Violence in psychiatric inpatient care

Abstract

This thesis investigates incidents of violence in two psychosis wards, analyses types of violence and the staff's emotional reaction to violence, assesses a new pharmacological treatment strategy of acutely disturbed psychotic patients. One of aims was to investigate the efficiency of violence prevention programme in a new ward for 12 acute psychotic patients. Furthermore, the staff members' and psychotic patients' experiences of one and the same violent incident was compared. Finally. psychological support to staff exposed to violence is described.

The present thesis is based on the following papers: I Incidents of violence in in-patient care. II Pharmacological treatment of acutely violent behavior. A practical management from clinicians. III Manageable violence in a new ward for acutely admitted patients. IV Violence and threats of violence within psychiatric care-comparison of staff and patient experience of the same incident. V Psychological support following serious incidents of violence. A crisis team for personnel.

The Staff Observation Aggression Scale (SOAS) for recording and assessing aggressive incidents was used. Staff subjected to violence or threat of violence was interviewed. The patients who had exhibited the violent behaviour were interviewed one day prior to discharge from the ward. Violent incidents were distributed all over 24 hours, but with two distinct peaks-morning and evening. Violence incidents most often occured with patients with some kind of schizophrenic psychosis. The female staff was more exposed to violence than male. There were significant differences in the emotional reactions of female and male staff to the violent incidents; men were more frightened while women got surprised. Staff members of both genders felt insulted and angry.

By using zuclopenthixol acetate, a neuroleptic with a prolonged action, the number of violent incidents was significantly reduced. The implementation and evaluation of the violence prevention programme resulted in either a decrease or unchanged incidence of violence. The number of work-reported injures on the ward did not increase during the period studied. The total number of violent incidents at the new ward was the lowest number reported during the previous three years.

When comparing the SOAS data with the patient interviews, it was found that the staff was able to identify less than 50 percent of the provocations that the patients experienced. The staff. who has been exposed to threats and violence dealt with the traumatic situation successfully. After two weeks, their problems had diminished substantially.