Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6595. Adviser: Arch I. Carson. Includes bibliographical references.

Background: Psychiatric inpatient staff members work with arguably the most challenging service users. However, reference to these challenges often does not go beyond ‘challenging behaviour’, offering no insight into the actual presentation, thus preventing formulation of the perceived challenges, or subsequent interventions. Moreover, studies have shown that staff responses to challenging presentations can impact on both the staff member and the service user. In particular, staff causal attributions have been shown to impact on their therapeutic response (Apel & Bar-Tal, 1996), as well as being associated with staff emotions (Colson et al., 1987). In turn, the emotional response has been found to be associated with coping, both of which have also been found to effect staff behavioural response, as well as staff members’ psychological well-being (Wykes & Whittington, 1998). However, there have been limited studies assessing these relationships with psychiatric inpatient staff. This may be due to the lack of assessment tools developed for this staff group to measure these particular domains. A specifically designed tool would enable consistent assessment to take place to build on our theoretical knowledge of psychiatric inpatient staff members’ perceived challenges, and their responses to them, as well as highlight specific areas within these domains where further staff training and support is required. Aims: The first aim of the study was to explore psychiatric staff’s views on the challenges they faced when working with service users in inpatient settings, their emotional responses, attributions, and coping strategies about those challenges and then to develop a measure which would accurately capture these (the SEACCS). The second aim was to assess the reliability of the new scale as well as explore relationships within the SEACCS. Finally, the third aim was to assess content and face validity, as well as conduct preliminary psychometric investigations of the construct validity of the newly developed measure. Method: The study was conducted using various methods across three phases. In order to generate items for the SEACCS, a systematic review of the relevant literature and semi-structured interviews took place during the first phase. Secondly, the results of Phase I were combined in order to develop and construct the SEACCS. The third phase involved a postal survey of the SEACCS (including re-test), followed by psychometric investigations to scrutinise the items, explore the reliability, and construct validity of the SEACCS.Results: Twenty three studies were included in the systematic review. The results highlighted inconsistent measurement and findings of the domains concerned. Seven multi-disciplinary staff interviews took place. Thematic analysis was used to conduct four separate analyses focusing on each of the research questions. Several themes and sub-themes were found. Themes such as: ‘Engagement’, ‘Attributions of controllability’, and ‘Behavioural responses’. Findings from the review, thematic analyses, and consultation groups (content and face validity) were combined in order to develop the 64 item SEACCS. A total of 76 multi-disciplinary psychiatric inpatient staff members completed the SEACCS, 15 of which completed re-tests. No items were removed following item scrutiny assessments. Preliminary psychometric investigations indicated good reliability, significant relationships across domains within the SEACCS, and partial construct validity with the GHQ-28.Conclusion: The results of the current study provide the first step in the development and construction of a clinically relevant tool that can be used to assess these domains. The methodological limitations and clinical implications are considered, and future directions for research in this area are suggested.

Malm, Ch & Agnesa, R. Åtgärder för att förebygga fall och fallskador. En litteraturstudie Examensarbete i omvårdnad 15 högskolepoäng. Malmö Högskola: Hälsa och Samhälle. Utbildningsområde omvårdnad, 2009Fall och fallolyckor är ett mycket vanligt problem särskilt för patienter som är 65 år och äldre. Ju äldre personen är desto större är risken att falla. Syftet med studien var att undersöka om sjuksköterskan i sin profession kan arbeta preventivt och sänka fall/fallskadefrekvensen på patienter inlagda på sjukhus. Studien koncentrerades till fall och fallskador inom sjukhusvården och kom att inriktas på 10 vetenskapliga artiklar som skattades utifrån forskningsmetoden, tillförlitligt resultat, bortfall, etiskt resonemang samt kvalitetsbedömning. Resultatet av artiklarna visar att det finns åtgärder att vidta för att minska fall och fallskador inom sjukhusvården samt att det även finns verktyg tillgängliga som sjuksköterskan kan använda sig av för att identifiera eventuella fallriskfaktorer hos patienten. Studierna visar att fallriskfaktorer som påvisats finns hos individen själv såväl som i den omgivande miljön och tidigare fall hos patienten är den största funna påvisade riskfaktorn. Multipreventionsprogram som innehåller olika individuella åtgärder har visat sig reducera antalet fall och fallskador. Denna studie visar hur sjuksköterskan med korrekta åtgärder kan förebygga fall och fallskador hos patienter. / Malm, C & Rogova, A. To find interventions for preventing falls and fallinjuries. A literature review. Degree Project in nursing, 15 Credit Points. Nursing Programme, Malmö University: Health and society, Department of Nursing, 2009Falls and fallinjuries are a very serious problem especially for older inhospital patients. The older a person is the greater the risk of falling. The aim of this study was to investigate if the nurse can prevent and decrease the incidence of inpatient falls.This study was concentrated on falls and fall injuries on inpatients. The study was based on ten scientific articles that were assessed from their method, reliability, loss, ethical line of argument and the quality of the article. The articles show that there are measures to take to be able to decrease falls and fallinjuries. It is also shown that there are tools available that the nurse can use for help to identify riscfactors if any. The studies show that the riscfactors pointed out are individual as well as environmental and earlier falls is the highest rated riscfactor for having a fall. Multi prevention programs that contains different individual measures has shown to help decrease the number of falls. This study shows how the nurse with proper measures can help preventing falls and fall injuries on inpatients.

No / Community hospitals are an important component of the post-acute care pathway for older people. The objective of this study was to describe and contrast patients' and carers' experiences of community and general hospitals. Interviews with patients and carers revealed similarities in the perceptions of care between the two settings. These included appreciation of staff sensitivity, a sense of security, encouragement of independence and lack of activity. The community hospital was appreciated for its location, atmosphere, accommodation, greater sense of freedom, quality of food and staff attitudes. UK health policy promotes the development of community hospitals. This should be progressed in a way that retains key strengths of the specific service they offer.

Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

A identificação de reações adversas a medicamentos (RAM) nos hospitais constitui uma importante medida da morbidade associada a medicamentos e de seu ônus sobre o sistema de saúde. Este estudo observacional não intervencionista teve por objetivo avaliar a incidência de RAM em pacientes hospitalizados, as características clínicas das reações e fatores de risco associados. Foram avaliados 472 pacientes de cinco clínicas do Hospital das Clínicas da FMUSP (Clínica Médica, Cirurgia Geral, Neurologia, Geriatria, Alergia e Imunologia Clínica), com formação de coorte prospectiva, analisando as características demográficas, comorbidades, número de medicações utilizadas antes e durante a hospitalização e tempo de internação. A prevalência das RAM foi de 1,7% e a incidência geral de RAM foi 16,2%, variando conforme a clínica avaliada, sendo maior na Clínica Médica (30%). As reações mais frequentes foram as do tipo A, predominando as manifestações gastrointestinais. A maior parte das reações foi classificada de gravidade moderada. O maior número de medicações utilizadas por paciente, insuficiência renal crônica e tempo de internação foram fatores de risco para RAM, porém não houve associação das reações com idade avançada. Antecedente de RAM anterior à internação foi identificado como fator de proteção. A incidência de reações de hipersensibilidade a medicamentos (RHM) foi de 3,2%, com maior número de medicações utilizadas por paciente como único fator de risco isolado, sem associação com as clínicas avaliadas ou gênero dos pacientes. As medicações mais associadas às RAM e RHM foram os antibióticos, opióides e contrastes iodados. Os medicamentos mais prescritos foram os sintomáticos. O estudo concluiu que as RAM são frequentes e potencialmente evitáveis. O conhecimento da incidência e dos fatores associados pode estimular a prevenção. A prescrição de medicações para pacientes internados deve ser mais criteriosa, especialmente para os mais susceptíveis, evitando a polifarmácia / The detection of adverse drug reactions (ADRs) in hospitalized patients is an important measure of morbidity associated with drugs and its burden on the health system. The objective of this non-interventionist observational study was to assess the incidence of ADRs in hospitalized patients, the clinical characteristics of reactions and associated risk factors. We evaluated 472 patients from five medical specialties of the Hospital das Clínicas-FMUSP (Internal Medicine, General Surgery, Neurology, Geriatrics, Clinical Immunology and Allergy). We performed a prospective cohort, analyzing the demographics features, comorbidities, number of medications used before and during hospitalization and length of stay in the hospital. The prevalence of ADRs was 1.7% and the overall incidence of ADRs was 16.2%, varying according to the specialty assessed, higher in the Internal Medicine (30%). The most frequent reactions were type A, with gastrointestinal manifestations being the most frequent. Most of the reactions were classified as moderate in severity. The greater number of drugs used, chronic renal failure and longer hospital stays were risk factors for ADRs, but there was no association between reactions and age. History of previous ADRs to admission was identified as a protective factor. The incidence of hypersensitivity drug reactions (HDRs) was 3.2%, with the greater number of medications used per patient as the sole isolated risk factor, without association with specialty or patient\'s gender. The main medications associated with ADRs and HDRs were antibiotics, opioids and iodinated contrast media. The most commonly prescribed medications were symptomatic ones. The study concluded that the ADRs are frequent and potentially preventable. Knowledge of the incidence and associated factors can stimulate prevention. The pharmacotherapy of in-patients should be more careful, especially for the more susceptible patients, avoiding polypharmacy

The IDSA Community-Acquired Pneumonia (CAP) Guideline recommends ceftriaxone in combination with doxycycline as an alternative to combination therapy with ceftriaxone and azithromycin for non-intensive care unit (ICU) patients hospitalized with CAP. This is an attractive alternative regimen due to recent concerns of increased cardiovascular risk associated with azithromycin. The objective of this study was to compare the clinical outcomes of azithromycin and doxycycline each in combination with ceftriaxone for non-ICU Veterans hospitalized with CAP.

A identificação de reações adversas a medicamentos (RAM) nos hospitais constitui uma importante medida da morbidade associada a medicamentos e de seu ônus sobre o sistema de saúde. Este estudo observacional não intervencionista teve por objetivo avaliar a incidência de RAM em pacientes hospitalizados, as características clínicas das reações e fatores de risco associados. Foram avaliados 472 pacientes de cinco clínicas do Hospital das Clínicas da FMUSP (Clínica Médica, Cirurgia Geral, Neurologia, Geriatria, Alergia e Imunologia Clínica), com formação de coorte prospectiva, analisando as características demográficas, comorbidades, número de medicações utilizadas antes e durante a hospitalização e tempo de internação. A prevalência das RAM foi de 1,7% e a incidência geral de RAM foi 16,2%, variando conforme a clínica avaliada, sendo maior na Clínica Médica (30%). As reações mais frequentes foram as do tipo A, predominando as manifestações gastrointestinais. A maior parte das reações foi classificada de gravidade moderada. O maior número de medicações utilizadas por paciente, insuficiência renal crônica e tempo de internação foram fatores de risco para RAM, porém não houve associação das reações com idade avançada. Antecedente de RAM anterior à internação foi identificado como fator de proteção. A incidência de reações de hipersensibilidade a medicamentos (RHM) foi de 3,2%, com maior número de medicações utilizadas por paciente como único fator de risco isolado, sem associação com as clínicas avaliadas ou gênero dos pacientes. As medicações mais associadas às RAM e RHM foram os antibióticos, opióides e contrastes iodados. Os medicamentos mais prescritos foram os sintomáticos. O estudo concluiu que as RAM são frequentes e potencialmente evitáveis. O conhecimento da incidência e dos fatores associados pode estimular a prevenção. A prescrição de medicações para pacientes internados deve ser mais criteriosa, especialmente para os mais susceptíveis, evitando a polifarmácia / The detection of adverse drug reactions (ADRs) in hospitalized patients is an important measure of morbidity associated with drugs and its burden on the health system. The objective of this non-interventionist observational study was to assess the incidence of ADRs in hospitalized patients, the clinical characteristics of reactions and associated risk factors. We evaluated 472 patients from five medical specialties of the Hospital das Clínicas-FMUSP (Internal Medicine, General Surgery, Neurology, Geriatrics, Clinical Immunology and Allergy). We performed a prospective cohort, analyzing the demographics features, comorbidities, number of medications used before and during hospitalization and length of stay in the hospital. The prevalence of ADRs was 1.7% and the overall incidence of ADRs was 16.2%, varying according to the specialty assessed, higher in the Internal Medicine (30%). The most frequent reactions were type A, with gastrointestinal manifestations being the most frequent. Most of the reactions were classified as moderate in severity. The greater number of drugs used, chronic renal failure and longer hospital stays were risk factors for ADRs, but there was no association between reactions and age. History of previous ADRs to admission was identified as a protective factor. The incidence of hypersensitivity drug reactions (HDRs) was 3.2%, with the greater number of medications used per patient as the sole isolated risk factor, without association with specialty or patient\'s gender. The main medications associated with ADRs and HDRs were antibiotics, opioids and iodinated contrast media. The most commonly prescribed medications were symptomatic ones. The study concluded that the ADRs are frequent and potentially preventable. Knowledge of the incidence and associated factors can stimulate prevention. The pharmacotherapy of in-patients should be more careful, especially for the more susceptible patients, avoiding polypharmacy

Nearly 700,000 suspects with mental disorders are arrested and Mirandized each year. The current study systematically examined the effects of cognitive deficits and psychological symptoms on both Miranda comprehension and reasoning. The current sample was comprised of 85 adult psychiatric inpatients recruited from University Behavioral Health (UBH), a private psychiatric hospital in North Texas. Unexpectedly, most inpatients demonstrated pervasive deficits in their immediate recall of a representative Miranda warning, omitting approximately four-fifths of its content. In addition, the majority of inpatients evidenced damaging errors in their reasoning about waiver decisions. As a result, 64.7% waived and subsequently confessed after only a 3-5 minute interrogation. Interestingly, impaired verbal ability but not the severity of their symptoms predicted greater deficits in Miranda comprehension.

L’utilisation des mesures de contrôle pour la gestion des comportements violents constitue une préoccupation majeure pour les infirmières qui pratiquent dans les unités de soins de santé mentale adulte. Le recours à ces mesures engendre des conséquences physiques et des traumatismes psychologiques chez les patients et tout le personnel soignant. Par conséquent, la prévention et la réduction de leur utilisation deviennent une priorité. De par l’aspect multifactoriel de cette problématique, la connaissance des facteurs qui influencent l’utilisation de ces mesures est primordiale pour cibler les interventions qui permettent de les prévenir ou les réduire. Les facteurs reliés aux caractéristiques cliniques des patients et au personnel soignant sont bien décrits dans la littérature. Toutefois, les facteurs reliés à l’environnement du patient ne sont pas attribués à l’ensemble des dimensions qui le constituent. Ceci est dû à la rareté des modèles conceptuels qui donnent une représentation structurée et globale de cet environnement. L’absence de cette représentation laisse les facteurs associés à l’environnement circonscrits seulement dans sa dimension physique, alors que d’autres facteurs reliés à ses autres dimensions sont rapportés dans la littérature sans être définis comme des facteurs environnementaux. Le but de cette revue de la portée a donc été d’explorer l’étendue des connaissances et d’identifier les facteurs de l’environnement qui sont associés à l’utilisation des mesures de contrôle chez les patients atteints de troubles mentaux. Afin d'intégrer une représentation globale de l’environnement, le cadre de référence du modèle de l’environnement thérapeutique optimal a été retenu (Optimal healing environment, ETO) (Jonas et al. , 2014). Les étapes de la revue de la portée selon Peters et al. (2020) ont été suivis, ce qui a donné lieu à l'inclusion de 35 écrits. L’analyse thématique des données extraites a permis d'identifier deux dimensions, à savoir l’environnement interpersonnel et l’environnement externe du patient. L’environnement interpersonnel décrit le développement et le maintien d’une relation thérapeutique à travers l’amélioration des compétences de communication du personnel soignant, l’utilisation des stratégies de prévention de crise d’agressivité, l’implication du patient, le retour post-évènement d’isolement et/ou contention et le sentiment d’appartenance à la communauté de l’unité de soins. Il décrit également la création d’organisations thérapeutiques via l’exercice du leadership organisationnel, les initiatives d’améliorations de l’organisation des soins, et la gestion des ressources humaines et technologiques. Pour sa part, l’environnement externe décrit la conception architecturale et le design intérieur des unités de soins où le patient est hospitalisé. Finalement, on pourrait conclure que des trois dimensions de l’ETO qui ont été incluses dans ce travail, les dimensions de l’environnement interpersonnel et l’environnement externe sont les plus représentées dans la littérature des cinq dernières années. De plus, les interventions de prévention de crise d’agressivité et le leadership organisationnel se sont montrés des facteurs clés d'un environnement thérapeutique favorisant la réduction de l’utilisation des mesures de contrôle. / The use of coercive measures (seclusion and restraints) to manage violent behaviors is a major preoccupation for adult mental health nurses. The use of these measures results in physical consequences and psychological trauma for patients and all caregivers. Therefore, prevention and reduction of their use becomes a priority. Due to the multifactorial aspect of this problem, understanding of the factors influencing this measures use is essential in order to target interventions to reduce them. Factors related to the clinical characteristics of patients and caregivers are well described in the literature. However, factors related to the patient's environment are not attributed to all of its dimensions. This is due to the scarcity of conceptual models that provide a structured, global representation of this environment. The absence of such a representation leaves the factors associated with the environment circumscribed only within its physical dimension, while other factors related to its other dimensions are reported in the literature without being defined as environmental factors. The aim of this scope review was therefore to explore the extent of knowledge and identify the environmental factors associated with reduced use of coercive measures in patients with mental disorders. In order to incorporate a holistic representation of the environment, the framework of the Optimal healing environment (ETO) model was selected (Jonas et al., 2014). The scope review steps according to Peters et al. (2020) were followed, resulting in the inclusion of 35 literatures. Thematic analysis of the extracted data identified two dimensions, namely the patient's interpersonal environment and external environment. The interpersonal environment describes the development and maintenance of a therapeutic relationship through the improvement of caregivers' communication skills, the use of aggressive crisis prevention strategies, patient involvement, the post-event return from isolation and/or restraint, and the sense of belonging to the care community. It also describes the creation of therapeutic organizations through the exercise of organizational leadership, initiatives to improve the organization of care, and the management of human and technological resources. For its part, the external environment describes the architectural and interior design of the care units where the patient is hospitalized. Finally, we may conclude that of the ETO three dimensions included in this work, interpersonal environment and external environment are the most represented in the literature of the last five years. In addition, aggression crisis prevention interventions and organizational leadership have been shown to be key factors in a therapeutic environment conducive to reducing the use of coercive measures.