Reports of Police Calls for Service as a Risk Indicator for Intimate Partner Violence

Objectives:  The purpose of this study was to evaluate the utility of asking female emergency department (ED) patients about police calls for service as a possible indicator of intimate partner violence (IPV).
Methods:  Trained research assistants screened female, adult, English-speaking patients presenting to an urban university ED 7 am to midnight, 7 days per week during the 2006–2007 academic year. Patients were asked two commonly used IPV screening questions regarding past-year experience with physical violence or threat by an intimate partner and whether or not the police had been called due to a fight between themselves and a male partner.
Results:  Of the 4,984 patients screened, 3.9% screened positive for an IPV-related police call in the past 12 months; more than one-third (37.8%) of those screened negative for IPV on the traditional screening questions. The question about an IPV-related police call for service identified an additional 74 cases of possible IPV, representing 1.5% of the overall sample or a 30.8% increase over those identified with the traditional IPV screening questions.
Conclusions:  Adding an additional question regarding police calls to standard IPV screening could alert healthcare providers to possible IPV risk.     

Pediatric Nurses: Advocates Against Youth Violence

ISSUES AND PURPOSE. This article examines the issues of youth violence and the role of the pediatric nurse in addressing youth at risk for violence. An example of a school-based violence prevention program is included.
CONCLUSIONS. Black adolescent males from lower socioeconomic backgrounds and violent communities tend to be at highest risk. However, the profile of risk for violence is expanding to include youth in rural and middle-class suburban settings.
PRACTICE IMPLICATIONS. Pediatric nurses play a vital role in the identification of at-risk youth and in the planning and evaluation of interventions for youth violence prevention.     

Intimate Partner Violence: Development of a Brief Risk Assessment for the Emergency Department

Objectives:  Women assaulted by intimate partners are frequently patients in emergency departments (EDs). Many victims and health care providers fail to take into account the potential risks of repeat partner violence. The objective of this study was to use data from a larger study of domestic violence risk assessment methods to develop a brief assessment for acute care settings to identify victims at highest risk for suffering severe injury or potentially lethal assault by an intimate partner or former partner.
Methods:  Victims of intimate partner violence (IPV) were interviewed twice between 2002 and 2004. The baseline interview included the 20 items of Campbell's Danger Assessment (DA; predictor). The follow-up interview, conducted 9 months later on average, assessed abuse inflicted since the baseline interview (outcome). Multiple logistic regression was used to identify questions on the DA most predictive of severe abuse and potentially lethal assaults. Female IPV victims were recruited from New York City family courts, Los Angeles County Sheriff's Department 9-1-1 calls, New York City and Los Angeles shelters, and New York City hospitals; 666 women responded to the DA at baseline, and 60% participated in follow-up interviews.
Results:  Severe injuries or potentially lethal assaults were experience by 14.9% of retained study participants between the baseline and follow-up interviews. The best brief prediction instrument has five questions. A positive answer to any three questions has a sensitivity of 83% (95% confidence interval = 70.6% to 91.4%).
Conclusions:  This instrument can help predict which victims may be at increased risk for severe injury or potentially lethal assault and can aid clinicians in differentiating which patients require comprehensive safety interventions.     

Interpersonal Violence,Alcohol Use,and Acquired Capability for Suicide

Acquired capability for suicide (ACS), defined as pain tolerance and fearlessness about death, is theorized as necessary to enact suicide. This study examined the associations of interpersonal violence and alcohol use with ACS in 502 college students. General fearlessness/pain tolerance was positively associated with male gender and alcohol use. Fearlessness about death was positively associated with male gender and general physical violence perpetration. However, these risk factors did not explain variance in ACS beyond male gender and history of suicide attempts/nonsuicidal self-injury. These findings add to the understanding of ACS correlates.     

Decreased Risk for Violence in Patients Admitted to Forensic Care,Measured With the HCR-20

Aim

The aim of this study was to explore if patients admitted to forensic psychiatric care decreased their assessed risk for violence over time, to identify patients who decreased their assessed risk for violence exceptionally well (30% or more) on the clinical (C) and risk management (R) scales in the (HCR-20), and to compare them in terms of demographic data.

Methods

The HCR-20 risk assessment instrument was used to assess the risk for violence in 267 patients admitted to a Swedish forensic psychiatric clinic between 1997 and 2010. Their assessments at admission were compared with a second, and most recent, risk assessment.

Results

The risk for violence decreased over time. Demographic criteria had no impact on differences on decreased risk. Only two factors, namely gender and psychopathy showed a difference. Risk factors associated with stress and lack of personal support were the items that turned out to be the most difficult to reduce.

Conclusion

The results show that risk prevention in forensic care does work and it is important to continue to work with risk management. The study highlights the importance of a careful analysis of the patient's risk for violence in order to work with the patient's specific risk factors to reduce the risk.     

Workplace Violence in Healthcare Settings: Risk Factors and Protective Strategies

This article describes the risk factors and protective strategies associated with workplace violence perpetrated by patients and visitors against healthcare workers. Perpetrator risk factors for patients and visitors in healthcare settings include mental health disorders, drug or alcohol use, inability to deal with situational crises, possession of weapons, and being a victim of violence. Worker risk factors are gender, age, years of experience, hours worked, marital status, and previous workplace violence training. Setting and environmental risk factors for experiencing workplace violence include time of day and presence of security cameras. Protective strategies for combating the negative consequences of workplace violence include carrying a telephone, practicing self‐defense, instructing perpetrators to stop being violent, self‐ and social support, and limiting interactions with potential or known perpetrators of violence. Workplace violence is a serious and growing problem that affects all healthcare professionals. Strategies are needed to prevent workplace violence and manage the negative consequences experienced by healthcare workers following violent events.     

Protective Effects of Self-Esteem and Family Support on Suicide Risk Behaviors among At-Risk Adolescents

PROBLEM:  If and how family support and self-esteem might interact to protect against adolescent suicide risk is not well understood.
METHODS:  Hierarchical multiple regression was used to examine the moderating effect of family support on the relationship between self-esteem and suicide risk behaviors among potential high school dropouts ( N = 849), using questionnaires and in-depth assessment interviews.
FINDINGS:  Family support moderated the impact of self-esteem on suicide risk; the ameliorating effect of self-esteem was stronger among adolescents with low versus high family support.
CONCLUSIONS:  Self-esteem influences adolescent suicide risk behaviors for youth with low as well as high family support. Interventions designed to strengthen both self-esteem and support resources are appropriate.     

Children's Exposure to Community Violence

Purpose: To analyze the effects of exposure to chronic community violence on children and adolescents.
Design: An integrative review of the literature was conducted on reports of studies about children's exposure to community violence.
Sources: Studies for analysis were identified through a literature search of relevant topics in Medline, CINAHL, and PsycINFO.
Conclusions: Exposure to community violence is related to significant stress and depression in children. Evidence on how exposure to violence affects children's growth patterns, intellectual growth, school performance, decision-making ability, or their hope for a future is needed.     

Attachment Theory and Violence Toward Women by Male Intimate Partners

Purpose: Explore whether understanding of violence toward women by their male intimate partners is enhanced by attachment theory.
Organizing Framework: This review was focused on the evidence that men prone to intimate partner violence were insecurely attached as infants, and as a consequence, their internal working models of attachment relationships include the use of aggression to gain power and control. These internal working models are brought to their adult relationships with intimate partners. The intergenerational transmission of violence occurs when children who witness episodes of violence in their homes, or experience violence directly as victims, become aggressive in adult relationships. Parallels between concepts of infant attachment and adult romantic attachment, such as maintaining proximity to attachment figures, were examined.
Methods: The literature on attachment theory and intimate partner violence was reviewed. References were identified from electronic databases and from a manual search of the literature.
Conclusions: Evidence about intimate partner violence is consistent with attachment theory. This framework is a base for extension of knowledge of intimate partner violence. Changes in practice, research, and policy to support an attachment perspective are discussed.     

Violence Risk Assessment in the Emergency Department

IntroductionWorkplace violence is a prevalent problem in health care, with mental health and emergency departments being the most at-risk settings. The aim of this evidence-based practice project was to pilot use of a violence risk assessment tool, the Broset Violence Checklist, to assess for risk of type II violence and record the interventions that nurses chose to implement to mitigate the situation. Additionally, reports made to the hospital reporting system were tracked and compared to previous reporting frequency.MethodsFollowing staff education, nurses were instructed to complete checklists for all patients who have a score of 1 or higher, which indicates the presence of at least 1 high-risk behavior, and continue hourly scoring until the score returned to 0 or the patient was dispositioned. The number of incidents recorded, time of day, scores, interventions applied to mitigate violence, and change in scores after interventions were evaluated. The number of Broset Violence Checklist scoring sheets submitted and reports made via the hospital reporting system were compared.ResultsIncidents were most frequent from 11 am until 3 am. The highest scores occurred in the late evening and early morning hours. There were significantly more incidents captured with the use of the Broset Violence Checklist as compared to the hospital reporting system. Incidents significantly associated with higher scores included providing comfort measures, addressing concerns, and applying restraints.DiscussionThe Broset Violence Checklist was used successfully in the emergency department setting to identify behaviors associated with violence. Under-reporting to the hospital report system was identified in this project, consistent with reports in the literature. Specific interventions were not associated with a decrease in Broset Violence Checklist scores.     

Levels of Violence Among Nurses in Cape Town Public Hospitals

BACKGROUND.  The paper presents findings from a study examining violence in nursing.
DESIGN.  A combined ethno-phenomenology was identified as the most appropriate approach. Ethnography is to understand the culture of nursing that permits violence to occur within the profession. Phenomenology is to explore and capture nurse-on-nurse experiences of violence. The population is all nurses registered with the South African Nursing Council. The research participants are nurses employed in eight public hospitals in Cape Town during 2005.
METHOD OF DATA COLLECTION.  The first stage of data collection was the distributions of confidential questionnaires to nurses employed in eight hospitals and willing to participate in the study.
ANALYSIS.  Responses to close-ended questions were analyzed using Microsoft Excel. Responses to open-ended questions were grouped per question. The qualitative data were then compared for similarities and differences in information provided.
CONCLUSIONS.  Six levels of violence exist among nurses. The highest forms of violence among nurses occurred at the psychological level, with the least at the physical level of interaction. The other four levels of violence among nurses were vertical, horizontal, covert, and overt. All categories of nurses in the study had resorted to one or more levels of violence against other nurses during their nursing career. Professional nurses and senior nurse managers were identified as the main category of nurses that frequently resort to mistreating other nurses. However, auxiliary nurses were identified as the main perpetrators of physical violence against other nurses.     

The Relationship of Violence and Trichotillomania

Purpose: To examine the relationship between violence and the development of trichotillomania (TTM) in women.
Design and methods: Semistructured interviews were conducted with a convenience sample of 44 women with trichotillomania from 21 American states and Canada. The participants were asked to describe how they live and cope with TTM. The data were subjected to content analysis and were quantified for presentation. Checks were instituted to establish reliability of the content analysis using the criteria of reproducibility and stability.
Findings: Forty of the 44 women (91%) reported some form of trauma or violence occurring during their lives and 38 (86%) reported a history of violence concurrent with the onset of TTM. Events ranged from repetitive and moderate to severe abuse (including sexual assault, rape, and gang rape) by family members, acquaintances, and strangers.
Conclusions: These women with trichotillomania experienced a disproportionate number of traumatic or violent episodes in childhood. In most cases, the onset of TTM was correlated with specific episodes of violence. Of special interest is the possible relationship between family chaos experienced during childhood and the onset of TTM.     

The Effects of Exposure to Community Violence on Aspects of Adolescent Identity Development

PROBLEM:    A gap exists in our understanding of the impact of exposure to community violence on identity development. The purpose of this study was to explore how exposure to community violence affects adolescents' identity development. Data were collected to describe the perceptions, interpretations, and meanings adolescents ascribe to their experiences with community violence.
METHODS:    Male and female inner-city adolescents (13–18 years) were invited to share their personal stories about exposure to community violence. A constant comparative approach was employed to analyze data from personal narratives.
RESULTS:    All adolescents in this study reported exposure to violence and shared stories about living and coping with the prevalence of violence. Aspects of identity development that emerged in the data included self-perceptions, coping patterns, efficacy, and a moral self. Some stories revealed psychological distress that had potential for long-term developmental consequences. Personal strengths and positive attributes of the participants were also evident in the data.
CONCLUSIONS:    Exposure to community violence affected the identity development of these adolescents. When working with adolescents, it is important for nurses to assess for community violence exposure and promote coping strategies that reduce distress and foster healthy intimacy.     

Development of Instructional Competencies for Assessing and Managing Suicide Risk for Baccalaureate Nursing Education: A Modified Delphi Study

Suicide is a major health problem and a leading cause of death throughout the world. A primary goal for suicide prevention is reforming health professional education in order to increase the competence of health professionals in assessing and managing suicide risk. Nursing leadership is involved in this reform, yet nurses frequently lack the competence to care for patients in suicidal crisis. An identified gap in baccalaureate nursing education is instructional competencies for assessing and managing suicide risk. A modified Delphi study was used. The study began with a focus group which was conducted in order to develop the Round I Survey which included forty-four competencies. After scoring these competencies, thirty-four were scored for inclusion, two were dropped and eight were revised according to panel members' comments. The Round II Survey comprised the eight revised competencies which were scored for inclusion, resulting in forty-two competencies in the final set of instructional competencies. Forty-two instructional competencies were developed: fourteen pre-assessment instructional competencies, fifteen assessment instructional competencies, and thirteen management instructional competencies. Incorporating these instructional competencies into baccalaureate nursing education might increase the competence of nursing students, and thus new nurses, in caring for patients at risk for suicide. These instructional competencies provide a first step to address the challenging task of intervening with patients at risk for suicide.     

A Systematic Review of Violence Risk Assessment Tools Currently Used in Emergency Care Settings

IntroductionViolence risk assessment is commonplace in mental health settings and is gradually being used in emergency care. The aim of this review was to explore the efficacy of undertaking violence risk assessment in reducing patient violence and to identify which tool(s), if any, are best placed to do so.MethodsCINAHL, Embase, Medline, and Web of Science database searches were supplemented with a search of Google Scholar. Risk of bias assessments were made for intervention studies, and the quality of tool development/testing studies was assessed against scale development criteria. Narrative synthesis was undertaken.ResultsEight studies were included. Three existing violence risk assessment tools featured across the studies, all of which were developed for use with mental health patients. Three newly developed tools were developed for emergency care, and 1 additional tool was an adaptation of an extant tool. Where tested, the tools demonstrated that they were able to predict patient violence, but did not reduce restraint use. The quality issues of the studies are a significant limitation and highlight the need for additional research in this area.DiscussionThere is a paucity of high-quality evidence evaluating the psychometric properties of violence risk assessment tools currently used along the emergency care pathway. Multiple tools exist, and they could have a role in reducing violence in emergency care. However, the limited testing of their psychometric properties, acceptability, feasibility, and usability in emergency care means that it is not possible to favor one tool over another until further research is conducted.     

Development of a Brief Mental Health Screen for Intimate Partner Violence Victims in the Emergency Department

Background: Emergency physicians routinely treat victims of intimate partner violence (IPV) and patients with mental health symptoms, although these issues may be missed without routine screening. In addition, research has demonstrated a strong association between IPV victimization and mental health symptoms.
Objectives: To develop a brief mental health screen that could be used feasibly in an emergency department to screen IPV victims for depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and suicidal ideation.
Methods: The authors conducted a pretest/posttest validation study of female IPV victims to determine what questions from the Beck Depression Inventory II, Posttraumatic Stress Diagnostic Scale, and Beck Scale for Suicide Ideation would predict moderate to severe levels of depressive symptoms, PTSD symptoms, and suicidal ideation. A principal components factor analysis was conducted to determine which questions would be used in the brief mental health screen. Scatter plots were then created to determine a cut point.
Results: Scores on the brief mental health screen ranged from 0 to 8. A cutoff score of 4 was used, which resulted in positive predictive values of 96% for the brief mental health screen for depression, 84% for PTSD symptoms, and 54% for suicidal ideation. In particular, four questions about sadness, experiencing a traumatic event, the desire to live, and the desire to commit suicide were associated with moderate to severe mental health symptoms in IPV victims.
Conclusions: The brief mental health screen provides a tool that could be used in an emergency department setting and predicted those IPV victims with moderate to severe mental health symptoms. Using this tool can assist emergency physicians in recognizing at-risk patients and referring these IPV victims to mental health services.     

精神科住院抑郁症患者自杀预防及护理干预措施专家共识

目的 形成《精神科住院抑郁症患者自杀预防及护理干预措施专家共识》,规范精神科住院抑郁症患者自杀护理干预措施。 方法 运用循证方法及文献分析法提取住院抑郁症患者自杀护理干预措施推荐建议和研究结论,形成共识初稿,通过2轮专家函询及2次专家论证会,结合专家意见,对初稿进行调整、修改和完善,形成共识终稿。 结果 2轮函询专家积极系数均为100%,专家权威系数均为0.924,各指标重要性赋值均数均>3.5分,且变异系数均<0.25,专家肯德尔和谐系数分别为0.182和0.260（均P<0.01）。最终对精神科住院抑郁症患者自杀护理干预操作性定义、自杀风险评估、干预形式、干预时间、干预理论基础、干预一般原则、自杀意念的干预措施、自杀行为的干预措施、特殊人群自杀护理干预要点、干预效果评价及出院后的健康教育计划共11个部分的内容达成一致意见。 结论 该共识为精神科住院抑郁症患者自杀护理干预措施提供指导依据,使精神科住院抑郁症患者的自杀护理干预更规范。