Browsing by Subject "inpatient aggression"

Background. The Dynamic Appraisal of Situational Aggression (DASA) is a 7-item rating scale used to predict imminent aggression in psychiatric inpatients. DASA measures the presence of seven behaviors that predict the probability of violence within 24 hours. The purpose of this research was to validate the sensitivity of DASA in a Finnish psychiatric inpatient population, examine the risk decreasing interventions applied after identifying high-risk patients and study which interventions were the most effective in decreasing the DASA score over one day of follow-up. Examinations also took into account the number of interventions needed to decrease the perceived risk of violence. Methods. The data (n = 300) were collected in a naturalistic setting during a six-month period in an acute psychiatric admission ward. Interventions were clustered into four groups by frequency of use: (1) interventions restricted by the Finnish Mental Health Act, (2) PRN-medication, (3) discussion with nursing staff, and (4) other interventions. Associations between interventions and change in DASA scores were examined separately for each intervention and also in a single model adjusted for all other interventions. Results and conclusions. There were 44 incidents in which a patient had been mechanically restrained or secluded. Patients had been rated as potentially violent (DASA ≥ 4) in 61 % (n = 27) of the incidents and non-violent (DASA = 0) in 16 % of the incidents (n = 7). The most frequently used interventions were PRN-medication (33.5 % of all interventions), seclusion (15.8 %) and focused discussion with nurse (10.8 %). Interventions regulated by the Finnish Mental Health Act (seclusion, mechanical restraint, involuntary intramuscular medication, limitation of the freedom of movement, physical restraint, and limitation of contacts), PRN-medication, and discussion with nursing staff were not associated with DASA score the following day. Only the category of "other interventions" (e.g., daily activities) were associated with lower DASA score the following day when examined separately or when adjusted for the use of other concurrent interventions. The results showed that the total DASA score decreased if the patient received one to three interventions. Four or more interventions had no statistical relevance on DASA score the following day. DASA is an effective method to predict imminent aggression in the Finnish psychiatric patient population, even though there remains unpredictable violence that is foreseen through DASA scores. Psychiatric staff tend to use fairly restrictive and coercive methods, but DASA scores were seen to decrease only in individuals who received non-coercive interventions.