Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Vic., Australia.
Victorian Institute of Forensic Mental Health, Forensicare, Melbourne, Vic., Australia.
J Clin Nurs. 2018 Mar;27(5-6):e971-e983. doi: 10.1111/jocn.14107. Epub 2018 Jan 30.
To examine associations between risk of aggression and nursing interventions designed to prevent aggression.
There is scarce empirical research exploring the nature and effectiveness of interventions designed to prevent inpatient aggression. Some strategies may be effective when patients are escalating, whereas others may be effective when aggression is imminent. Research examining level of risk for aggression and selection and effectiveness of interventions and impact on aggression is necessary.
Archival case file.
Data from clinical files of 30 male and 30 female patients across three forensic acute units for the first 60 days of hospitalisation were collected. Risk for imminent aggression as measured by the Dynamic Appraisal of Situational Aggression, documented nursing interventions following each assessment, and acts of aggression within the 24-hours following assessment were collected. Generalised estimating equations were used to investigate whether intervention strategies were associated with reduction in aggression.
When a Dynamic Appraisal of Situational Aggression assessment was completed, nurses intervened more frequently compared to days when no Dynamic Appraisal of Situational Aggression assessment was completed. Higher Dynamic Appraisal of Situational Aggression assessments were associated with a greater number of interventions. The percentage of interventions selected for males differed from females; males received more pro re nata medication and observation, and females received more limit setting, one-to-one nursing and reassurance. Pro re nata medication was the most commonly documented intervention (35.9%) in this study. Pro re nata medication, limit setting and reassurance were associated with an increased likelihood of aggression in some risk bands.
Structured risk assessment prompts intervention, and higher risk ratings result in more interventions. Patient gender influences the type of interventions. Some interventions are associated with increased aggression, although this depends upon gender and risk level.
When structured risk assessments are used, there is greater likelihood of intervention. Intervention should occur early using least restrictive interventions.
检查攻击风险与旨在预防攻击的护理干预之间的关联。
探索旨在预防住院患者攻击的干预措施的性质和有效性的实证研究很少。当患者升级时，一些策略可能有效，而当攻击迫在眉睫时，其他策略可能有效。有必要研究检查攻击风险水平以及干预措施的选择和有效性，以及对攻击的影响。
档案病例。
从三个法医急性病房的 30 名男性和 30 名女性患者的临床档案中收集了数据，这些数据是在住院的前 60 天内收集的。使用动态情境攻击评估测量即将发生的攻击风险，记录每次评估后的护理干预措施，以及评估后 24 小时内的攻击行为。使用广义估计方程来研究干预策略是否与减少攻击有关。
当完成动态情境攻击评估时，与未完成动态情境攻击评估的日子相比，护士更频繁地进行干预。更高的动态情境攻击评估与更多的干预措施相关。选择的干预策略因男性和女性而异；男性接受了更多的按需药物治疗和观察，而女性接受了更多的限制设置、一对一护理和安慰。在这项研究中，按需药物治疗是最常记录的干预措施（35.9%）。在某些风险带中，按需药物治疗、限制设置和安慰与攻击的可能性增加有关。
结构化风险评估提示干预，较高的风险评分导致更多的干预。患者性别影响干预类型。一些干预措施与增加的攻击有关，尽管这取决于性别和风险水平。
当使用结构化风险评估时，干预的可能性更大。应尽早使用限制最小的干预措施进行干预。
