Childhood abuse and cannabis use among adolescents with mental health needs in Ontario,Canada

Objective: The purpose of this study was to examine the association between childhood abuse (emotional, physical and sexual abuse) and cannabis use among adolescents with mental health needs. Methods: Data on 3681 adolescent in-patients, 12–18 years old, were obtained from the Resident Assessment Instrument for Mental Health (RAI-MH). Using logistic regression, we estimated the odds of using cannabis by adolescents who experienced childhood abuse after controlling for age, gender, Aboriginal origin, problems with addiction, history of criminal justice involvement and symptoms of depression and mania. Results: There were 1844 adolescents, representing 50.1%, who reported using cannabis within the last 12 months. Controlling for demographic and patient characteristics, we found that cannabis use in the past year was strongly associated with childhood sexual and physical abuse. Compared to non-abused females, females who experienced sexual and physical abuse were more likely to have used cannabis. For males, the experience of physical abuse was marginally associated with cannabis use. Conclusion: The current data demonstrate the strong association between childhood sexual and physical abuse and cannabis use with a particularly strong association for females. Efforts aimed at treating cannabis use in adolescents who present with mental health needs should also consider their abuse histories.     

Medical consequences of violence: a two-year prospective study from a primary care accident and emergency department in Norway

Objective - To assess the medical consequences of violence from the perspective of a primary care accident and emergency department. Design - Prospective observational study. Setting - Bergen Legevakt (AED). Subjects - All assault victims treated at the AED 1994-96. Main outcome measures - Diagnoses, treatments, number of consultations at the AED, sickness certificates, rates of admittances to hospitals, referrals to specialists and injury severity ratings using Abbreviated Injury Scale (AIS) and Shepherd's injury severity scale. Results - 1803 assault victims were registered, 433 (24%) females and 1370 (76%) males. Most injuries were of slight severity, corresponding to AIS 0 to 1 (82%) or Shepherd's scale 0 to 1 (74%). Bruises/contusions and cuts/lacerations dominated. The majority of patients did not receive any specific treatment at the AED and they were not given sickness certificates, but 11% were admitted to hospitals and 30% were referred to specialists. Males were more likely to be seriously injured than females. Conclusion - Most physical injuries caused by violence and treated at a primary care accident and emergency department are minor.     

Medical consequences of violence: a two-year prospective study from a primary care accident and emergency department in Norway

OBJECTIVE: To assess the medical consequences of violence from the perspective of a primary care accident and emergency department. DESIGN: Prospective observational study. SETTING: Bergen Legevakt (AED). SUBJECTS: All assault victims treated at the AED 1994-96. MAIN OUTCOME MEASURES: Diagnoses, treatments, number of consultations at the AED, sickness certificates, rates of admittances to hospitals, referrals to specialists and injury severity ratings using Abbreviated Injury Scale (AIS) and Shepherd's injury severity scale. RESULTS: 1803 assault victims were registered, 433 (24%) females and 1370 (76%) males. Most injuries were of slight severity, corresponding to AIS 0 to 1 (82%) or Shepherd's scale 0 to 1 (74%). Bruises/contusions and cuts/lacerations dominated. The majority of patients did not receive any specific treatment at the AED and they were not given sickness certificates, but 11% were admitted to hospitals and 30% were referred to specialists. Males were more likely to be seriously injured than females. CONCLUSION: Most physical injuries caused by violence and treated at a primary care accident and emergency department are minor.     

Sexual assault victims in the emergency department: analysis by demographic and event characteristics

The objective of this study was to analyze demographic and event characteristics of patients presenting to the Emergency Department (ED) for evaluation after sexual assault, using a Sexual Assault Nurse Examiner standardized database. Data were prospectively collected as part of the Sexual Assault Nurse Examiner program at an urban teaching hospital. This study reviewed all ED patient records with a complaint of sexual assault between January 1, 2000 and December 31, 2004. Data were collected on 1172 patients; 92.6% were women, with a mean age of 27 years. The sample was 59.1% black, 38.6% white, and 2.3% “Other.” Black victims of sexual assault were significantly more likely to be young (25 years or less) than Whites. Over half (54%) reported involvement of drugs or alcohol during the event. Fifty-three percent knew their assailant(s), and black and young patients were significantly more likely to know the perpetrator(s). Threats of force were common (72.4% of sample), and multiple assailants were uncommon (18.1% of sample). Physical evidence of trauma was present in more than half (51.7%), with increased rates among Whites and older persons. Multivariate analysis showed that race, age, threats, and substance use during the event were independent risk factors for evident trauma on physical examination. Survivors of sexual assault who present to the ED are overwhelmingly female, relatively young, often know the perpetrator of the event, and are likely to be threatened and show signs of physical trauma. Differences between patients according to demographic and event characteristics may have important implications for ED management and treatment plans.     

Partner violence, depression, and practice implications with families of Chinese descent

Because the Chinese tend to display psychological problems such as depression in somatic This article examines cultural aspects, experiences, and the mental health consequences of partner violence among families of Chinese descent. A total of 262 Chinese men and women participated in a telephone survey about partner violence and psychological well-being. Symptoms, two indicators of mental health were employed in the research study. Findings indicated a high level of verbal aggression both perpetrated and sustained by participants. Rates of physical abuse were lower; however, these figures dispel the model minority myth associated with Asian Americans. In addition, findings showed a positive correlation between depression and partner violence. Those who experienced verbal and physical aggression by a spouse/intimate partner in the last 12 months were more likely to experience depression. Those who perpetrated physical aggression were more likely to experience somatic symptoms. Practice and research implications are highlighted.     

Anogenital injuries in childhood sexual abuse victims treated in a pediatric Forensic Nurse Examiner (FNE) program

Medical forensic exams for victims of childhood sexual abuse (CSA) can be a helpful resource for addressing patients' complex medical, psychological, and legal needs. These exams can be performed by physicians or forensic nurses to identify and treat injuries, evaluate the risk for sexually transmitted infections and pregnancy, and collect evidence. In this study, we examined CSA cases treated in a midwestern, community-based forensic nurse examiner (FNE) program to document rates of anogenital injury and identify what factors predict the presence of such injuries (N= 203). Overall, 39% of the cases had anogenital injury. Victims who were examined for suspected vaginal and/or anal assault were significantly more likely to have anogenital injuries, and patients examined within 24 hours of an assault were also significantly more likely to have documented injuries. Patients who were seen for vaginal and/or anal assaults and who had bathed since the assault were significantly less likely to have injury. Nurses who had less experience with pediatric medical forensic exams were somewhat more likely to document anogenital injuries. Findings suggest that clinical pediatric practice would benefit from additional practitioner training in injury detection to avoid false positives.     

Are mental health staff getting better at asking about abuse and neglect?

This study ascertained the extent to which abuse and neglect are identified and recorded by mental health services. A comprehensive audit of 250 randomly selected files from four community mental health centres in Auckland, New Zealand was conducted, using similar methodology to that of a 1997 audit in the same city so as to permit comparisons. Significant increases, compared to the 1997 audit, were found in the rates of child sexual and physical abuse, and adulthood sexual assault (but not adulthood physical assault) identified in the files. Identification of physical and emotional neglect, however, was poor. Male service users were asked less often than females; and male staff enquired less often than female staff. People with a diagnosis indicative of psychosis, such as ‘schizophrenia’, tended to be asked less often and had significantly lower rates of abuse/neglect identified. Despite the overall improvement, mental health services are still missing significant amounts of childhood and adulthood adversities, especially neglect. All services need clear policies that all service users be asked about both abuse and neglect, whatever their gender or diagnosis, and that staff receive training that address the barriers to asking and to responding therapeutically to disclosures.     

The extent, nature, and precipitating factors of nurse assault among three groups of registered nurses in a regional medical center.

INTRODUCTION: This study investigated nurse perceptions of the incidence and nature of verbal and physical assault or abuse by patients and their family members or visitors. METHODS: A survey was given to ED, ICU, and general floor nurses in a 770-bed acute care north Florida medical center. RESULTS: The response rate was 68.8% (86 out of 125). Large percentages of nurses reported being victims of verbal assault or abuse and physical assault by patients and family members or visitors; 88% reported being verbally assaulted and 74% reported being physically assaulted while at work in the past year. ED nurses reported the highest rates of these incidences, with 100% reporting verbal assault and 82.1% reporting physical assault within the past year. Assaults were most commonly perpetrated by patients with cognitive dysfunction (79.1%), patients with substance abuse (60.5%), and persons who were angry because of the patient's condition (55.8%). Surprising information: the most common causes of assault by family members and visitors were anger related to enforcement of hospital policies (58.1%), anger related to the patient's condition/situation (57%), anger related to long wait times (47.7%), and anger related to the health care system in general (46.5%). DISCUSSION: Nurses were confused about what legally constitutes "assault" and "abuse"; nurse rights versus patient rights; and policies and procedures for reporting assault or abuse incidences. Our results indicate that nurses are experiencing abusive and assaultive behavior from family members and visitors just as often as they are from patients, and ED nurses are at higher risk. Nurses perceive a lack of institutional support and an institutional emphasis on patient rights and satisfaction and do not feel safe in the workplace.     

Recognising Narcissistic Abuse and the Implications for Mental Health Nursing Practice

Emotional and psychological abuse are components of what are now more commonly accepted as aspects of domestic violence in addition to physical assault. Narcissistic abuse formulations of domestic violence are lesser known concepts and not recognised in UK health care in general, nor commonly in UK mental health services and by default mental health nursing. The effects on the individual who has experienced narcissistic abuse can be fatal or extremely debilitating, long lasting and individual recovery can be a complex process. This article will argue that the language and formulation of narcissistic abuse should be at the forefront of the multidisciplinary teams’, and in particular mental health nurses’ knowledge in order that victims can be directly supported or signposted to support to enable timely interventions and in-depth understanding.     

护士工作场所暴力的现状调查与分析

目的:调查护士工作场所暴力水平并分析原因,为今后干预护士工作场所暴力提供依据。方法:采用医院工作场所暴力调查量表对广州市5家三级甲等医院的护士进行调查。结果:60.8%的护士在过去一年中遭受过工作场所暴力,其中,辱骂、威胁、语言性骚扰、躯体攻击(无损伤)、躯体攻击(轻度损伤)、躯体攻击(明显损伤)、性袭击的发生率分别是57%、39%、13.1%、8.8%、3.7%、1%、2.5%。80.2%的急诊科护士在过去一年中遭受过工作场所暴力,45%在过去一年中遭受过工作场所暴力。结论:护士遭受高水平工作场所暴力,暴力的形式主要是非身体暴力,急诊科护士较非急诊科护士遭受更多工作场所暴力。     

Understanding the psychological impact of rape and serious sexual assault of men: a literature review

Until recently, very little attention has been paid to male victims of sexual abuse in childhood and male victims of rape and sexual assault in adulthood. Increasingly, researchers and clinicians are turning their attention to the particular problems encountered by male victims of abuse and sexual assault. Recent changes in British Law have acknowledged the existence of rape of male victims and have highlighted the need to identify the number of male victims of sexual assault and plan appropriate clinical services. A review of the literature reveals very little British empirical research on the psychological impact of rape upon male victims, although the studies that have been carried out provide clear evidence of a wide range of psychological consequences, both in the immediate period following the assault and in the long-term. Differences and similarities with female victims of rape are discussed. The particular problems encountered by male victims mean that they are even less likely than female victims to report an assault; when they do seek help the most pervasive themes that emerge from the literature concern their problems in reconciling their masculine identity with their experience of being a sexual victim. Issues concerning treatment of male victims are also discussed.     

A comparison of female and male adolescent victims of violence seen in the emergency department

Background

Violence is a leading cause of injury and death among adolescents. Reports indicate increasing incidence of violent injuries among adolescent females, but have not described characteristics of or charting completeness for these assault victims in the emergency department (ED).

Objectives

To compare demographic and injury-related characteristics of assaulted urban adolescent females and males presenting to an ED; and to compare completeness of hospital coding for intentionality of females’ and males’ injuries.

Methods

Retrospective, cross-sectional analysis of potentially violent injuries (identified by E-codes and chart review) among urban youth presenting to a city’s only level I trauma center. Demographics, injury characteristics, and chart- vs. hospital-determined intentionality were described with proportions and relative risks.

Results

E-code search resulted in 828 charts with injury diagnoses; 385 were determined by chart review to represent violent injuries (150 females, 235 males). Female victims had similar race, age, and socioeconomic status to males. Females’ injuries were more likely to be documented as caused by a single person, by someone known to them, and at home. Females were less likely to be injured by weapons or in a public space. Females’ charts were more likely to contain information about the circumstances of injury. Intentionality was equally likely to be miscoded for females and males.

Conclusions

Adolescent female victims of community violence presenting to an urban ED have different assault characteristics from males. Females’ charts have less missing information. A high percentage of all charts have assault intentionality miscoded, suggesting that E-code-based violence surveillance in this population may not be accurate.     

Violence Against Nurses in the Triage Area: A Mixed-Methods Study

IntroductionWorkplace violence is a serious occupational problem among nurses in emergency departments. The aim of this study was to better understand workplace violence experienced by triage nurses.MethodsA mixed-methods study was carried out with 27 Italian nurses involved in the triage area of an emergency department. Quantitative data were collected using the Violent Incident Form and qualitative data were obtained from 3 focus groups.ResultsNinety-six percent of triage nurses had suffered an episode of violence during the previous year. Participants reported that perpetrators of violence were primarily patients' relatives or friends (62%), usually male and in a lucid state of consciousness. The aggressor was a male patient in 31% of violent episodes. Male nurses reported only verbal abuse, unlike female nurses who suffered both physical and verbal episodes. Females received assistance from other staff during the aggression event more frequently than males, and females more frequently suffered from physical injury. Only physical and verbal aggressions were associated with physical injury. Four main themes emerged from the focus groups.DiscussionNurses reported that high exposure to workplace violence in triaging had significant consequences on their psychological well-being and on their behavior at work and at home. Violence, perceived as a personal and/or professional injury owing to insufficient organizational support, led professionals to experience feelings of resignation and to believe that abuse was an inevitable part of the job. Nevertheless, in our study, the precipitating factors were investigated, suggesting several possible solutions to limit this phenomenon.     

Risk factors for recent domestic physical assault in patients presenting to the emergency department

Objective: To identify risk factors for physical or sexual assault as a result of domestic violence in patients presenting to the ED. Methods: Backward prevalence study of two urban teaching hospital emergency departments measuring the 1‐year period prevalence, acute incidence of ED presentation and risk factors of domestic physical assault. Results: Of the 1326 patients (62% female) completing the study, 115 (9% CI 7%, 10%) reported assault by a partner or ex‐partner within the preceding 12 months and 31 (2% CI 1.6%, 2.3%) reported domestic physical assault as the cause of their presentation. Risk factors for recent domestic physical assault included female gender (prevalence rate ratio, (PRR) 1.5 CI 1.0 2.2), age 17 to < 25 years (PRR 6.8 CI 1.7 27.7) or 25 to < 35 years (PRR 5.7 CI 1.4 23.0), past presentation to an ED for assault (PRR 2.5 CI 1.7 3.7) and a past history of child abuse (PRR 2.2 CI 1.5 3.1). There was no association between health service utilization or mental illness and the reporting of recent domestic physical assault. Conclusion: The study characterizes ED patients at high risk of injury from domestic violence.     

Individual and contextual antecedents of workplace aggression in aged care nurses and certified nursing assistants

Employees in aged care are at high risk of workplace aggression. Research rarely examines the individual and contextual antecedents of aggression for specific types of workers within these settings, such as nurses and certified nursing assistants (CNAs). The study aimed to explore characteristics of the job demands‐resources model (JD‐R), negative affectivity (NA) and demographics related to workplace aggression for aged care workers. The survey study was based on 208 nurses and 83 CNAs working within aged care. Data from each group were analysed separately using ordinal regressions. Both aged care nurses and CNAs reported high rates of bullying, external emotional abuse, threat of assault and physical assault. Elements of the JD‐R model and individual characteristics were related to aggression types for both groups. Characteristics of the JD‐R model, NA and demographics are important in understanding the antecedents of aggression observed among aged care workers.     

Domestic violence: a challenge to accident and emergency nurses

A wide range of victims of assault are admitted to our Accident and Emergency (A&E) departments. Their injuries vary from minor to severe trauma and multiple injuries. Lloyd (1991) recognized that the victims of domestic violence are usually female and that the aggressor is almost always known to them. Indeed, the person who administers the assault is often the spouse or partner in a relationship in which there is a regular cycle of abuse. While it is sometimes difficult for A&E nurses to remain impartial it is vital that they do so. It is also essential that the A&E nurse is aware of the support networks that are available and how to access them. Patients arriving at the A&E department following an incident of domestic violence often need protection as well as physical and psychological care. This article aims to explore issues of domestic violence that involve the admission of abused females to A&E departments.     

The Relationship Between Childhood Abuse,Psychological Symptoms and Subsequent Sex Offending

Background Childhood sexual and physical abuse has been related to subsequent offending behaviour in non‐disabled individuals as well as people with intellectual disabilities, but there is a dearth of research examining the link between these two characteristics and psychological, behavioural and psychiatric symptoms amongst sex offenders with intellectual disabilities. The aim of this study was to examine the relationship between childhood abuse, history of psychological and psychiatric symptoms, and patterns of violence in later offending. Methods Twenty sex offenders with intellectual disabilities were compared with 20 non‐disabled sex offenders. The Kaufman Brief Intelligence Test, the Vineland Adaptive Behavior Scales, and a structured clinical interview were administered to participants. Results Offenders with ID were more likely to report that they had been the victim of physical abuse during childhood; aggressive behaviour during adulthood was related to a history of having been the victim of childhood physical abuse, or exposure to family violence. Participants in the ID group were more likely to be diagnosed with depression, post‐traumatic stress disorder and aggressive behaviour. A history of childhood exposure to violence was related to the development of later symptoms, for both ID and non‐disabled offenders. Perpetrators with ID who had been physically abused during their developmental years were significantly more likely to threaten or use violence during the offence. Conclusions The study suggests that childhood abuse may be related to severity of the crime, and to the development of later psychological and psychiatric symptoms. Longitudinal research in this area and a larger sample size are needed to clarify and extend the present findings.     

Gender differences in discipline of nurses in Missouri

Analysis of discipline of nurses by the Missouri Board of Nursing, 2000-2003, demonstrated differing rates by gender. Males received disproportionately high rates at 18.9%, although they represented 7.5% of Missouri nurses. Males received more severe discipline than females, with higher rates of license suspension and revocation, regardless of infractions or license level. Males surrendered licenses at higher rates. For 3 of the 28 infractions, males exceeded the number of females by a ratio of 2:1. Males committed one infraction that females did not. For three infractions, females outnumbered males by a ratio of 2:1. Females committed eight infractions not committed by males, including four murders. Consistent with previous studies, substance abuse was the behavior disciplined in the majority of cases (41.3%). Disparity in nurse discipline suggests the need for further study to analyze contributing factors, roles that nursing culture and gendered behaviors may play in the disciplinary process.