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To improve management of challenging patient and visitor behavior on a medicalsurgical unit, the unit practice council implemented the REBELS model of communication and developed staff education on its use. The project provided a standardized re - sponse to challenging situations, increased staff confidence and skills, decreased the need for security interventions, and improved the culture of safety. [ABSTRACT FROM AUTHOR]

Patient assault is a serious issue for the well-being of staff in psychiatric hospitals. To guide workplace responses to patient assault, more information is needed about social support from different sources and whether those supports are associated with staff well-being. The present study examines social support after patient assault from work-based and nonwork-based sources, and whether inpatient psychiatric staff desires support from them and perceive the support received as being effective. Received support across sources was examined in relations to staff well-being (physical health, mental health, anger, sleep quality) and perceptions of safety. Survey data was collected from 348 clinical staff in a large public forensic mental hospital. Among the 242 staff who reported an assault in the last year, 71% wanted support and 72% found effective support from at least one source. Generally, effective support from supervisors, coworkers, and their combination was associated with better well-being. Support from nonwork sources was related to less concerns about safety, but not to other well-being measures. However, 28% of staff did not receive effective support from any source postassault. Gaps in support as reported in this study and as found by other investigators call for systematic programming by hospital organizations to enhance the well-being of clinical staff, which in turn has implications for patient care. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Although health care providers and systems are increasingly interested in patients' nonmedical needs as a means to improve health, little is known about neighborhood conditions that contribute to child health problems. We sought to determine if a novel, publicly available measure of neighborhood context, the Child Opportunity Index, was associated with pediatric acute care visit frequency and diagnoses. METHODS: This cross-sectional study included San Francisco residents <18 years of age with an emergency department and/or urgent care visit to any of 3 medical systems (N = 47 175) between 2007 and 2011. Hot-spot analysis was used to compare the spatial distribution of neighborhood child opportunity and income. Generalized estimating equation logistic regression models were used to examine independent associations between neighborhood child opportunity and frequent acute care use (>4 visits per year) and diagnosis group after adjusting for neighborhood income and patient age, sex, race and/or ethnicity, payer, and health system. RESULTS: Neighborhood child opportunity and income had distinct spatial distributions, and we identified different clusters of high- and low-risk neighborhoods. Children living in the lowest opportunity neighborhoods had significantly greater odds of >4 acute care visits per year (odds ratio 1.33; 95% confidence interval 1.03-1.73) compared with those in the highest opportunity neighborhoods. Neighborhood child opportunity was negatively associated with visits for respiratory conditions, asthma, assault, and ambulatory care-sensitive conditions but positively associated with injury-related visits. CONCLUSIONS: The Child Opportunity Index could be an effective tool for identifying neighborhood factors beyond income related to child health. [ABSTRACT FROM AUTHOR]

Aim To understand staff factors associated with patient aggression towards the staff of an inpatient forensic psychiatric hospital. Background Violence by patients is a serious concern in psychiatric hospitals and staff are the most frequent targets of physical and verbal assault. Assault and its consequences can severely disrupt the hospital environment and impair the functioning of staff members and patients. This study examined the interplay of staff dispositional and interpersonal factors associated with patient violence. Design This cross-sectional study surveyed the staff of a large public forensic hospital. Methods A sample of 348 psychiatric staff participated in an online survey about their workplace experiences, psychosocial characteristics and well-being. Data were collected from November - December 2011. Findings Nearly all staff reported verbal conflict with patients (99%) and 70% reported being assaulted during the previous 12 months. Verbal conflict with other staff (92%) was also high. Multiple regression analyses indicated that in addition to static risk factors (i.e. staff position, years of experience and gender), the risk of assault was associated with the frequency of conflicts with staff and patients, which in turn was moderated by personal stress reactivity. Conclusion Physical violence by patients was a pervasive threat for a high proportion of staff. Frequent conflict interactions with volatile patients contributed the most risk, but reactivity to conflict was a dynamic risk factor. The strain associated with assault risk and stress reactivity could be prospectively mitigated by resilience enhancement programming for staff. [ABSTRACT FROM AUTHOR]

ideker k., todicheeney-mannes d. & kim s.c. (2011) A confirmatory study of Violence Risk Assessment Tool (M55) and demographic predictors of patient violence. Journal of Advanced Nursing 67(11), 2455-2462. Abstract Aim. The aims of this study were to confirm the usefulness of Violence Risk Assessment Tool (M55) for prospectively identifying violent patients in medical-surgical units and to explore predictors of Code-55 activation for violent behaviour or physical attack. Background. A previous retrospective case-controlled study claimed moderate sensitivity and high specificity of the M55 in identifying potentially violent patients. However, the usefulness of M55 needs to be confirmed in a prospective study before wide adoption. Methods. A prospective cohort study of patients in medical-surgical units of a hospital in southern California was conducted from August 2009 to December 2009. A checklist containing the M55 was completed on admission. Following a violent event or just prior to discharge, the violent event outcome section of the data collection tool was completed. The sensitivity and specificity of M55 for identifying the violent patients were calculated using the original M55 flagging criteria. Results. Of 2063 patients, 32 (1·6%) had a violent event of Code-55 activation (12), physical attack (26) or both (6). The M55 showed a low sensitivity (41%) and acceptable specificity (99%) for prospectively identifying violent patients. The multivariate logistic regression model indicated higher odds of violent events for patients ≥70 years of age [odds ratio (OR) = 2·3; 95% confidence interval (CI): 0·9-5·7], males (OR = 2·7; 95% CI: 1·2-6·1) or Caucasian (OR = 3·4; 95% CI: 0·8-14·7). Conclusion. The M55 does not appear to be useful for prospectively identifying violent patients in medical-surgical units because of low sensitivity. Older, male or Caucasian patients had higher odds of becoming violent. [ABSTRACT FROM AUTHOR]