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Biomedical subjects

Henk Nijman

Publications and source records attributed to Henk Nijman.

10 recordsLinked to original sources
PubMed2007

Junior staffing changes and the temporal ecology of adverse incidents in acute psychiatric wards.

AIM: This paper reports an examination of the relationship between adverse incident rates, the arrival of new junior staff on wards, and days of the week on acute psychiatric wards. BACKGROUND: Incidents of violence, absconding and self-harm in acute inpatient services pose risks to patients and staff. Previous research suggests that the arrival of inexperienced new staff may trigger more adverse incidents. Findings on the relationship between incidents and the weekly routine are inconsistent. METHOD: A retrospective analysis was conducted of formally reported incident rates, records of nursing student allocations and junior doctor rotation patterns, using Poisson Regression. Variance between days of the week was explored using contingency table analysis. The data covered 30 months on 17 psychiatric wards, and were collected in 2002-2004. FINDINGS: The arrival of new and inexperienced staff on the wards was not associated with increases in adverse incident rates. Most types of incidents were less frequent at weekends and midweek. Incident rates were unchanged on ward-round days, but increased rates were found on the days before and after ward rounds. CONCLUSION: Increased patient tension is associated with raised incident rates. It may be possible to reduce incident rates by moderating stimulation in the environment and by mobilizing support for patients during critical periods.

Acute Disease↗
PubMed2006

Attitude to personality disorder among prison officers working in a dangerous and severe personality disorder unit.

BACKGROUND: It is well established that staff attitudes to personality disordered patients are commonly negative, characterised by pessimism and rejection. A recent study in forensic psychiatric hospitals has described the psychological and social factors underlying positive attitudes, and suggested that staff with more positive attitudes perform better and are less stressed. AIM: To assess whether it is possible to predict which staff will adjust positively to working with personality disordered people. More specifically to confirm links between attitude to personality disorder and: job performance; perception of managers; personal well-being; burnout; and interaction rates with inmates. METHODS: The opening of a new Dangerous and Severe Personality Disorder unit within a UK prison allowed a longitudinal study of prison officers to be performed, in which a number of measures, including the Attitude to Personality Disorder Questionnaire (APDQ), were collected at three fixed points (at baseline, eight and sixteen months after the opening of the unit). RESULTS: Attitude to Personality Disorder varied over the course of the study, and changes in attitude were linked to events experienced by individual officers. More positive attitude to personality disorder was associated with improved general health and job performance, decreased burnout, and favourable perception of managers. CONCLUSIONS: Attitude to Personality Disorder has important outcomes, and is responsive to the psychosocial environment. Its measurement is not useful for staff selection, because of low stability over lengthy time periods. The APDQ has been demonstrated to be valid measure of attitude to PD, and potentially useful for outcome studies, or benchmarking between units.

Absenteeism↗
PubMed2006

Serious untoward incidents and their aftermath in acute inpatient psychiatry: the Tompkins Acute Ward study.

Serious untoward incidents, or sentinel events (suicide, homicide, suicide attempt, serious assault, and absconding of high-risk patients) occur from time to time in association with acute psychiatric inpatient wards. The aim of this study was to discover the impact of serious untoward incidents on inpatient wards. Doctors, nurses, and occupational therapists at three hospitals were interviewed about these events and their impact on their wards. Staff reported feelings of shock, depression, demoralization, upset, loss, and grief, followed by ruminations, guilt, and anxiety. Levels of containment increased, as did the focus on risk assessment. Processing of the emotional impact was hindered by the pace of ward life, a lack of external support, and management investigations. Patient responses were largely ignored. A few staff responded negatively, hindering service improvements. Much more attention needs to be given to the needs of the patient group following incidents. Substantial planning, organization, and investment are required to properly prepare for such events and manage their outcome. Without this planning and action, acute inpatient work has the capacity to be damaging to staff.

Acute Disease↗
PubMed2006

Prevention and management of aggression training and violent incidents on U.K. Acute psychiatric wards.

OBJECTIVE: Reports of violence and injuries to staff and patients in acute psychiatric inpatient settings have led to the development and implementation of training courses in the Prevention and Management of Violence and Aggression (PMVA). The purpose of this study was to explore the relationship between PMVA training of acute psychiatric ward nursing staff and officially reported violent incident rates. METHODS: A retrospective analysis was conducted of training records (312 course attendances) and violent incident rates (684 incidents) over two-and-a-half years on 14 acute admission psychiatric wards (5,384 admissions) at three inner-city hospitals in the United Kingdom as part of the Tompkins Acute Ward Study. RESULTS: A positive association was found between training and rates of violent incidents. There was weak evidence that increased rates of aggressive incidents prompted course attendance, no evidence that course attendance reduced violence, and some evidence that attendance of briefer update courses triggered small short-term rises in rates of physical aggression. Course attendance was associated with a rise in physical and verbal aggression while staff were away from the ward. CONCLUSIONS: The failure to find a drop in incident rates after training, coupled with the small increases in incidents detected, raises concerns about the training course's efficacy as a preventive strategy. Alternatively, the results are consistent with a threshold effect, indicating that once adequate numbers of staff have been trained, further training keeps incidents at a low rate.

Aggression↗
PubMed2005

Changes in attitudes to personality disorder on a DSPD unit.

BACKGROUND: Psychiatric professionals tend to have poor attitudes towards people who suffer from personality disorder. Previous studies suggest that such attitudes are influenced by sufferer behaviours, organizational factors and the characteristics of individual professionals, but do similar considerations apply outside health services? AIM: To identify what events, experiences and factors in the course of daily work with personality-disordered people influence the attitudes and beliefs of prison staff. METHOD: Semi-structured interviews were conducted with prison officers working in a pilot "Dangerous and Severe Personality Disorder" Unit within a UK prison. Open questions were asked about any changes in their attitudes to or beliefs about personality-disordered inmates. RESULTS: Positive influences on attitude were: development of greater understanding of personality disorder and prisoners as individuals; improvement in inmate behaviours; education; the staff counselling programme; staff sharing support and skills; the challenge and purpose of the new role and having their views listened to. Negative influences were: delays in establishing the treatment programme; some inmate behaviours; fear and concern over their new roles and negative portrayal as a profession in the media. CONCLUSIONS: In order to maintain a high overall positive attitude among staff to working with people with personality disorder, units should have: consistency of direction and timely implementation of anticipated developments; clear philosophy and treatment regime; substantial investment in staff training programmes and effective programmes for the provision of clinical supervision to frontline staff.

Adult↗
PubMed2004

PCL-R psychopathy predicts disruptive behavior among male offenders in a Dutch forensic psychiatric hospital.

In this study, the relationship between psychopathy, according to the Dutch language version of Hare's Psychopathy Checklist-Revised (PCL-R), and various types of disruptive behavior during inpatient forensic psychiatric treatment is investigated. Ninety-two male participants were administered the PCL-R following admission to an inpatient forensic hospital. From daily hospital information bulletins, incidents of verbal abuse, verbal threat, physical violence, and violation of hospital rules were derived. Also, the number of seclusion episodes was recorded. As expected, significant correlations were found between PCL-R scores and verbal abuse, verbal threat, violation of rules, total number of incidents, and frequency of seclusion. Psychopaths (PCL-R > or = 30) were significantly more often involved in incidents than nonpsychopaths. Multiple regression analyses revealed that the PCL-R Factor 2 score in particular contributed uniquely to the prediction of the total number of incidents. The findings are discussed in terms of their clinical implications.

Adult↗
PubMed2004

Alcoholic blackout for criminally relevant behavior.

Some criminal suspects claim to have had an alcohol-induced blackout during crimes they have committed. Are alcoholic blackouts a frequently occurring phenomenon, or are they merely used as an excuse to minimize responsibility? Frequency and type of blackout were surveyed retrospectively in two healthy samples (n = 256 and n = 100). Also, a comparison of blood alcohol concentrations was made between people who did and those who did not claim a blackout when stopped in a traffic-control study (n = 100). In the two survey studies, blackouts were reported frequently by the person himself (or herself) and others (67% and 76%, respectively) in contrast to the traffic-control study (14%), in which blackouts were reported only when persons were involved in an accident. These results indicate that although blackouts during serious misbehavior are reported outside the court, both the denial and the claim of alcoholic blackout may serve a strategic function.

Adolescent↗
PubMed2003

Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists.

OBJECTIVE: In the Netherlands, it is considered good medical practice to offer patients with gender identity disorder the option to undergo hormonal and surgical sex reassignment therapy. A liberalization of treatment guidelines now allows for such treatment to be started at puberty or prepuberty. The question arises as to what extent gender identity disorder can be reliably distinguished from a cross-gender identification that is secondary to other psychiatric disorders. METHOD: The authors sent survey questionnaires to 382 board-certified Dutch psychiatrists regarding their experiences with diagnosing and treating patients with gender identity disorder. RESULTS: One hundred eighty-six psychiatrists responded to the survey. These respondents reported on 584 patients with cross-gender identification. In 225 patients (39%), gender identity disorder was regarded as the primary diagnosis. For the remaining 359 patients (61%), cross-gender identification was comorbid with other psychiatric disorders. In 270 (75%) of these 359 patients, cross-gender identification was interpreted as an epiphenomenon of other psychiatric illnesses, notably personality, mood, dissociative, and psychotic disorders. CONCLUSIONS: These data suggest that there is little consensus, at least among Dutch psychiatrists, about diagnostic features of gender identity disorder or about the minimum age at which sex reassignment therapy is a safe option. Therapy options proposed to patients with gender identity disorder appear to depend on personal preferences of psychiatrists. These results underline the need for more specific diagnostic rules in this area.

Adolescent↗