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.

'Speaking Up' for patient safety and staff well-being: a qualitative study.

BACKGROUND: Freedom To Speak Up Guardians (FTSUGs) and Confidential Contacts (CCs) were appointed nationally following the Mid Staffordshire inquiry to listen to and support staff who were unable to address concerns through normal channels of communication. AIM: Explore perceptions of an FTSUG and CCs through shared experiences and personal stories. OBJECTIVES: (1) Explore perceptions of an FTSUG and CCs. (2) Consider how individuals can be best supported. (3) Improve staff knowledge on speaking up. (4) Understand factors influencing reflections around patient safety. (5) Share exemplars of good practice through use of personal stories to promote a culture of openness to raise concerns. METHOD: A focus group of eight participants, namely the FTSUG and CCs working within one large National Health Service (NHS) trust, was used to gather data. Data were collated and organised using a created table. Thematic analysis enabled each theme to emerge and be identified. CONCLUSION: (1) An innovative approach to the introduction, development and implementation of an FTSUG and CC roles and responsibilities in healthcare. (2) To gain insight into the personal experiences of a FTSUG and CCs working within one large NHS trust. (3) To be supportive of culture change with committed leadership responsiveness.

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.

Risk Assessment of Self-Injurious Behavior and Suicide Presentation in the Emergency Department: An Integrative Review.

INTRODUCTION: Globally, there is a lack of clarity regarding the best practice to distinguish patients at the highest risk of suicide. This review explores the use of risk assessment tools in emergency departments to identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide. METHODS: The review question ("Does the use of risk assessment tools in emergency departments identify patients at high risk of repeat self-harm, suicide attempts, or death by suicide?") focused on exposure and outcome. Studies of any design were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used. Study characteristics and concepts were extracted, compared, and verified. An integrative approach was used for reporting through narrative synthesis. RESULTS: Nine studies were identified for inclusion. Two risk assessment tools were found to have good predictive ability for suicide ideation and self-harm. Three had modest prediction of patient disposition, but in one study, the clinical impression of nurses had higher predictive ability. One tool showed modest predictive ability for patients requiring admission. DISCUSSION: This review found no strong evidence to indicate that any particular risk tool has a superior predictive ability to identify repeat self-harm, suicide attempts, or death by suicide. Best practice lacks clarity to determine patients at highest risk of suicide, but the use of risk assessment tools has been recommended. Nevertheless, such tools should not be used in isolation from clinical judgment and experience to evaluate patients at risk. Education and training to augment risk assessment within the emergency department are recommended.

Developing a Process for Criteria-Led Discharge: Selection of Patients for Efficient and Effective Discharge (SPEED).

BACKGROUND: Criteria-led discharge (CLD) is an approach for maximizing bed capacity by expediting patient discharge. PROBLEM: In acute medicine settings, patients commonly have multiple medical problems, which render single care pathway and clinical protocols of limited use. CLD offers potential, but little evidence exists about how to best implement it in these contexts. APPROACH: Retrospective case note analysis generated characteristics from patients' discharge plans to design a criterion-based framework to aid patient selection for CLD. These criteria were hypothetically tested on patient case notes (n = 50). OUTCOMES: CLD was identified as suitable (n = 27) and unsuitable (n = 23) from 50 case notes. Interrater agreement was 86% between 3 reviewers. CONCLUSIONS: This review has provided greater understanding of the complexity of discharge in acute medicine settings. Implementing CLD to optimize timeliness of patient discharge might offer a solution for selected patients.

A Systematic Review of Criteria-Led Patient Discharge.

BACKGROUND: This article reports on a systematic review conducted to critique safety, quality, length of stay, and implementation factors regarding criteria-led discharge. PURPOSE: Improving patient flow and timely bed capacity is a global issue. Criteria-led discharge enables accelerated patient discharge in accordance with patient selection. METHODS: A systematic review was conducted to identify literature on criteria-led discharge from 2007 to 2017. The quality of articles was appraised using a tool for disparate studies. Two reviewers extracted relevant data independently. RESULTS: Fifteen studies were identified that showed no increase in patient readmission or complication rates with criteria-led discharge, demonstrating patient safety. The quality of the patient discharge was unremarkable. None of the studies showed an increase in length of stay. CONCLUSIONS: The safety, quality, and length of stay for patients discharged through criteria-led discharge are inextricably linked to the process adopted for its implementation.

Principles for discharging patients from acute care: a scoping review of policy.

BACKGROUND: Acute medicine units (AMUs) are part of acute hospital care, where length of patient stay is short and turnover is high. Expediting patient discharge safely is a major function of AMUs, which need up-to-date bespoke guidance. AIM: To carry out a scoping review of UK discharge policy to critically consider, compare and contrast the relevant discharge policies and guidance that underpin the assessment of acute patient discharge. OBJECTIVES: To inform the production of bespoke patient discharge guidance for AMUs. Design and stages: Identify the review questions; identify relevant studies; select the studies; chart the data; collate, summarise and report the results. FINDINGS: 28 patient discharge policy guidelines were identified that had no specific guidance for patient discharge from AMUs. New bespoke principles for AMUs were created through a pragmatic interpretation of current relevant policies. CONCLUSION: There is a gap in specific patient discharge guidance for AMUs. New guidance should contribute in practice to improve patient discharge.

Providing a navigable route for acute medicine nurses to advance their practice: a framework of ascending levels of practice.

This article conveys concerns raised by delegates at the International SAM Conference (Manchester, 2015) regarding how to advance nursing practice in acute medicine. It endeavors to capture the essence of 'how to advance practice' and 'how to integrate advanced practice' within the workforce structures of an acute medicine unit (AMU). It addresses the production of tacit knowledge and the recognition and integration of this to developing the nursing workforce. The current context of NHS efficiencies and recruitment issues emphasize the value of retaining tacit knowledge. Uniquely, this article offers an early conceptual framework through which levels of advancement and potential transition points to advance nursing practice in acute medicine are articulated. Determining how to advance requires identification of prior accomplishments such as, tacit knowledge, experiential learning, CPD, specialist courses and management experience. This requires nurses to make judicious decisions to advance their practice and the distinction between 'amassing experience' and 'career progression'. It aims to stimulate thinking around the practicalities of advancement, the value of tacit knowledge and potential realization through the framework trajectory.