Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
BMJ Open. 2023 Feb 17;13(2):e067943. doi: 10.1136/bmjopen-2022-067943.
Aggression on psychiatric wards develops under influence of patient, staff and ward factors. Assessment of naturalistic derived staff and ward factors might increase better understanding of how aggressive incidents develop on psychiatric wards.
Studying staff and ward factors including interactions between patients and nurses prior and after development of aggression, within a naturalistic closed ward setting.
A prospective naturalistic experience sampling method (ESM) study.
A high intensive care unit of a mental health institution in The Netherlands where 29 nurses answered beeps generated by an app during approximately 7 consecutive days with questions regarding their subjective feelings, ward atmosphere, location, interaction they had with patients and their colleagues and whether an incident took place.
Associations were established between different staff and ward factors and the occurrence of aggressive incidents on the ward.
Risk for aggression was associated with the nurse being with a patient (OR=2.26, 95% CI 0.99 to 5.15, p=0.05). No significant association was found between discussing with the patient and setting a limit or physical absence of the nurse on the one hand and aggression on the other. More experienced nurses encountered more aggression (OR=3.5, 95% CI 1.32 to 8.26, p=0.01). Age and gender of the nurse were not associated with aggression development. Exceeding the maximum bed capacity was associated with a greater risk for aggression (OR=5.36, 95% CI 1.69 to 16.99, p=0.004). There was no significant association when analysing a more positive atmosphere on the ward or positive affect of the nurse, but negative affect of the nurses showed a trend for an association with less aggression.
Aggression is a problem that should be managed from a multidimensional perspective. The quality of interaction between nurses and patients is crucial. Exceeding the maximum bed capacity is likely associated with more aggression.
在自然封闭的病房环境中，研究包括患者与护士之间互动在内的医护人员和病房因素，这些因素可能有助于更好地了解攻击事件是如何在精神科病房发生的。
前瞻性自然观察采样法（ESM）研究。
荷兰一家心理健康机构的高度密集护理病房，29 名护士在大约 7 天的时间内通过应用程序回答蜂鸣声，询问他们的主观感受、病房氛围、位置、与患者和同事的互动以及是否发生事件。
不同医护人员和病房因素与病房内攻击事件的发生之间建立关联。
发生攻击的风险与护士与患者在一起有关（OR=2.26，95%CI 0.99 至 5.15，p=0.05）。护士与患者讨论和设定限制或物理上不在场与攻击之间没有发现显著关联。经验更丰富的护士遭遇更多的攻击（OR=3.5，95%CI 1.32 至 8.26，p=0.01）。护士的年龄和性别与攻击的发展无关。超过最大床位容量与更大的攻击风险相关（OR=5.36，95%CI 1.69 至 16.99，p=0.004）。当分析病房内更积极的氛围或护士的积极情绪时，没有显著关联，但护士的消极情绪与攻击减少呈趋势相关。
攻击是一个需要从多维度角度管理的问题。护士与患者之间互动的质量至关重要。超过最大床位容量可能与更多的攻击有关。
