Leadership support for ward managers in acute mental health inpatient settings.

This article shares findings of work undertaken with a group of mental health ward managers to consider their roles through workshops using an action learning approach. The tensions between the need to balance the burden of administrative tasks and act as clinical role models, leaders and managers are considered in the context of providing recovery-focused services. The group reviewed their leadership styles, broke down the administrative elements of their roles using activity logs, reviewed their working environments and considered how recovery focused they believed their wards to be. Findings support the notion that the ward manager role in acute inpatient settings is at times unmanageable. Administration is one aspect of the role for which ward managers feel unprepared and the high number of administrative tasks take them away from front line clinical care, leading to frustration. Absence from clinical areas reduces opportunities for role modeling good clinical practice to other staff. Despite the frustrations of administrative tasks, overall the managers thought they were supportive to their staff and that their wards were recovery focused.

Improving confidence in suicide risk assessment.

Suicide risk assessment is a complex task for mental health professionals. Attendance at mandatory training programmes designed to equip staff with the skills to undertake suicide risk assessments can be helpful in ensuring staff understand theoretical aspects. In reality, more support in practice is also required. To address this, we introduced a system of reflective peer review. This has helped staff to reflect on their risk assessments, consider the knowledge and information that has informed their risk management plans and discuss this with their peers in a supportive environment. This process has improved staff skills, confidence and documentation.

A reading group in acute mental health care.

Training provided by The Reader Organisation enabled Berkshire Healthcare Foundation Trust to run reading groups for people in acute inpatient mental wards. A five-week pilot project provided an opportunity for patients to spend some time off the wards to enjoy reading together. The group offered a therapeutic engagement and self-expression.

A pilot study to test an intervention for dealing with verbal aggression.

Verbal aggression has been defined as communication with an intention to harm an individual through words, tone or manner, regardless of whether harm occurs. It includes verbal threat to harm, ridicule, openly hostile remarks, unjust persistent criticism, shouting or yelling insults, as well as more covert actions such as spreading hurtful rumours (Cox, 1987; Farrell et al, 2006). Receiving verbal aggression from a patient has been closely associated with psychological distress which may negatively affect work performance. A verbal aggression work book was developed to help nursing staff to deal with verbal aggression from patients in clinical practice. This was piloted over a six-week period with 18 nurses working on one acute psychiatric inpatient ward. Findings revealed that the intervention had some promising effects. However, much more attention needs to be paid to changing attitudes towards verbal aggression.

The prevalence of verbal aggression against nurses.

There have been many anecdotal and press reports of verbal aggression against nurses. The authors undertook a structured review of the published literature on the topic. They found that no consistent definitions or time periods had been used, a consistent estimate of prevalence was impossible to establish, studies had been retrospective, and the commonest form of measurement had been self-report. There had been no culmination of replicable knowledge. The claim of most studies is that verbal aggression is commonplace in nursing. The best available evidence suggests that verbal aggression is often viewed as 'part of the job'. Consequences can range from emotional effects such as anger and humiliation, through to intent to leave the profession and for some it may have a negative psychological impact. Further research is needed to investigate the multi-faceted nature of verbal aggression. This must be guided by clear definitions and incorporate standardized measures of the effects of verbal aggression so that nurses can compare findings and fully understand all of the complexities and consequences.

The psychological impact of aggression on nursing staff.

Aggression and violence towards nursing staff in UK health care is a growing problem. While the National Institute for Health and Clinical Excellence's (NICE, 2005a) guidelines 'The Short-Term Management of Disturbed/Violent Behaviour in In-Patient Psychiatric Setting and Emergency Department' offer a way forward in managing aggression for healthcare staff, the psychological impact of aggression remains an area of concern. Post-incident review has been identified as an approach to considering untoward incidents of aggression, yet post-incident support and interventions for staff experiencing the psychological effects of aggression remain inconsistent and curtailed in many areas. This article discusses the care of a nurse who experienced post-traumatic stress disorder as a result of aggression in the workplace. The process of assessment and treatment is presented with underpinning theories of trauma used to illuminate the discussion. Practical use of current recommended treatments of cognitive behavioural therapy and eye movement desensitization and reprocessing is offered as a method of addressing a growing problem in UK health care.

Phase II and coagulation cascade biomarker study of bevacizumab with or without docetaxel in patients with previously treated metastatic pancreatic adenocarcinoma.

PURPOSE: Treatment options are limited for advanced pancreatic cancer progressive after gemcitabine therapy. The vascular endothelial growth factor pathway is biologically important in pancreatic cancer, and docetaxel has modest antitumor activity. We evaluated the role of the anti-vascular endothelial growth factor antibody bevacizumab as second-line treatment for patients with metastatic pancreatic cancer. DESIGN: Patients with metastatic adenocarcinoma of the pancreas who had progressive disease on a gemcitabine-containing regimen were randomized to receive bevacizumab alone or bevacizumab in combination with docetaxel. RESULTS: Thirty-two patients were enrolled; 16 to bevacizumab alone (Arm A) and 16 to bevacizumab plus docetaxel (Arm B). Toxicities were greater in Arm B with the most common grade 3/4 nonhematologic toxicities including fatigue, diarrhea, dehydration, and anorexia. No confirmed objective responses were observed. At 4 months, 2 of the 16 patients in Arm A and 3 of the 16 patients in Arm B were free from progression. The study was stopped according to the early stopping rule for futility. Median progression-free survival and overall survival were 43 days and 165 days in Arm A and 48 days and 125 days in Arm B. Elevated d-dimer levels and thrombin-antithrombin complexes were associated with decreased survival and increased toxicity. CONCLUSION: Bevacizumab with or without docetaxel does not have antitumor activity in gemcitabine-refractory metastatic pancreatic cancer. Baseline and on-treatment d-dimer and thrombin-antithrombin complex levels are associated with increased toxicity and decreased survival.