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The Resident-intruder Paradigm: A Standardized Test for Aggression, Violence and Social Stress
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Instruments for Measuring Violence on Acute Inpatient Psychiatric Units: Review and Recommendations.

Lisa A Mistler1, Matthew J Friedman1

  • 1Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Mistler, Friedman); New Hampshire Hospital, Concord (Mistler); National Center for PTSD, White River Junction Veterans Affairs Medical Center, White River Junction, Vermont (Friedman).

Psychiatric Services (Washington, D.C.)
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PubMed
Summary
This summary is machine-generated.

Patient violence against psychiatric staff is common, but standardized measurement tools are lacking. The Observed Aggression Scale (OAS) and its variants are frequently used, and adapting them could improve data collection for violence prevention.

Keywords:
AggressionClinical measurementInpatient treatmentOutcome scalesViolence

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Area of Science:

  • Psychiatry
  • Healthcare Management
  • Clinical Psychology

Background:

  • Patient-to-staff violence in psychiatric units is a significant issue, leading to staff suffering and lacking standardized measurement tools.
  • The Joint Commission mandated standardized instruments in 2018, yet a gold standard for measuring violence and aggression remains unidentified.
  • Accurate data on patient-to-staff violence frequency are crucial for developing effective institutional policies and evaluating interventions.

Purpose of the Study:

  • To review commonly used scoring instruments for measuring patient-to-staff violence in recent studies.
  • To inform recommendations for developing standardized scales to quantify violence in psychiatric settings.
  • To address the lack of accurate data hindering the development of safer clinical policies.

Main Methods:

  • A comprehensive literature search was conducted for violence measurement instruments in English articles from June 2008 to June 2018.
  • Studies included were those measuring patient-to-staff violence or aggression in acute, nonforensic, nongeriatric populations.
  • Studies on child/adolescent populations, staff-to-staff violence, or staff/visitor-to-patient violence were excluded.

Main Results:

  • 74 studies were identified, with 74% utilizing structured instruments to measure aggression and violence on inpatient psychiatric units over the past decade.
  • Observed Aggression Scale (OAS) variants were the primary instruments used; 26% of studies employed unstructured clinical notes or researcher questionnaires.
  • Key implementation barriers included time constraints, workflow issues, and difficulties in instrument usage.

Conclusions:

  • Observed Aggression Scale (OAS) variants with proven validity and reliability have been consistently employed over the last 10 years.
  • The Modified OAS presents a potential solution for real-time clinical data collection, overcoming barriers to standardized violence measurement.
  • Adapting the Modified OAS can enhance the quantification of violence against psychiatric staff, aiding policy development and intervention assessment.