CNA803: Systematic Review of Violence in Psychiatric Inpatients

This paper presents a systematic review and meta-analysis focusing on the prevalence and risk factors of violence among psychiatric acute inpatients. The study examines the introduction, literature review, methodology, analysis, evaluation, discussion, conclusion, and references related to the topic. The research investigates the impact of violence on patients and staff, exploring factors like substance abuse, demographics, and ward characteristics. The methodology involves a meta-analysis of 35 studies, utilizing electronic databases and specific search terms to identify relevant research published between 1995 and 2014. The analysis employs random effects models and meta-regression to assess the proportion of violent patients and associated factors. The findings highlight the need for understanding violence in psychiatric settings, the importance of identifying the history of violence, and the application of effective intervention strategies to improve patient and staff safety. The paper also discusses the implications of violence on patient outcomes and the well-being of healthcare professionals.

Paper for Publication
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Contents
INTRODUCTION...........................................................................................................................3
LITERATURE REVIEW................................................................................................................4
METHODS......................................................................................................................................6
ANALYSIS......................................................................................................................................7
EVALUATION AND DISCUSSION.............................................................................................8
CONCLUSION..............................................................................................................................10
REFERENCES..............................................................................................................................11
APPENDIX....................................................................................................................................12
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Topic- Prevalence & Risk Factors of Violence by Psychiatric Acute Inpatients: A systematic
review and meta-analysis.
INTRODUCTION
The study is related to the violence which is mainly occurred by the Psychiatric Acute
Inpatients and identify the specific problem or issue. Physical Violence is one of the psychiatric
wards and this can happen due to the major injury of patient, staff members. Multiple effects can
be examined through therapeutic approach and also measure suitable prevention of violence (di
Giacomo & et.al., 2020). To explore the emotional effect because of physical violence on other
inpatient that include fear, depression, shock, anxiety and sleep disturbance. It is all about the
way in which estimated between 75%-100% staff nurses face on acute psychiatric units. In most
of cases, physical violence can be identified against staff members who are contribution towards
low morale value, high rates of sick leaves and increases staff turnover. Moreover, it has been
identified the threat of physical violence which may show as result in greater use of different
coercive measurement such as medication, restraint among patients.
There are wide variation reported in the physical rate of violence in acute inpatient,
because of differences in context of measurement, method of data collection. On the basis of
study, it has been reviewed about the socio-demographic as well as clinical variables directly
associated with aggression of inpatient and measure high rate of violence among individual
patients. Author has been performed the different analysis of study in order to record all
aggressive incidents of patient, who are facing in past decade. Therefore, it become easier for
identifying the longer hospitalization, admission, hostility and involuntary. Furthermore, study
will be conducting the Meta-analysis and associated with different factors of aggression or
violence in diversified range of inpatient settings. Generally, it include intensive care units,
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psychiatric and forensic wards. The problem of aggression are majorly associated with the young
age, male, involuntary admission. In order to be examined in the history of violence, which has
been increased the high rate of self-destructive behaviour. Hence, different factors are integrated
with inpatient violence which may appear to behaviour change condition of patients. Sometimes,
it would be surprising to determine the specific wards where patient can admit who are likely to
be become face a situation or violent incidents. So as, it must require to applicable some essential
factors with entire rate of violence in context of actuate psychiatric wards.
For purpose of better understanding, it is important for identifying all essential factors that
related to the planning of service, presentation measurements and also comparing the
performance of services for inpatients. The primary aim of study is to use appropriate met-
analysis approach in order estimate or calculate the actual rate of violence, in order to explore the
aggregate level ward characteristics. It might have expressed the variation in the rate of violence
between different wards.
LITERATURE REVIEW
Ways in which violence in acute psychiatric wards affect safety of patients and staff members
According to the view of Renwick & et. al., (2019), Acute psychiatric wards are those
wards in which patients are admitted and provided care who are likely to harm themselves and
others as they are suffering from severe mental illness. Staff members working in acute
psychiatric wards mostly become target of suffering from violence due to extremely violent
patients. Many times due to this violence can many times affect overall safety of other patients as
well or can affect effectiveness of overall treatment provided to them. Renwick & et. al., (2019)
further explains that more than 40 percent of acute psychiatric wards patients or staff members
face violence. Out of every five patients one patient in acute psychiatric ward commit physical
violence either to hurt themselves or hurt other patients or staff members.
As per the view of Niu & et. al. (2019) many times violence faced by staff members can
affect effectives of treatment provided by them to patient conducting violent act. These violent
acts directly impact psychological and mental health of other patients and they start feeling
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unsafe within hospital surrounding. It further impact psychological and emotional well-being of
staff members. Most of times violent act faced by staff members and patients are verbal threats,
serious assault and death threats. Many times, due to this violent reason many experienced or
talented staff members resign and do not prefer working in acute psychiatric wards. Due to this it
becomes important for management of such psychotic wards to focus upon reducing this
violence level within their wards so that safety of patients and staff members can be maintained.
Factors because of which chances of violence increase in psychiatric ward patients
According to the view of Niu & et. al. (2019) there are various kinds of factors that can
result in increasing violent behaviour of patients towards other patients and staff members. If
these factors are focused upon to be managed then it can directly help in reduction of violent
behaviour of inpatients admitted to psychiatric ward. Some of the main factors because of which
violent behaviour among such patients increase is due to alcohol and substance abuse. These are
two most common factor that are major reason behind violent behaviour of such patients.
As per the view of Renwick & et. al., (2019) patients who are alcoholic or addicted to any
kind of drugs are mostly the one who are violent and can show violent behaviour and can harm
other patients or staff members. Alcohol or substance abuse or addicted to these thigs is another
kind of disorder because of which people do not have any kind of control over their actions.
People who are addicted to alcohol and victim of substance abuse are at greater risk of
developing psychiatric symptoms. Renwick & et. al., (2019) further explains that people who are
already addicted to drugs and alcohol can become violent people with any kind of mental
disorder such as schizophrenia. Researcher further explains that out of 10 patients every one
patient is a victim of substance or alcohol abuse because of which they become prone to develop
violent behaviour.
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METHODS
Methodology is one of the most important section of a research study that helps in
understanding different types of methods chosen by the researcher for collection and analysis of
data in order to achieve main aim of the study. In the chosen study systematic meta- analysis of
35 studies have been done. Systematic meta- analysis method helps the researcher in using
statistical method for analysing and summarizing results of secondary data or studies selected by
researcher in order to achieve main aim of the study (Rolin, Lawrence & Appelbaum, 2021). For
selection of appropriate studies for this research paper proper search strategy was developed and
inclusion and exclusion criteria was set so that appropriate studies are only selected that are
useful for the research study. For searching appropriate studies only electronic databases were
selected. Selected databases in which studies were searched are PubMed, Scopus and Cumulative
Index to Nursing and Allied Health Literature (CINAHL). All the 35 studies that were chosen
were published between January 1995 and December 2014. Selection of studies was done in
such a manner that they focused upon reporting act of violence in acute psychiatric wards of
general or psychiatric hospitals in high income countries. In order to select appropriate studies
proper search terms were sued such as: violence, aggression, aggressive behaviour, mental
disorder, assault, hospitalization, acute psychiatric ward etc.
In this study, it has been included the proportion of adults patients, who were admitted to
acute psychiatric wards in the high income nations. This is because where they have faced an
issue of violence at the time of hospitalization. Violence is becoming consider the complex
incident in which directly affecting patient or attempted to physically harmful for another person.
The study has been reported the proportion of people, who have suffered from physical violence.
This is not all about the way in which identify possible discriminate among aggressive behaviors
(Beames and Onwumere, 2021). Additionally, this article excluded which may contain
proportion of aggressive nature of patient towards physical violence. On the basis of study
analysis, it has found that violence committed by adult patients, conducted in wards admitting
only adolescent up to the age of 18 years old. Finally, it has concluded that middle income
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countries, large number of peoples have face an issue of violence so that it requires for setting
different approaches. On the basis of World Bank, it may be increased the physical violence rate
because of inequality among peoples. It is simply consider appropriate in order to compare
violence in context of hospital setting among different countries.
ANALYSIS
By using meta-analysis method, it has been identified the overall estimation of proportion of
inpatients who are mainly suffering from violence. Generally, it has been applied random effects
model chosen by investigator within study. Therefore, it become easier for implementing
conservation approach because it can assume that would be significant aspect in between
heterogeneity in large population, measures the rate of violence through methods. This study
should include various kind of characteristics and identified on the basis of analysis, calculate the
significant effect of violence in term of prevalence. In several countries such as UK, Ireland, US,
Canada and Australia etc. these are becoming consider the most powerful countries and
implementing measurement tool to find the actual rate of physical violence among different
peoples (Payne-Gill, Whitfield & Beck, 2021). Furthermore, it has been continuously identified
the characteristics which include number of beds in the ward, average length of days, proportion
rate of violence among women and men. In order to estimate the overall needs for treatment
while identifying the actual history of violence by using random effects.
According to the statistical analysis, it has been performed the operations by using
language and environmental based computing. When using studies reported on the 23 thousand+
patients and shown detailed information. In order to gather, collect data from different countries
and identify the major physical violence among young generations (Payne-Gill, Whitfield &
Beck, 2021). The study has been focused on the several kind of violent incidents which are
collected with the help of standardized incident forms. As per identification, it has been
calculated the large scale of violence and measure aggression patient which being reported by
medical staff members.
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Meta-analysis is becoming consider the possible factors associated with in-patient
violence. The actual proportion of violent patients was measured by division of sub groups and
rated as being lower quality of study. Generally, it may prefer to the check the sensitive analysis
and extent to which manage or control the presence of studies. Various kind of effect sizes,
confidence boundaries were helping to be re-computed after study analysis. in this way, it helps
to generate accurate result or outcome. In this study, it has been focused on meta-regression
model which revealed about the actual proportion of male patients and estimated that 40% of
people face physical violence. At initial stage, The multi-variable regression model is applicable
in which considerations of moderator variables that were completely significantly related to
physical violence, analysis 68% of people diagnosis as schizophrenia and abuse of alcohol
(Camus & et.al., 2021). The investigator has been collected large amount of information on the
basis of history of violence in present analysis but it is always include comprehensive multi-
variable model. This is the best method that help to find relevant information about lifetime
history of violence which was examined through different studies. In additional, it impact on the
history of violence which may explain heterogeneity and confirmed through meta-regression
model. Afterwards, it calculate that 97% of heterogeneity examined in context of gender based
categorised.
EVALUATION AND DISCUSSION
According to the analysis, it has been evaluated the concept of physical violence which
means that identified almost 1 in 5 patients, who are admitted in the acute psychiatric wards
those having a high income nations and committed towards act of violence. During research, it
has been setting the important benchmarks in regards of psychiatric services, in order to maintain
high level of heterogeneity in the inpatients. It indicates the result but it does not completely
apply to all kind of patients (Gao & et.al., 2021). Discussion on the higher rate of proportions of
male, and other involuntary patients because they were using alcohol in which increases high
rate of disorder. The Finding is becoming consistent with directly associated with physical
violence in the patients.
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In term of gender and involuntary hospitalization, it has been calculated the overall
proportion of patient in acute wards because some people are trying to act as physical violence.
At some point, it was very surprising for medical staff and other practitioners. In most of cases,
Male is being associated with physical violence in the social community. According to the
analysis, it has been suggested that consider proportion of makes which might have exert a
strongly effect on the patients. Furthermore, it has been analysed that involvement of involuntary
patients who are admitted in the hospital and under provision of mental health condition. At that
time, it may have increased the chances of physical violence among different patients who are
admitted in the hospital of their critical condition. The association between violence and
involuntary admission are likely to become complex. On the basis of evidence, it has been
concluded that a person in danger when they are depended on others. During research analysis, it
has been selecting the different patients who have been violent and likely to commit act as
violence.
By using meta-analysis, it has been identified the result or outcome on the basis of
different factors from those of individual patient. Generally, it has found that maximum number
of younger age patient with diagnosis of Schizophrenia (Payne-Gill, Whitfield & Beck, 2021).
These kind of people does not independently do their tasks so that it must be associated with
increased proportion of violent patients. It is also helping to provide brief idea about the greatest
strength of violence and factors by patients. For Example- meta-analysis helps to calculate the
effect size of age and also examined the presence of psychotic illness among young patients.
These are quite strongly effect on the health condition of people.
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CONCLUSION
From above discussion, it has concluded that increases the rate of violence within acute
psychiatric wards in different high income nations. These kind of situations are basically
identified in both disturbingly as high and highly variable between wards, settings. Analysing the
general settings with involvement of large number of patients, who have been faced a major risk
or threat in context of violence. Usually, a major physical threat appear in the psychiatric wards
because patient become unconscious condition and not able to understand the situation. While it
reinforce the actual result or outcome which is very important to find the risk factors of male
gender, who can use alcohol and harmful substances. It remain increasing high possibility to
create modification factors in wards themselves plays an important role. In this way, it has been
identified the rate of inpatient violence. In this report, it can be measured the actual rate of
violence and also develop understanding the factors associated with individual people.
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REFERENCES
Books and Journals
Beames, L. & Onwumere, J. (2021). Risk factors associated with use of coercive practices in
adult mental health inpatients: A systematic review. Journal of Psychiatric and Mental
Health Nursing.
Camus, D. & et.al., (2021). Factors associated with repetitive violent behavior of psychiatric
inpatients. Psychiatry research. 296. 113643.
di Giacomo, E. & et.al., (2020). Prevalence and risk factors of violence by psychiatric acute
inpatients: Systematic review and meta-analysis—A 2019 update. Violence and Mental
Disorders, 181-202.
Gao, Y. N. & et.al., (2021). Medication use and physical assaults in the psychiatric emergency
room. medRxiv.
Niu, S. F., & et. al. (2019). Prevalence of workplace violent episodes experienced by nurses in
acute psychiatric settings. PLoS One. 14(1). e0211183.
Payne-Gill, J., Whitfield, C., & Beck, A. (2021). The impact of the UK's first COVID-19
lockdown on rates of violence and aggression on psychiatric inpatient wards. medRxiv.
Renwick, L., & et. al. (2019). The physical and mental health of acute psychiatric ward staff, and
its relationship to experience of physical violence. International journal of mental
health nursing. 28(1). 268-277.
Rolin, S. A., Lawrence, R. E. & Appelbaum, P. S. (2021). Violence in psychiatric settings:
demographic and clinical characteristics of patients who were targets of aggression. The
Journal of nervous and mental disease. 209(4). 307-310.
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APPENDIX
Journal Name- Prevalence & Risk Factors of Violence by Psychiatric Acute Inpatients: A
systematic review and meta-analysis.
Description- the journal article is related to Violence in acute psychiatric wards affect different
patients in regards of safety treatment. By using meta-analysis method to the identify the
variations in research study.
Source Link-
https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0128536&type=printable
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