Authors (including presenting author) :
Cheng PYI(1), Kan CK(1), Ng CP Tony(1), Cheng CH(1), Lam SL(1), K W Shun (1), S F Lui(1)
Affiliation :
(1) Pamale Youde Nethersole Eastern Hospital
Introduction :
Violence was recognized and acknowledged as a problem in health care settings especially in mental health units. The exposure to any type of violence results in negative impacts on the patients, staff, carers, and to the organization. The emotional effects of being involved in violent events may break the therapeutic relationship between healthcare professionals and patients, as well as carers. It may also have negative consequences on patient’s recovery.
However, there is limited understanding of the patients’ and carers’ views of the occurrence of violent events and how these incidents could be minimized effectively. The aim of this study is to understand patients’ aggressive behaviors and the management of patient violence in Department of Psychiatry, Pamale Youde Nethersole Eastern Hospital (PYNEH). This will has been done by exploring challenging situations in psychiatric hospitals and gaining ideas for the future development from the point of view of patients and carers.
Methodology :
This study used a qualitative research design with focus group interviews. The participants included patients who were admitted to the psychiatric wards of PYNEH and their carers. The focus group interviews were guided by structured open-ended questions from 4/2018 to 6/2018, both date inclusive. Participants were invited to describe the situations, causes and outcomes related to patients’ aggressive behaviors in wards, and suggestions for how the aggressive behaviors could be managed and minimized in the future. The recorded interviews were recorded. The audios were transcribed and analyzed by inductive content analysis.
Result & Outcome :
Total 14 patients and 17 carers joined the focus group interviews. The causes of aggressive behaviors in ward were categorized into three aspects including 1) patient aspect, 2) staff aspect and 3) environmental aspect. Firstly, the unstable mental state of patients and unsatisfactory ward environment were the most frequently mentioned aspect by the participants. The major difference between the patient and carer group was that the patients more concerned about the ward environment, including noisy and crowded environment, while the carers raised the concern of complex patient mix in ward that would trigger patients’ aggressive behaviors.
The short-term outcomes of aggressive behaviour were also identified, including being restrained, being sedated and being timeout. Among the three outcomes, being restrained was understood as the last approach in both patient and carer group. The long term outcome including medication review also reported by the participants.
Some suggestions were proposed for how patients’ aggressive behaviors could be managed and minimized in the future. The suggestions were categorized into the following themes: ward environment, ward resources, varieties of activities, therapeutic relationship and medication. An additional suggestion from the carer group that the substance abuse patients and dementia patients better not to mix with other psychiatric patients in the same ward.
Recommendation
Based on this preliminary analysis of the data, some strategies for preventing aggressive behaviors were proposed, to prevent, or minimize aggressive behaviors in in-patient settings.
Patients:
- Increase the variety of psychiatric rehabilitation activities on Sunday/public holidays;
- Give choices to the patients for joining the psychiatric rehabilitation activities based on their needs, strengths and risks;
- Add quiet rooms/areas for providing a relaxed and calm environment for patients especially those who are facing stress or negative emotions;
- Organize educational talks about “Prevention of Violence in Psychiatric Ward” and weekly rehabilitation activities about “Relapse Management Plan”
Carers:
- Take initiatives to communicate with carers about patients’ recovery plans;
- Involve carers into rehabilitation activities about “Relapse Management Plan”.
