A 5-year review of physical and verbal aggression in a psychiatric ward in Ilorin, Nigeria
Keywords:
Violence, aggression, psychiatry unitAbstract
Objective: Violence on psychiatric wards is increasing globally. Its consequences are not just on the ward staff, but also other patients, relations and hospital facilities. There is a need for more studies especially in developing countries, where not many of such studies have been documented. The study aimed at determining the prevalence of aggression and its clinical and psychosocial factors in a tertiary psychiatric facility in Nigeria.
Method: A review of medical records of all patients admitted to the psychiatric ward, over a 5-year period in the study location.
Result: The prevalence of aggression was found to be 3.6% with Staff Observation Aggression ScaleRevised (SOAS-R) score of 18.1±2.3. Aggression was significantly associated with the male gender (÷2=
11.5; p=0.001), first 10 days of admission (÷2=8.0; p=0.005), first 20 minutes of verbal aggression (÷2 = 11.5; p=0.001), and during the evening shift as compared with morning and night duties (÷2=25.3; df=2; p=0.000). At bed occupancy of ≥50%, the chance of physical aggression increased to 84% (÷2=20.5; p=0.000). There was no significant relationship between aggression and patient's religion (÷2=0.5; p=0.8), who patient's delusion is directed at (÷2=0.32; p=0.6) and previous episode of mental illness in patient (÷=00; p=1.0).
Conclusion: The obtained prevalence of 3.6% may be a reflection of under-reporting of aggression. It was suggested that the thrust of management of aggression should be preventive with attention paid to staff training and continuous improvement of ward culture, staff-to-staff and staff-to-patient dynamics and environment.
References
Ng B, Kumar S, Ranclaud M, Robinson E. Ward crowding and incidents of violence on an acute psychiatric inpatient unit. Psychiatr Services 2001; 52: 521-5
James BO, Isa EW and Oud N. Patient aggression in psychiatric services: the experience of a sample of nurses at two psychiatric facilities in Nigeria. Afr J Psychiatry 2011: 14; 130-3.
Haller RM, Deluty RH: Assaults on staff by psychiatric inpatients: a critical review. Br J
Psychiatry. 1988; 152:174-9.4.
Hubschmidt T: The prosecution of violent psychiatric inpatients: one respectable intervention. Psychiatr Praxis. 1996; 23:268.
Hodgkinson PE, Mclvor L, Phillips M: Patient assaults on staff in a psychiatric hospital: a two-year retrospective study. Med Sci Law. 1985; 25:288-94.
Nijman HLI, Allertz WWF, Merckelbach HLGJ, a Campo JMLG, Ravelli DP. Aggressive behaviour on an acute psychiatric admission ward. Eur J Psychiat. 1997; 11: 106-14.
Zhou JS, Zhong BL, Xiang YT, Chen Q, Cao XL, Correll CU et al. Asia Pac Psychiatry. 2015 doi: 10.1111/appy.12209. [Epub ahead of print]
Fottrell E: A study of violent behaviour among patients in psychiatric hospitals. Br J Psychiatry. 1980; 136:216-21.
Hurlebaus A. Aggressive behavior management for nurses: an international issue? J Healthc Prot Manage. 1994; 10:97-106.
Perron A, Jacob JD, Beauvais L, Corbeil D, Berube. Identification and management of violence in psychiatry: nurse and patient perception of safety and dangerousness. Rech Soins Infirm. 2015; 120: 47-60.
Lee HK, Villar O, Juthani N, Bluestone H. Characteristics and behavior of patients involved in psychiatric ward incidents.
Hosp Community Psychiatry. 1989; 40:1295-7.
Larkin E, Murtagh S, Jones S: A preliminary study of violent incidents in a special hospital (Rampton). Br J Psychiatry. 1988; 153:226-31.
Jonker EJ, Goossens PJJ, Steenhuis IHM, Oud NE. Patient aggression in clinical psychiatry; perception of mental health nurses. J Psychiatr Ment Health Nurs 2008; 15:492-9.
Blomhoff S, Seim S, Friis S. Can prediction of violence among psychiatric inpatients be improved? Hosp Community Psychiatry. 1990; 41:771-5.
Estroff SE, Zimmer C, Lachicotte WS, Benoit J. The influence of social networks and social support on violence by persons with serious mental illness. Hosp Community Psychiatry. 1994; 45:669-79.
Craig TJ: An epidemiologic study of problems associated with violence among psychiatric inpatients. Am J Psychiatry. 1982; 139:1262-6.
Katz P, Kirkland FR: Violence and social structure on mental hospital wards. Psychiatry. 1990; 53:262-77.
Lanza ML, Kayne HL, Hicks C, Milner J. Environmental characteristics related to patient assault. Issues Ment Health Nurs. 1994; 15:319-25.
Palmstierna T, Huitfeldt B, Wistedt B. The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. Hosp Community Psychiatry. 1991; 42:1237-40.
M ILMIS Project Group: Monitoring inner London mental illness services. Psychiatr Bull. 1995; 19:276-80.
Atakan Z. Violence on psychiatric inpatient units: what can be done? Psychiatr Bull. 1995; 19:593-6.
Bowers L, Allan T, Simpson A, Jones J, Van Der Merwe M, Jeffery D. Identifying key factors associated with aggression on acute inpatient psychiatric wards. Issues Ment Health Nurs. 2009; 30:260-71.
Cheung P, Schweitzer I, Tuckwell V, Crowley KC. A prospective study of assaults on staff by psychiatric patients. Med Sci Law. 1997; 37:46-52.
Livingston JD, Verdun-Jones S, Brink J, Lussier P, Nicholls T. A narrative review of the effectiveness of aggression management training programs for psychiatric hospital staff. J Forensic Nurs. 2010: 6:15-28.
Abderhalden C, Needham I, Dassen T, Halfens R, Haug HJ, Fischer JE. Structured risk assessment and violence in acute psychiatric wards: randomized controlled trial. Br J Psychiatry. 2008; 193:44-50.
Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and unit cultural improvements. Issues Ment Health Nurs. 2009; 30:214-26.
Palmstierna T, Huitfeldt B, Wistedt B. The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. Hosp Community Psychiatry. 1991; 42: 1237-40.
Lambert MJ and Hill CE. Assessing psychotherapy outcomes and processes. In A.E Bergin & SL Garfield (Eds). Handbook of psychotherapy and behavior change (4th
ed., pp. 72-113), New York; Wiley.
Nijman HLI, Muris P, Merckelbach HLGJ, Palmstierna, T, Wistdt B, Vos A.M et al. The
Staff Observation Aggression ScaleRevised (SOAS-R). Aggressive Behaviour. 1999; 25: 197-209.
Myers KM, Dummer DL. Self- and otherdirected violence on a closed acute-care ward. Psychiatr Q 1984; 56:178-88.
Owen C, Tarantello C, Jones M, Tenant C. Violence and aggression in psychiatric units. Psychiatr Serv 1998; 49: 1452-7.
Lion JR, Synder W, Merrill GL.
Underreporting of assaults on staff in a state hospital. Hospital and Community
Psychiatry. 1981; 32: 497-8.
Edwards JG, Jones D, Reid WH, Chu CC. Physical assaults in a psychiatric unit of a general hospital. Am J Psychiatry. 1988; 145:1568-71.
Kalogerakis MG. The assaultive psychiatric patient. Psychiatr Q. 1973; 45: 372-81.
Roaldset JO, Hartvig P, Bjorkly S. V-RISK10: validation of a screen for risk of violence after discharge from acute psychiatry. European Psychiatry 2011; 26: 85-91.
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