ABSTRACT
Asklepian medicine - as an archetype of healing - was underpinned by therapeutic uses of self, which, if understood, could be beneficial to modern healthcare. It is being proposed in this article that therapeutic uses of self from instrumental, authentic and transpersonal perspectives could support the process of endogenous healing. Such therapeutic uses of self could play a pivotal role in activating and enhancing the potential for placebo responses, with spiritual significance.
Subject(s)
Dreams , Mythology , Placebo Effect , Religion and Medicine , Religion and Psychology , Self Care/psychology , Spiritual Therapies , Ceremonial Behavior , Humans , Unconscious, PsychologyABSTRACT
Assessment of living skills and violence risk in forensic psychiatric patients is a priority for clinicians. Suitably fine-grained instruments are rare. The goal of this study was to compare a norm-based psychometric assessment battery (the Behavioural Status [BEST] Index) with known valid instruments. Parallel cohort studies were undertaken in four European countries. Inpatients from 24 forensic psychiatric clinics were assessed three times using five instruments measuring living skills, psychological symptoms, aggression, and violence risk. Positive clinical changes were noted in insight, empathy, and some behaviors related to communication and living skills, with little change in violence risk, which was low to medium for most patients. Clinical congruence was observed between logically cognate items of the BEST Index and comparison instruments. Evidence for the scientific and clinical utility of the BEST Index as an effective tool for forensic psychiatric practice is discussed.
Subject(s)
Activities of Daily Living , Hospitals, Psychiatric/statistics & numerical data , Prisons/statistics & numerical data , Violence/statistics & numerical data , Aggression/psychology , Communication , Europe/epidemiology , Humans , Observer Variation , Risk Factors , Surveys and Questionnaires , Violence/psychologyABSTRACT
BACKGROUND: A supportive ward atmosphere is considered by many to be a precondition for successful treatment in forensic psychiatry, but there is a clear need for a valid and economic climate evaluation instrument. AIMS: To validate a short questionnaire, designed for assessing forensic psychiatric wards. Climate dimensions measured with the 'Essen Climate Evaluation Schema' (EssenCES) are 'Therapeutic Hold', 'Patients' Cohesion and Mutual Support' and 'Safety' (versus threat of aggression and violence). METHOD: In 17 forensic mental hospitals in Germany, patients and staff completed the EssenCES and other questionnaires. Problematic events were recorded over a period of 3 weeks on each ward. RESULTS: The anticipated three factor structure of the instrument was confirmed. The pattern of correlations also provided support for the validity of the subscales. CONCLUSIONS: The climate questionnaire is an economic and valid instrument for assessing the ward atmosphere in forensic psychiatry. Findings from a pilot study in England give confidence to the structural validity of the English version too.
Subject(s)
Attitude of Health Personnel , Forensic Psychiatry/methods , Hospitals, Psychiatric , Inpatients/psychology , Mental Disorders/psychology , Personnel, Hospital/psychology , Social Environment , Adult , Female , Germany , Humans , Internal-External Control , Male , Mental Disorders/therapy , Patient Satisfaction , Professional-Patient Relations , Psychiatric Department, Hospital , Surveys and Questionnaires , WorkplaceABSTRACT
Recent legislation from the Health and Safety Executive will have a significant impact on the expectations of how an organization manages stress. This paper considers the need for more awareness of risk assessment and risk management that takes into account the systemic antecedents of stress. It is suggested that assessment of organizational stress levels should include qualitative and quantitative methods of data collection to analyse the cumulative wear and tear on staff that contributes to the experience of workplace stress. This paper explores the importance of leadership within organizational hierarchies. Rank and status dynamics are identified as a potentially significant source of workplace stress. It is proposed that training in rank dynamics and relationship awareness are potential mediators in reducing workplace stress. The National Health Service could be a leader in establishing organizational well-being through patterns of leadership and relationship that tackles the growing epidemic of workplace stress.
Subject(s)
Burnout, Professional/prevention & control , Interprofessional Relations , Leadership , Nurse Administrators/organization & administration , Nursing Staff/psychology , State Medicine , Adaptation, Psychological , Awareness , Burnout, Professional/psychology , Cooperative Behavior , Health Services Needs and Demand , Humans , Nurse's Role , Nursing Staff/organization & administration , Occupational Health , Organizational Culture , Planning Techniques , Power, Psychological , Risk Assessment , Risk Factors , Risk Management , Social Support , State Medicine/organization & administration , United Kingdom , Workplace/organization & administration , Workplace/psychologyABSTRACT
The Behavioural Status Index model suggests that 'social risk' tends to vary inversely with an individual's insight and capacity to perform key communication and social skills. The aim of this study was to describe emergent trends in data related to the risk, insight, and communication and social skills subscales used in the model. Data were collected from 503 patients in two high security mental health hospitals. Although a distinct factorial structure emerged suggesting groupings of behaviours, results provide little support for the overall model proposed.
Subject(s)
Dangerous Behavior , Forensic Psychiatry/methods , Mental Disorders/diagnosis , Nursing Assessment , Psychological Tests , Factor Analysis, Statistical , Female , Humans , Male , Reproducibility of Results , Risk Assessment , United KingdomABSTRACT
The Behavioural Status Index was developed for risk assessment within forensic care. This paper reports data analysis for the Behavioural Status Index and its subscales. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals in the UK. Results are reported for inter-item correlations, factor analysis, and differences among independent groups of patients, categorized by Mental Health Act 1983 classification, patient ward dependency, and patient gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of behaviours.
Subject(s)
Communication , Forensic Psychiatry/methods , Mental Disorders/diagnosis , Psychiatric Status Rating Scales/standards , Risk Assessment/methods , Social Behavior , Affect , Aggression/psychology , Cognition , Facial Expression , Factor Analysis, Statistical , Female , Hospitals, Psychiatric , Humans , Kinesics , Linear Models , Male , Mental Disorders/psychology , Nursing Assessment/methods , Predictive Value of Tests , Psychiatric Nursing/methods , Psychometrics , Security Measures , Statistics, Nonparametric , United Kingdom , Violence/psychologyABSTRACT
The authors have developed a security needs assessment profile designed to match the service provided in secure, forensic psychiatric units more accurately with the needs of individual patients. They are carrying out an 18-month survey of all secure units in England and are seeking participants to help refine the profile, gain more understanding of what is provided throughout the country, and assess the views of other clinicians and managers.
Subject(s)
Psychiatric Department, Hospital , Security Measures , Humans , Psychiatric Department, Hospital/organization & administration , Psychiatric Nursing , State Medicine , United KingdomABSTRACT
AIM: To study attitudes towards Rampton Hospital by reviewing the attitudes of external students and professionals in training following an arranged guided tour of the hospital; and examining media coverage of the hospital over one year. METHOD: All visitors had a guided day tour of Rampton. Everyone was given a questionnaire to complete at the end of the tour, and responses were reviewed. Rampton public relations department collects all print media coverage and monitors broadcasts in the UK. The department then assimilates this information into an annual report, which was examined for the relevant year. RESULTS: Questionnaires were given to 995 visitors and completed by 416 (42 per cent). Of those that returned the questionnaires, 95 per cent (n = 395) rated their satisfaction with the tour as either 'satisfied' or 'very satisfied'. A positive change in attitude was indicated by approximately one quarter of respondents (n = 105) following their tour. There were no negative changes in attitude expressed. Of the 203 press cuttings relating specifically to the hospital, 59 (29 per cent) were classed as positively enhancing and building the reputation of the hospital, 86 (42 per cent) were classed as negative and 58 (29 per cent) were classed as neutral. CONCLUSION: The tour of Rampton was valuable in bringing about a positive attitude change in the visitors. Although some media coverage assessed was negative, it had been expected to be more so. The authors wonder whether people's negative impressions are formed from the wider media, such as television dramas and movies.
