Factors associated with repetitive violent behavior of psychiatric inpatients.

A small number of psychiatric inpatients displays a large proportion of Violent Behaviors (VB). These can have a major impact on both victims and patients themselves. This study explored personal, situational and institutional risk factors and their combined effects, which could lead to repetitive VB (three or more assaults). Data from 4518 patients, aged 18 to 65, admitted to an acute psychiatric care facility, were included in the analysis. VB, defined as physical aggressions against another person, were assessed by the Staff Observation Aggression Scale-Revised. 414 VB were reported during the study period, involving 199 patients. 0.75 % of all patients were repetitively violent and committed 43% of all VB. Factors that were linked to repetitive VB were living in sheltered housing before hospitalization, suffering from schizophrenia with substance abuse comorbidity, cumulating hospitalization days and some situational factors, like the fact of being in nursing offices and pharmacies. When all personal, situational and institutional factors were considered together, the combined effects of length of stay and living in sheltered housing increased the risk of repetitive VB. We have identified a small group of vulnerable patients for whom new modalities of inter-institutional networking should be developed to prevent repetitive VB.

[Q-sort, a useful research method in care in cases of psychiatric nursing of the aged]. / Le Q-sort, un outil pour la recherche en soins le cas des représentations chez les infirmiers en psychiatrie de l'âge avancé.

Q-sort is a research method which allows defining profiles of attitudes toward a set of statements, ordered in relation to each other. Pertaining to the Q Methodology, the qualitative analysis of the Q-sorts is based on quantitative techniques. This method is of particular interest for research in health professions, a field in which attitudes of patients and professionals are very important. The method is presented in this article, along with an example of application in nursing in old age psychiatry.

[Professionals' reactions to patient's suicide]. / Suicide d'un patient et réactions des professionnels.

Physicians, nurses and social workers have a high risk of being confronted with the suicide of a patient during their career. After such an event they may react with sadness, anger or feelings of helplessness. Acute stress reactions are also observed, with irritability, disordered sleep and intrusive thoughts. Some professionals may fear to take care of suicidal patients. Reactions are particularly intense when there was a strong therapeutic relationship. Clinicians should recognize their need for support and look for help, particularly from colleagues. Such an experience may also help them to accept their limits and to become more vigilant and more sensitive to signs of suicidal risk.

The changing context of Western European healthcare systems: convergence versus divergence in nursing problematics.

Many countries reorganizing their health services are drawn toward similar reform programs and tend to experience what seem to be similar problems relating to implementation outcomes. One such problem is the major crisis within the nursing profession relating to the labor market, working conditions and level of autonomy. This research examines the thesis that the profile of nursing problems is global (the 'convergence' thesis) by comparing the changing hospital contexts nursing has been confronting in 20 Western European countries between 1990 and 2001. The analysis indicates that in spite of growing convergence, the divergence in patient care processes, workforce composition and resources allocated for care is still rather remarkable and that similarity or divergence between countries changes over time. This contextual variability highlights why problems such as the crisis of the nursing profession must be analysed from a divergent rather than a convergent perspective.

Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening.

BACKGROUND: Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS: To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD: 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS: Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION: Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.

Swiss nurses' knowledge related to health care reforms: an exploratory study.

BACKGROUND: This study examines health care reforms' implementation processes from the perspective of nurses' knowledge regarding the reforms. The research has been carried out in the Swiss (Canton Vaud) context, where health care reforms have been initiated, on the National (Federal) level, in 1996. OBJECTIVES: Three research questions were formulated: (a) What is the level of nurses' knowledge regarding the basic principles of LAMal (Loi fédérale sur l'assurance maladie, Federal Health Insurance Law)? (b) What is the level of nurses' knowledge concerning the principles of health care reforms in Canton Vaud (NOPS, Nouvelles Orientations de la Politique Sanitaire)? and (c) Are there knowledge differences relating to employment setting (hospital, community, and education), nurses' roles (managerial vs. staff nurses) and level of education? METHODS: The sample consisted of a total of 74 nurses. Of these, 20 were employed in the community, 30 in hospital settings and 24 worked in schools of nursing. The research tool utilized was 40-items nurses' knowledge questionnaire developed for the purpose of this study. Three knowledge subscales and a subscale of certainty were constructed. RESULTS: Overall, data showed a moderate to high mean level of knowledge (around 70% correct responses) on all knowledge scales considered. Community setting, managerial position, and a nonacademic nursing degree were all positively related to higher levels of reforms' knowledge. On the contrary, employment in a hospital setting and having a university degree had both negative impacts on achieving a high score of knowledge. Levels of certainty were significantly higher for LAMal than NOPS and for correct rather than for wrong responses.