Reliabilitätnund Validität. Die Skalankann für die Anwendung im Altenheimnempfohlen werden. Zukünftigenweitere methodologischenPrüfungen werden empfohlen.Summary.The Dutch Care DependencynScale, an instrument fornthe assessment of a patient’s carendependency, has been translatedninto German. The purpose of thisnstudy was to examine the reliabilitynand validity of the Germannversion of the scale. The 15-itemnscale has been developed for thenuse in nursing homes. Data werencollected from 81 people living innnursing homes in Berlin, Germany.nThe sample was measured threentimes. Cronbach’s alpha was 0.94.nInterrater and intrarater reliabilitynrevealed moderate to substantialnKappa statistics. As the results ofnthis study were satisfying, positivenrecommendations regarding thensuitability of the German versionnof the Care Dependency Scale fornuse in nursing homes could benmade. However, further psychometricntesting of the scale is recommended.

Care dependency in nursing home : a psychometric study

Zusammenfassung.nEin niederländischesnInstrument zur Erfassungnder Pflegeabhängigkeit wurdenins Deutsche übersetzt undnhinsichtlich verschiedener Gütekriteriennüberprüft. Es wurdenngute Ergebnisse erzielt für die Reliabilitätnund Validität. Die Skalankann für die Anwendung im Altenheimnempfohlen werden. Zukünftigenweitere methodologischenPrüfungen werden empfohlen.Summary.The Dutch Care DependencynScale, an instrument fornthe assessment of a patient’s carendependency, has been translatedninto German. The purpose of thisnstudy was to examine the reliabilitynand validity of the Germannversion of the scale. The 15-itemnscale has been developed for thenuse in nursing homes. Data werencollected from 81 people living innnursing homes in Berlin, Germany.nThe sample was measured threentimes. Cronbach’s alpha was 0.94.nInterrater and intrarater reliabilitynrevealed moderate to substantialnKappa statistics. As the results ofnthis study were satisfying, positivenrecommendations regarding thensuitability of the German versionnof the Care Dependency Scale fornuse in nursing homes could benmade. However, further psychometricntesting of the scale is recommended.

Reliability and validity of the EORTC QLQ-C30 in palliative care cancer patients

Palliative care aims at improving the patient’s quality of life. The assessment of this quality of life (QoL) is crucial for the evaluation of palliative care outcome. Many patients require hospital admissions for symptom control during their cancer journey and most of them die in hospitals, although they would like to stay at home until the end of their lives. In 1986, the European Organization for Research and Treatment (EORTC) initiated a research programme to develop an integrated, modular approach for evaluating the quality of life of patients participating in international clinical trials. This questionnaire measures cancer patients’ physical, psychological and social functions and was used in a wide range of clinical cancer trials with large numbers of research groups and also in various other non-trial studies. The aim of this study was to evaluate the psychometric properties, especially the reliability, validity and applicability of the EORTC QLQ-C30 in a German sample of terminally ill cancer patients receiving palliative care in different settings. The questionnaire was well accepted in the present patient population. Scale reliability was good (pre-treatment 0.80) especially for the functional scale. The results support the reliability and validity of the QLQ-C30 (version 3.0) as a measure of the health-related quality of life in German cancer patients receiving palliative care treatment.