Biomedical subjects

Raymond B Flannery

Publications and source records attributed to Raymond B Flannery.

At least 19 recordsLinked to original sources

PubMed2007

Characteristics of staff victims of pschiatric patient assaults: 15-year analysis of the Assaulted Staff Action Program (ASAP).

Psychiatric patient assaults on staff victims are a worldwide occupational hazard. This paper reports on a 15-year study of the characteristics of staff victims of patient assaults and a crisis intervention procedure to ameliorate the aftermath of theses incidents. The debate on the efficacy of early interventions is outlined and the present 15-year findings are presented, findings demonstrating remarkable consistency in victim characteristics over time. The crisis intervention procedures were associated with sharp declines in disrupted victim functioning. The validity of the study's findings are noted and the implications for enhanced risk management training and staff victim crisis intervention procedures are discussed.

Adult↗

PubMed2006

Characteristics of assaultive psychiatric patients: fifteen-year analysis of the Assaulted Staff Action Program (ASAP).

This study reports on a fifteen-year longitudinal analysis of the characteristics of assaultive patients in one public-sector mental health care system. The data were gathered within the context of the Assaulted Staff Action Program (ASAP), a crisis intervention service for staff victims. The fifteen-year findings were consistent with previous worldwide research on assaultive patients and included both older male patients with schizophrenia and younger personality-disordered patients as high-risk assailants. Both groups had appreciable histories of violence toward others, personal victimization, and substance use disorders. The role of these three clinical variables in association with subsequent assaults, the role of trauma in female assailants, and the consistency of the fundamental characteristics of assaultive patients during several service system initiatives were examined. Implications for research and intervention are discussed.

Adult↗

PubMed2006

Precipitants of psychiatric patient assaults on staff: three-year empirical inquiry of the Assaulted Staff Action Program (ASAP).

Patient violence toward health care staff is a complex function of person x event x environment model. Thirty-five years of research on the characteristics of patient assailants and staff victims has yielded no predictive markers and researchers are examining other possible components of the model. The precipitants, or motivation, for assaults is one area of inquiry. Although research to date has been sparse, acute psychosis, excessive sensory stimulation, and staff restrictions on patient behaviors (denial of services, privileges, etc.) appear to be common precipitants. This paper continued this inquiry over a three-year period. The most common precipitants were denial of services, acute psychosis, and excessive stimulation. No statistically significant interactions were obtained for patient / staff victim variables and these precipitants.

Adolescent↗

PubMed2006

Past violence, substance use, and precipitants to psychiatric patient assaults: eleven-year analysis of the Assaulted Staff Action Program (ASAP).

Thirty-five years of empirical research on assaultive psychiatric patients has documented the presence of consistent patient assailant characteristics. However, these characteristics studies have yielded little in the way of predictor variables. This study examined three commonly present, patient clinical variables (past violence toward others, personal victimization, and substance use disorder) singly and in combinations as potential predictor variables. An additional subset analysis of patient precipitants was added to ascertain whether precipitant data would add further predictive power The combinations of past violence toward others and personal victimization with and without substances use disorder during an eleven-year period were associated with 61% of the subsequent assaults. A trend for denial of services to female patients during a three-year period was also associated with subsequent assaults. The predictive implications of these findings and their relevance for emergency services personnel are examined.

Adolescent↗

PubMed2006

Elderly patient assaults: empirical data from the Assaulted Staff Action Program (ASAP) with risk management implications for EMS personnel.

Some elderly patients may become violent in the course of receiving health care services. This paper reviews the largely cross-sectional research on elder assaultive patients in health care settings and patient assaults, including those by the elderly, in EMS services. Data on the assault characteristics of elderly patients are presented from a 15-year, retrospective, longitudinal study of the Assaulted Staff Action Program (ASAP). The findings and their implications for the delivery of health care services are discussed and a detailed series of risk management strategies to reduce assaults in EMS services are presented.

Accidents, Occupational↗

PubMed2005

Precipitants of elderly psychiatric patient assaults on staff: preliminary empirical inquiry.

Although there have been several studies of the characteristics of psychiatric patient assailants, there have been only six comprehensive, empirical assessments of precipitants to these assaults and no precipitant study has focused solely on elderly psychiatric patient assailants. This one and one-half year, retrospective study continued the inquiry into the nature of patient assault precipitants and focused only on elderly assailants. Older, male patients with a diagnosis of schizophrenia and histories of violence toward others and substance use disorder physically assaulted primarily male, mental health workers. These staff victims experienced disruptions in the domains of mastery, attachment, and meaning as well as the symptomatology associated with psychological trauma. The most common precipitants to these assaults were denial of services and acute psychosis. The findings and implications for health care providers in long-term care settings where elderly psychiatric patients reside are discussed.

Aged↗

PubMed2005

Precipitants to psychiatric patient assaults on staff: review of empirical findings, 1990-2003, and risk management implications.

Psychiatric patient assaults on staff are a serious and continuing problem in health care settings. Over thirty years of empirical research have documented the characteristics of both patient assailants and staff victims. Notably absent from this literature have been similar empirical studies on the nature of patient precipitants to these assaults. This paper reviewed empirical studies of patient assault precipitants from 1990-2003. Six studies from three countries were reviewed. Common precipitants included staff restrictions on patient behaviors, denial of services, excessive sensory overload, and provocation by others. The clinical, methodological, and risk management implications are examined.

Empiricism↗

PubMed2005

Critical incident stress management for persons residing in institutions.

Critical Incident Stress Management (CISM) approaches have proven themselves to be effective in mitigating the stress and anxiety that are often found in at-risk populations in the aftermath of traumatic incidents. A frequently overlooked group of persons at risk are those individuals who reside in a variety of institutions. Extensive research spanning a half century has shown these individuals to have heightened sensitivity to anxiety in general and traumatic events in particular. CISM approaches would appear to hold promise in assisting with these residents' needs. This paper outlines a basic CISM approach that could be adopted and adapted by a variety of institutional settings for the special needs of their residents. Preincident, acute care, and postincident response initiatives are presented, and the implications for such program development are discussed.

Crisis Intervention↗

PubMed2004

Theories of human violence: implications for health care safety.

Violence is a complex, multifactorial entity with no single source of explanation. Although much research is underway into the nature and causes of violence, much of this research is done in isolation and published in highly specialized journals. Thus, there has been no journal review article for the administrator, clinician, or safety officer in health care settings who must address issues of safety on a daily basis. This paper provides that review by examining major cultural, biological, sociological, and psychological theories of violence. The review includes risk management strategies for, and the role of, health care facilities as societal institutions to curb violence. Many of the risk management strategies noted for health care settings may also be fielded in schools, courts, businesses, and other settings in which emergency services personnel are asked to respond.

Culture↗

PubMed2004

Managing stress in today's age: a concise guide for emergency services personnel.

Many people in today's age feel overworked, overwhelmed, and worn out. Emergency services personnel are not exempt from this distress. The general life stress in society, coupled with the specific stress associated with emergency responding, leave many emergency services personnel in search of better strategies to cope more effectively. This paper begins to address this need by noting some of the major sources of stress in today's age for enhanced understanding of what is occurring and then reviewing the findings from four major studies of adaptive problem-solvers. It closes with six guidelines for managing stress that arise from these four studies and which have proven effective in an age of time scarcity.

Adaptation, Psychological↗

PubMed2003

Safety skills of mental health workers: empirical evidence of a risk management strategy.

To reduce violence in the workplace, health care facilities invest time and resources in risk management strategies such as photo identification and controlled access and surveillance. Studies of assaultive psychiatric patients continue to document that mental health workers (MHWs) are the most frequent targets of the patient violence. Unexamined in these findings is the role skilled MHWs contribute in restoring safety and order in the aftermath of these assaults. This six-year, empirical retrospective study examined the safety skills of MHWs in containing violence. Although they were 28% of the workforce, MHWs restored order in the majority of single assault incidents and restraint procedures. Their skills appear to be a risk management strategy in their own right. The implications are discussed.

Adult↗

PubMed2003

Precipitants of psychiatric patient assaults on staff: preliminary empirical inquiry of the Assaulted Staff Action Program (ASAP).

Although there has been extensive empirical research on the characteristics of psychiatric patient assailants and their staff victims, there has been a dearth of empirical research on the nature of the precipitants of these patient/staff interactions. Building on the few earlier studies, this year-long, retrospective, empirical study of patient precipitants was conducted within the context of the Assaulted Staff Action Program (ASAP) in ten public sector health care facilities. Excessive sensory stimulation, staff restrictions on patient behaviors (restraints), and acute psychosis were the most frequently occurring precipitants. There were no specific patterns to patient assailant and staff victim characteristics by assault precipitant. The implications of this study and future research needs are addressed.

Adolescent↗

PubMed2002

Characteristics of assaultive psychiatric patients: ten year analysis of the Assaulted Staff Action Program (ASAP).

Nearly thirty years of published research has documented the continuing presence of patient assaults on staff. These studies have included the traditional male patient with a diagnosis of schizophrenia and histories of violence and substance use disorder and the newer female, personality-disordered individual. This study reports on a ten-year longitudinal analysis of assaultive patients in one public-sector mental healthcare system during a period which included the national shift toward managed care initiatives. Data were gathered in the context of the Assaulted Staff Action Program, a crisis intervention program for staff victims. Patient assailants in both inpatient and community settings included both the traditional and newer personality-disordered individuals. The majority of assailants were females. Managed care initiatives appeared to have had little impact on type of assailants. Implications for safety and treatment are discussed.

Adult↗

PubMed2002

Critical Incident Stress Management (CISM): a statistical review of the literature.

Crisis intervention has emerged over the last 50 years as a proven method for the provision of urgent psychological support in the wake of a critical incident or traumatic event. The history of crisis intervention is replete with singular, time-limited interventions. As crisis intervention has evolved, more sophisticated multicomponent crisis intervention systems have emerged. As they have appeared in the extant empirically-based literature, their results have proven promising. A previously published paper narratively reviewed the Critical Incident Stress Management (CISM) model of multicomponent crisis intervention. The purpose of this paper was to offer a statistical review of CISM as an integrated multicomponent crisis intervention system. Using the methodology of meta-analysis, a review of eight CISM investigations revealed a Cohen's d of 3.11. A fail-safe number of 792 was similarly obtained.

Crisis Intervention↗

PubMed2002

Repetitively assaultive psychiatric patients: review of published findings, 1978-2001.

Embedded in samples of studies individual cases of psychiatric patient assault have been cases of persistent, repeat patient assailants. Although there have been literature reviews of samples of individual cases of assaults, there has been no similar review of the studies of repetitively violent patients. This paper reviewed 28 studies and found repetitively violent patients to be younger, equally male or female, and most frequently diagnosed with schizophrenia or personality disorder. The implications for safety, clinical care, and research are discussed. A new research approach is suggested.

Aggression↗

PubMed2002

Characteristics of assaultive patients with schizophrenia versus personality disorder: six year analysis of the Assaulted Staff Action Program (ASAP).

Literature reviews of individual assaultive patients, repetitively violent patients, and restrained assaultive patients document that persons diagnosed with schizophrenia or personality disorder are at the highest risk to become assaultive. While there has been some initial research of possible predictor variables across diagnostic groups, this six-year retrospective study is the first to compare only persons with schizophrenia or personality disorder on basic demographic and the selected clinical variables of history of violence, personal victimization, and substance use disorder. In this study, the variance suggested that persons with schizophrenia and personality disorder were both likely to be assaultive. Assaults by persons with schizophrenia were somewhat proportional to their presence in the population studied. However, personality disordered patients represented a disproportional increase from the population studied. Younger females with a diagnosis of personality disorder and with histories of violence toward others and personal victimization appeared at increased risk to be assaultive and to require restraints. The findings and their implications for safety and clinical care are discussed.

Adolescent↗

PubMed2002

Critical incident stress management and the Office of the Chief Medical Examiner: preliminary inquiry.

In critical incidents that involve loss of life, the Office of the Chief Medical Examiner (ME) is an integral part of the response team. It is the ME who determines the cause of death, explains the circumstances to family survivors, and releases the remains in a timely fashion. In the conduct of the ME's work, addressing the psychological needs of acutely grieving family survivors is important (Kaplan & Sadock, 1998). The importance of this support is becoming increasingly apparent both in supporting surviving family members and for ME staff in assisting families of deceased persons (Coburn, Borges, Knake, & Harper, 2000). Additionally, the work of the medical examiner is often highly stressful to the ME staff as well (Murphy, 2000). The ME staff is continuously exposed to stressful incidents and must interact with traumatized family members. This paper outlines a unique Critical Incident Stress Management (CISM) programmatic effort between Boston University School of Medicine's Center for Multicultural Mental Health and the office of the ME in Massachusetts to enhance the skills cf ME staff in working with family survivors of victims of sudden deaths (i.e., sudden accidents or suspicious deaths) and to address the emotional needs of ME staff themselves. Preliminary anecdotal findings and directions for future experimental inquiry are presented.

Bereavement↗

PubMed2002

Characteristics of repetitively assaultive patients: ten year analysis of the Assaulted Staff Action Program (ASAP).

The pre-incident components of CISM interventions focus on providing information on risk expectancy as well as cognitive and behavioral resources to enhance coping. This paper studied both the demographic and clinical variables of repetitively assaultive patients in a ten-year analysis of the Assaulted Staff Action Program (ASAP) in an attempt to enhance predictor variables that might be associated with repeat offenders and thus provide staff additional coping resources. Although the demographic variables offered little predictive information, the clinical variable of personal victimization was highly associated with subsequent repeat assault incidents. The methodological limitations, a proposal for a new research paradigm, and the power of pre-incident training initiatives are examined.

Adaptation, Psychological↗