Adverse mental health inpatient experiences: Qualitative systematic review of international literature.

BACKGROUND: Trauma has a well-established link with poor health outcomes. Adverse experiences in mental health inpatient settings contribute to such outcomes and should impact service design and delivery. However, there is often a failure to fully address these experiences. OBJECTIVE: To describe the spectrum of negative experiences that people identify while they are inpatients in adult mental health services. DESIGN: Qualitative systematic review of the international literature. SETTING(S): Inpatient mental health settings globally. PARTICIPANTS: Analysis includes findings from 111 studies across 25 countries. METHODS: CINAHL, MEDLINE and PsycINFO were searched from 2000 onwards, supplemented by Google Scholar. Studies were appraised using the Critical Appraisal Skills Programme qualitative checklist. Data were synthesised using the 'best-fit' framework synthesis approach, enriched by patient and public involvement. RESULTS: Adverse mental health inpatient experiences can be conceptualised under three headings: the ecosystem (the physical environment and the resources available, and other people within or influential to that environment); systems (processes and transitions); and the individual (encroachments on autonomy and traumatisation). CONCLUSIONS: This paper highlights the interplay between systemic, environmental and individual factors contributing to adverse experiences in mental health inpatient settings. By recognising and addressing these factors, we can significantly enhance patient outcomes. Application of adversity to Bronfenbrenner's ecological systems theory provides a strategic approach to improving service design and delivery, advocating for environments that prioritise patient safety, dignity and respect. However, further research is needed to validate the framework and effectively integrate these insights into practice, ultimately transforming the inpatient care experience for all stakeholders. REGISTRATION: The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022323237). TWEETABLE ABSTRACT: Review suggests traumatic experiences in mental health inpatient settings can worsen outcomes. Urges redesign of environment, processes and autonomy to improve care @dr_nutmeg @EmxEn @RAVresearchUoB @IMH_UoB.

Interventions aimed at preventing suicide in the healthcare workforce: a systematic review.

Healthcare workers are exposed to various factors in the workplace that may put them at an increased risk of suicide, but there is a lack of evidence reviewing interventions put in place by employers that may modify this risk. The authors undertook a systematic review to identify and assess organisational interventions aimed at preventing suicide in the healthcare workforce. Databases were systematically searched between January 2022 and August 2022. Eligibility for inclusion in the review was determined using a population, intervention, comparison, outcome framework, and 12 studies met the inclusion criteria. Studies were summarised using narrative synthesis and interventions included education, screening, modification of the workplace, referrals for support and/or therapy and peer support. Outcomes included: uptake, satisfaction, pre-training and post-training knowledge, symptoms, risk of suicide and economic costs. It was identified that various suicide prevention interventions are feasible in healthcare organisations and likely to have positive effects for staff. However, there is a lack of robust evaluation of these interventions, so further research is warranted.

Exploring staff experiences and perceptions of patient-perpetrated violence in hospital settings: A qualitative study.

AIMS: To explore hospital staff experiences and perceptions of patient-perpetrated violence. DESIGN: Descriptive qualitative study. METHODS: Twelve semi-structured interviews (June-August 2022) were held with a diverse sample of hospital nurses, doctors, allied health professionals, security and a non-clinical manager. The framework approach was used to organise and analyse data, using Attribution Theory as a theoretical lens. RESULTS: Three themes were identified: violence as (un)predictable, violence as (un)preventable and the cumulative toll of violence. In making sense of why patients become violent, participants described different 'types' of aggressive patients and variably attributed behaviours to situation, disposition or a combination of both. Regardless of perceived causal factors, staff overwhelmingly appeared to view violence as predictable. Participants also reflected on the wider structural problems underpinning violence, frequently alluding to their sense of relative powerlessness to initiate change. The cumulative toll of violence was a common thread, with staff describing their acquisition of 'resilience' and reflecting on its role in their responses to escalating situations. CONCLUSIONS: Many hospital staff are resigned to the inevitability of violence. The concept of staff 'resilience' following violence is not unproblematic, having the potential to serve as a guise for acceptance and as an additional variable for which staff are held accountable. When designing strategies, organisations should ensure that accountability for violence reduction is distributed across multiple levels. This study makes a novel contribution by exploring the perspectives of multiple staff groups working across diverse hospital settings, and adds to a sparse literature on this subject in the UK. IMPLICATIONS FOR THE PROFESSION: Efforts to address violence against healthcare staff need to be power-conscious, ensuring that accountability is distributed across multiple levels. REPORTING METHOD: This study is reported in line with the Consolidated Criteria for Reporting Qualitative Studies (COREQ). PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Workplace interventions to prevent suicide: A scoping review.

OBJECTIVES: To map organisational interventions for workplace suicide prevention, identifying the effects, mechanisms, moderators, implementation and economic costs, and how interventions are evaluated. BACKGROUND: Suicide is a devastating event that can have a profound and lasting impact on the individuals and families affected, with the highest rates found among adults of work age. Employers have a legal and ethical responsibility to provide a safe working environment for their employees, which includes addressing the issue of suicide and promoting mental health and well-being. METHODS: A realist perspective was taken, to identify within organisational suicide prevention interventions, what works, for whom and in what circumstances. Published and unpublished studies in six databases were searched. To extract and map data on the interventions the Effect, Mechanism, Moderator, Implementation, Economic (EMMIE) framework was used. Mechanisms were deductively analysed against Bronfenbrenner's socio-ecological model. RESULTS: From 3187 records screened, 46 papers describing 36 interventions within the military, healthcare, the construction industry, emergency services, office workers, veterinary surgeons, the energy sector and higher education. Most mechanisms were aimed at the individual's immediate environment, with the most common being education or training on recognising signs of stress, suicidality or mental illness in oneself. Studies examined the effectiveness of interventions in terms of suicide rates, suicidality or symptoms of mental illness, and changes in perceptions, attitudes or beliefs, with most reporting positive results. Few studies reported economic costs but those that did suggested that the interventions are cost-effective. CONCLUSIONS: It seems likely that organisational suicide prevention programmes can have a positive impact on attitudes and beliefs towards suicide as well reducing the risk of suicide. Education, to support individuals to recognise the signs and symptoms of stress, mental ill health and suicidality in both themselves and others, is likely to be an effective starting point for successful interventions.

Protocol for a scoping review of how people with ME/CFS use the internet.

INTRODUCTION: Myalgic encephalomyelitis (ME) is a chronic neurological illness affecting many bodily systems, commonly the nervous and immune systems. Also known as chronic fatigue syndrome (CFS), key symptoms are extreme fatigue, post-exertional malaise, cognitive problems and sleep disturbance. With reported higher levels of online activity for people with ME/CFS than other patient groups (Westerby 2013 cited in Ytre-Arne) it is crucial to gain more knowledge of usage characteristics and experience of online use, and its integration into everyday life. This scoping review protocol details the proposed methods for gaining insight into this little known phenomenon. METHODS AND ANALYSIS: This review uses the methodological framework for conducting a scoping review by Arksey and O'Malley, with further guidance by Levac et al, and the Joanna Briggs Institute. It also refers to the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols reporting guidelines. The following bibliographic databases will be searched: Embase, Medline, PsychINFO, Cinahl, AMED, and ASSIA, plus Web of Science, ProQuest Dissertations and Theses Global, Scopus, and Google Scholar for grey literature. Reference lists of included papers will be studied. Two reviewers will independently screen title abstracts, and then full text of studies against inclusion criteria. Remaining studies will be quality assessed using appropriate critical appraisal tools. Findings will be charted and mapped to gain in-depth knowledge of the use of the internet in people with ME/CFS. ETHICS AND DISSEMINATION: The findings from this review will be disseminated through peer-reviewed publication and a report for leading charities of ME/CFS. The review will collect secondary data only and therefore does not need ethical approval.

Reducing the risk of suicide among healthcare staff.

Reducing the number of deaths by suicide is an important area in public health. Several factors, including excessive workload demands and burnout, mean that healthcare staff such as nurses are at higher risk of death by suicide compared with people working in other occupations. This article explores the contributory factors involved in suicide among healthcare professionals and outlines some of the methods that nurses can use to enquire about suicide risk with their colleagues. It also details appropriate interventions that nurses can use to reduce the risk of suicide among their colleagues. The authors aim to increase nurses' understanding of their role in suicide prevention in the healthcare workforce.

Healthcare interventions for sex workers: protocol for a scoping review.

INTRODUCTION: Sex workers, who provide sexual or erotic acts in exchange for payment, often experience multiple disadvantages, including mental ill health and substance misuse. Mainstream healthcare services are generally not configured to facilitate engagement with sex workers and therefore, services are needed that are accessible to this population. The aim of this scoping review is to understand the evidence base for approaches, services and interventions that are aimed at addressing sex workers' health needs. METHODS AND ANALYSIS: Nine databases, CINAHL, Embase, EThOS, Google Scholar, Health Management Information Consortium, MEDLINE, ProQuest Dissertations and Theses, PsycINFO and Web of Science (Core Collection), will be searched, with results limited to English language publications and those published from 2003 onwards. De-duplication, study selection and data extraction will be conducted using Covidence software. Included studies will describe or evaluate approaches, services or interventions that address the health needs of sex workers who offer services that involve physical contact with a client. ETHICS AND DISSEMINATION: No ethical review is needed. The final report will be shared with Birmingham City Council as part of ongoing work and will be disseminated by peer-reviewed publication. STUDY REGISTRATION: Open Science Framework (doi: 10.17605/OSF.IO/N7WSX).

Student nurses' experiences of workplace violence: A mixed methods systematic review and meta-analysis.

OBJECTIVES: To identify the prevalence of student-directed violence on clinical placement and description of their related experience during clinical placements. DESIGN: Mixed methods systematic review and meta-analysis conducted following Joanna Briggs Institute guidelines and reported according to Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. DATA SOURCES: CINAHL, Embase, Medline, Proquest, PsycINFO and Google Scholar. REVIEW METHODS: Included studies were peer reviewed, published primary studies where pre-registration nursing students were surveyed about their experiences of physical, verbal, or sexual aggression, bullying or racism during clinical placement. Studies were quality assessed but not excluded based on the result. A convergent segregated approach to synthesis and integration was undertaken. Prevalence data were extracted and pooled using both random and quality effects models; separate analyses were conducted by violence type, source, and region. Qualitative data were thematically analysed. RESULTS: 14,894 student nurses from 42 studies were included across the meta-analyses. There was substantial heterogeneity in the included data. Pooled prevalence rates ranged from racism 12.2 % to bullying 58.2 %. Bullying (38.8 %) and physical aggression (10.2 %) were most perpetrated by nurses whereas sexual aggression was perpetrated mostly by patients (64.2 %) and physicians (18.6 %). Qualitative findings identified students' descriptions of reasons for, effects of, strategies for dealing with and higher education establishments' responsibilities with regards to workplace violence. CONCLUSIONS: Student nurses commonly experience violence during their clinical placements. Given the potential debilitating physical and psychological sequelae of all forms of violence then this study further emphasises the need to use multiple strategies to prevent violence and to better equip student nurses to manage potentially violent incidents, their responses to violence, and to whistle blow or report when they are subject to violence.

Mental health nurses' attitudes towards risk assessment: An integrative systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Risk assessment and risk management are considered to be important practices carried out by mental health nurses. Risk assessment can help keep mental health service users' safe, but some nurses see it as a 'tick the box' exercise. Some studies have looked at nurses' attitudes to risk assessment but no one has systematically described all the studies. WHAT THE ARTICLE ADDS TO EXISTING KNOWLEDGE?: Mental health nurses' attitudes towards risk assessment are diverse with regard to its legitimacy, conduct and value. This study provides an organised framework to help understand the areas in which these different attitudes occur. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Since attitudes can influence clinical practice, nurses need to reflect on how they view risk assessment. Further research is required to investigate whether particular attitudes are positive or negative and whether attitudes can be changed. ABSTRACT: INTRODUCTION: Understanding nurses' attitudes towards risk assessment could inform education and practice improvements. AIM/QUESTION: To explore mental health nurses' attitudes towards risk assessment. METHOD: An integrative systematic review (PROSPERO: CRD42023398287). Multiple databases (PubMed, CINAHL, MEDLINE, EMBASE and PsycINFO) were searched for primary studies of mental health nurses' attitudes towards risk assessment. Qualitative studies were subject to inductive coding and thematic analysis; quantitative data were integrated with emerging themes. RESULTS: Eighteen articles were included. Qualitative studies commonly lacked rigorous analyses. Four themes emerged: underlying purpose and legitimacy of risk assessment (philosophical orientation); use of structured approaches (technical orientation); value of intuition (intuitive orientation); and service user involvement (relationships orientation). There were contradictory study findings in each thematic category indicating different attitudes among mental health nurses. DISCUSSION: Mental health nurses' attitudes towards risk assessment vary in four key domains. Survey studies suggest they are more approving of structured approaches to risk assessment than many qualitative studies suggest. There is a need to develop a valid measure of attitudes to risk assessment. IMPLICATIONS FOR PRACTICE: This review could help health organisations to develop strategies to improve their risk assessment policies and practice. There is a need to develop structured training and education programmes.

Randomized controlled trials of mental health nurse-delivered interventions: A systematic review.

WHAT IS KNOWN ON THE SUBJECT?: Well conducted randomized controlled trials provide the highest level of evidence of effectiveness of healthcare interventions, including those delivered by mental health nurses. Trials have been conducted over the years but there has not been a comprehensive review since 2005, and never one including studies conducted outside the UK. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides a comprehensive overview of results from randomized controlled trials of mental health nurse-delivered interventions conducted in the UK, Ireland, US, Australia, New Zealand, or Canada and reported 2005 to 2020. It highlights that the trial evidence is limited and offers only partial evidence for interventions that are central to mental health nursing practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Much mental health nursing practice is not supported by the highest level trial evidence. Mental health nurses need to carefully select evidence on which to base their practice both from the mental health nursing literature and beyond. Mental health nurses and other stakeholders should demand greater investment in trials to strengthen the evidence base. ABSTRACT: INTRODUCTION: Nurses are the largest professional disciplinary group working in mental health services and have been involved in numerous trials of nursing-specific and multidisciplinary interventions. Systematic appraisal of relevant research findings is rare. AIM: To review trials from the core Anglosphere (UK, US, Canada, Ireland, Australia, New Zealand) published from 2005 to 2020. METHOD: A systematic review reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Comprehensive electronic database searches were conducted. Eligible studies were randomized controlled trials of mental health nurse-delivered interventions conducted in relevant countries. The risk of bias was independently assessed. Synthesis involved integration of descriptive statistics of standardized metrics and study bias. RESULTS: Outcomes from 348 between-group comparisons were extracted from K = 51 studies (N = 11,266 participants), Standardized effect sizes for 68 (39 very small/small, 29 moderate/large) statistically significant outcomes from 30 studies were calculable. All moderate/large effect sizes were at risk of bias. DISCUSSION: Trial evidence of effective mental health nurse-delivered interventions is limited. Many studies produced few or no measurable benefits; none demonstrated improvements related to personal recovery. IMPLICATIONS FOR PRACTICE: Mental health nurses should look beyond gold standard RCT evidence, and to evidence-based interventions that have not been trialled with mental health nurse delivery.

Use of sensory rooms in adult psychiatric inpatient settings: A systematic review and narrative synthesis.

Reducing the use of restrictive interventions within psychiatric inpatient settings is a global priority. There are many strategies which may support the prevention of violence before escalation into more severe incidences. Sensory rooms have been identified as one such intervention, aiding patients to emotionally regulate and reduce distress, with a growing body of academic literature interested in whether sensory rooms can ultimately impact incidences of patient violence and the use of restraint, seclusion, and other restrictive practices. A systematic literature review was conducted to identify how effective sensory rooms are at reducing patient violence and restrictive interventions within adult psychiatric inpatient settings. Eighteen studies met the eligibility criteria and were included in the review. There is a lack of evidence as to whether sensory rooms are effective at reducing seclusion, restraint, or violence. They are, however, likely to support a reduction in patient distress. Patient and staff experiences suggest sensory rooms support emotional regulation, promote self-management, and positively impact the overall patient admission experience and ward environment. Further research is needed to identify what works, for who and in what circumstances in relation to the design of sensory rooms.

Kinship Care and Child Protection in High-Income Countries: A Scoping Review.

Kinship care is a global phenomenon with a long history, which in high-income countries (HICs) at least, is being increasingly formalized through legislation and policy. There are many benefits to kinship care, including improved child mental health and well-being when compared to other types of out-of-home care. Despite this, kinship care is not without its risks with a lack of support and training for kinship carers putting children at an increased risk of abuse and neglect. This scoping review was conducted across 11 databases to explore the breadth and depth of the literature about abuse and neglect within kinship care in HICs and to provide initial indications about the relationship between kinship care and abuse. Of the 2,308 studies initially identified, 26 met the inclusion criteria. A majority of studies were from the United States, and most used case review methods. From the included studies, rates of re-abuse, and particularly rates of physical and sexual abuse, appear to be lower in kinship care settings when compared to other out-of-home care settings, but rates of neglect are often higher. This review has demonstrated that a small but significant number of children living in kinship care experience neglect or abuse.

A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings.

INTRODUCTION: Violence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so. METHODS: CINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken. RESULTS: Eight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area. DISCUSSION: There is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.

Mental health nurses' measured attitudes to people and practice: Systematic review of UK empirical research 2000-2019.

WHAT IS KNOWN ON THE SUBJECT?: Many studies have investigated the attitudes of mental health nurses towards a range of targets. These targets are person-oriented (for example groups of people with a similar mental health diagnosis) or practice-oriented (for example practices such as seclusion or restraint). It is thought that attitudes contribute to the practice of mental health nurses because research suggests attitudes have a role in shaping behaviour. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: To date, research about mental health nurses' attitudes has examined different attitudes in isolation from one another. By demonstrating a lack of connectedness across studies this paper highlights the need for new theory-informed approaches to attitudinal research. By standardizing measurements across different studies this review demonstrates that the most negatively appraised attitudinal targets-indicated by large proportions of respondents who appraise negatively-concern people with diagnoses of borderline personality disorder, substance misuse, and acute mental health presentations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Significant numbers of mental health nurses may have attitudes, especially towards people with borderline personality diagnoses and those who misuse substances, that may not be concordant with good practice. There is insufficient evidence about what the actual implications this has for practice because the body of relevant research lacks coherence, interconnectedness and a grounding in contemporary theoretical developments. Training programmes that focus on attitudinal change need to be more rigorously evaluated. ABSTRACT: Introduction Attitudes are considered integral to mental health nursing practice. Aims To comprehensively describe the (i) measured attitudes of UK mental health nurses towards people and practice; (ii) effectiveness of interventions to change attitudes; and (iii) relationships between their attitudes, other variables/constructs and practice. Methods Using systematic review methodology, multiple databases (CINAHL, Scopus, PsycINFO, Web of Science Core Collection, Google Scholar) were searched. Eligible studies involved measurement of UK-based mental health nurses' attitudes with multi-item scales. Studies were quality appraised, mean (SD) attitudinal data were standardized, and other results converted to standardized effect sizes. Results N = 42 studies were included. Negatively appraised attitudinal targets were people with a borderline personality disorder diagnosis, substance misuse, and acute mental health presentations. Educational interventions were associated with immediate increases in positive appraisals but sustainability was poorly evidenced. There was very limited study of attitude-practice links. Discussion This review identifies priority attitudinal targets for action but also demonstrates that future work must consider the interconnectedness of attitudes and their relationship with practice. Implications for Practice Priority areas for consideration are attitudes to borderline personality disorder, substance misuse and mental health co-morbidity. Addressing disparities between nurses' attitudes and those of service users is important. More robust research is required into the effectiveness of interventions to change attitudes and into attitude-practice links.

The impact of transition programmes on workplace bullying, violence, stress and resilience for students and new graduate nurses: A scoping review.

AIMS AND OBJECTIVES: This scoping review aims to identify whether transition programmes support new graduate nurses and nursing students in terms of dealing with workplace violence, bullying and stress and enhance new graduate nurses' resilience during the transition from education to clinical practice. BACKGROUND: Many new graduate nurses in their first year of employment experience issues at work such as violence, bullying and stress, which forces them to leave their jobs. Nursing students also experienced these issues during their clinical rotation. However, some hospitals and universities have developed transition programmes to help nursing students and new graduate nurses and ease their transition from education to clinical practice. Although transition programmes have been successful in increasing the retention rate for new graduate nurses, their impact on supporting new graduate nurses and nursing students in dealing with workplace violence, bullying and stress and in enhancing their resilience is unknown. DESIGN: A scoping review of the current literature (with no date limit) using the PRISMA-ScR checklist for reporting scoping reviews was utilised. METHOD: Following the scoping review framework of Arksey and O'Malley, a broad search (with no date limit) was performed in CINAHL, Scopus, Medline, Web of Science, ASSIA, PsycINFO, Embase, PROSPERO and ProQuest Dissertation databases. Reference lists of the included studies were searched. RESULTS: This review found that most transition programmes provide support for new graduate nurses when dealing with workplace violence, bullying and stress. Transition programmes varied in length, content and implementation. Preceptors' support, educational sessions and safe work environments are the most beneficial elements of transition programmes for supporting new graduate nurses. Education sessions about resilience provide new graduate nurses with knowledge about how to deal and cope with stressful situations in the work environment. We found no studies that focused on nursing students. CONCLUSION: The paucity of research on transition programmes' impact on workplace violence and bullying means that further research is recommended. This to determine which strategies support nursing students and new graduate nurses in clinical practice and to explore the effect of these programmes on experiences of workplace violence and bullying. RELEVANCE TO CLINICAL PRACTICE: Evidence indicates that there is a worldwide gap in how universities and colleges prepare nursing students for transitioning from the education system to clinical practice. New graduate nurses and nurse managers regularly report that their education did not fully provide them with the skills required for their transition to clinical practice. Transition programmes support new graduate nurses to deal with workplace violence and bullying and need to have structured implementation. Ongoing evaluation is required to ensure that the programmes meet the needs of nursing students and new graduate nurses and health organisations, improve new graduate nurses' transition to clinical practice safely, enhance their resilience to overcome issues in the workplace (such as violence, bullying and stress) and reduce their turnover.

Child abuse in children living with special guardians, a service evaluation of child protection medical examinations.

Objective: To determine difference in frequency of referral for child protection medical examination (CPME) in children subject to special guardianship order (SGO), subject to child protection plan (CPP) or neither. Design: Service evaluation analysing data from CPME reports. Setting: Acute and community healthcare providers in Birmingham UK, during 2018. Patients: All children aged 0-18 years requiring CPME. Main outcome measures: Details were obtained from CPME reports on: age, SGO status, CPP status, reason for CPME, injuries sustained, presence of non-accidental injury.Population data were obtained from the local children's safeguarding board and national statistics. Results: Reports were available for 292/298 (98%) CPME, relating to 288 children. 5 children were subject to SGO, 39 were subject to CPP, none subject to both. Non-accidental injury was substantiated in 189/288 (66%). The child population was 288 000. 1665 children were subject to CPP and approximately 750 subject to SGO. The relative risk (RR) for children subject to SGO requiring a CPME compared with children not subject to SGO or CPP is 7.86, p<0.0001 with 95% CI (3.26 to 19.02). The RR for children subject to a CPP requiring CPME compared with children not subject to SGO or CPP is 27.65, p<0.0001 with 95% CI (19.78 to 38.63). Conclusions: This is a small study and findings need interpreting cautiously. Children subject to SGO may potentially be at higher risk of abuse than the general population despite living with carers who have passed social care parenting assessments. There is no register of children subject to SGO so professionals may be unable to offer families additional support. SGO families should be offered enhanced support and monitoring routinely. Children subject to CPP are not being adequately protected from further abuse.

Role of occupational therapy in reducing and managing violence among mental health inpatients: a scoping review protocol.

INTRODUCTION: Violence is pervasive among psychiatric inpatients and has profound consequences for its victims, its perpetrators and mental health services. Currently, the unique contribution of occupational therapists to reducing and managing violence among this patient group has not been systematically explored. However, an a priori model which provides an initial understanding of its role in this respect can be identified from the wider scholarly literature. This scoping review aims to apply and refine this model, thereby producing an amended version that will form the basis for further research. METHODS AND ANALYSIS: This scoping review is based upon guidance from the Joanna Briggs Institute, Levac, Colquhoun and O'Brien's scoping review framework, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review checklist. Electronic databases (Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus, PsycINFO, Medline, PsycARTICLES, ProQuest Health and Medicine, Allied and Complementary Medicine Database (AMED) and Google Scholar) and grey literature will be searched to identify relevant papers. Included articles will apply occupational therapy theory or occupational science to the reduction or management of violence among psychiatric inpatients and will be critically appraised by two independent reviewers. Study characteristics will be presented using frequency counts, and qualitative data will be analysed using 'best-fit' framework synthesis and secondary thematic analysis to produce an overall model of occupational therapy's contribution to violence management and reduction. ETHICS AND DISSEMINATION: Results will be disseminated through a peer-reviewed academic journal and via professional conferences. The review will collect secondary data and therefore will not require ethical approval.

Nursing students' experiences of violence and aggression: A mixed-methods study.

BACKGROUND: Violence and aggression cause significant problems for nursing staff and students working across healthcare. OBJECTIVES: To identify the prevalence of aggression experienced by nursing students whilst on clinical placement in one UK city, and rates and experiences of reporting of aggression. DESIGN: A convergent mixed method design, with mixing occurring at the objective and inference stages. PARTICIPANTS: Preregistration nursing students who had completed at least one clinical placement. METHODS: A cross-sectional survey and concurrent focus groups were conducted between May and December 2018. Students completed the 'Students' Experiences of Violence and Aggression Survey' (SEVAS) and were separately invited to participate in focus groups. RESULTS: There were 129 responses to the survey and 36 students participated in five focus groups. Only about a third of non-physical aggression was reported and around half of the physical aggression and sexual harassment. Very few incidents were reported to the university. Themes from the focus groups encompassed ideas of the ubiquity of violence, that students did not know what they were doing, and issues of racism, bullying, and compassion. CONCLUSIONS: Universities have a responsibility to students; this includes preparing them adequately to manage aggression, and ensuring reporting is easy to do and adequately dealt with. A majority of students who responded to the survey had experienced non-physical aggression in the past year (81%), over half had experienced physical aggression (56%) and more than one in three had experienced sexual harassment (40%).

Taser use on individuals experiencing mental distress: An integrative literature review.

WHAT IS KNOWN ABOUT THE SUBJECT?: People experiencing mental distress have a high rate of contact with police in community crisis events. Police use a continuum of responses when managing situations involving agitation, aggression and behavioural problems. People experiencing mental distress have been subjected to Tasers as part of the police response. Following a number of deaths and numerous reports of injuries, concerns have been raised about the safety of Tasers. WHAT THIS PAPER ADDS?: Police use of Tasers in mental health crises is relatively common. Tasers are used in a range of settings including public places, private residences and healthcare facilities. People experiencing mental distress may be subjected to more use of Tasers than the general population. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health professionals need to work with police towards greater understanding of the needs of people experiencing mental distress and to promote the use of non-coercive interventions in mental health crisis events. Mental health researchers need to explore the qualitative experiences of people who are Tasered, to provide an evidence base for Taser use with people experiencing mental distress. ABSTRACT: Introduction Conducted electrical weapons, or "Tasers," are currently used by over 15,000 law enforcement and military agencies worldwide. There are concerns regarding the effectiveness, potential for harm and overuse with people experiencing mental distress. Aim To explore the literature about police use of Tasers with people experiencing mental distress. Method An integrative review was undertaken, and qualitative and quantitative analytical approaches were used. Results Thirty-one studies were included. Of all recorded usage, overall prevalence of Taser use on people experiencing mental distress was 28%. This population appears to experience higher Taser usage than the general population. Discussion There are substantial gaps in the research literature particularly with respect to the decision-making processes involved in deploying Tasers on this population and the physical and psychological consequences of Taser use in this context. Implications for practice Police use of Tasers in mental health crises is relatively common and occurs in a variety of environments including mental health settings. Mental health professionals need to work with police towards greater understanding of the needs of people with mental illness and to promote the use of non-coercive interventions in mental health crisis events.