Fifteen years of research with the Staff Observation Aggression Scale: a review.

OBJECTIVE: Research on the prevalence and causes of in-patient aggression has been hindered by the use of different methods for measuring aggression. Since Palmstierna and Wistedt presented the Staff Observation Aggression Scale (SOAS) in 1987, this data collection method has been used in various studies, which may make comparisons more useful. METHOD: Studies with SOAS aggression data were compiled using MEDLINE, the Internet, and references from SOAS papers. RESULTS: Reviews of studies on psychometric properties suggest fair to good inter-rater reliability and validity for SOAS assessments. The number of aggressive incidents per patient per year found on acute admissions wards (n = 38) considerably varied, with a range of 0.4-33.2 incidents (mean = 9.3). CONCLUSION: Although the aggression data included in the present review were obtained in highly comparable ways, substantial differences in aggression rates between wards were still found. Some countries (e.g. the Netherlands) appear to have a relatively high incidence of aggression on acute wards.

Predicting inpatient violence in acute psychiatric wards using the Brøset-Violence-Checklist: a multicentre prospective cohort study.

The Norwegian Brøset-Violence-Checklist (BVC) is one of the few instruments that is suitable for short-term prediction of violence of psychiatric inpatients by nursing staff in routine care. The instrument assesses the presence or absence of six behaviours or states frequently observed before a violent incident. We conducted a study to elucidate whether the predictive properties of the BVC are retained in other psychiatric settings than the original north-Norwegian validation dataset. During their admission period, 219 consecutive patients admitted to six acute psychiatric wards were assessed as to the risk for attack using a German version of the BVC (BVC-G). Data on preventive measures were concurrently collected. Aggressive incidents were registered using an instrument equivalent to the Staff Observation of Aggression Scale (SOAS-R). Fourteen attacks towards staff were observed with incident severity ranging from 5 to 18 of a possible 22 points. BVC-G sensitivity was 64.3%, the specificity 93.9%, the positive predictive value 11.1%, and the area under the receiver operating characteristic curve 0.88. In some false positive cases intense preventive measures had been implemented. The predictive accuracy of the BVC-G proved consistent with the Norwegian original.

The Brøset violence checklist (BVC).

OBJECTIVE: The Brøset violence checklist (BVC) is a short-term violence prediction instrument assessing confusion, irritability, boisterousness, verbal threats, physical threats and attacks on objects as either present or absent. The aim of this paper is to describe the evolution and usefulness of the BVC. METHOD: This paper reviews studies on the BVC and discusses implications for further research. RESULTS: Empirical research has shown that it has moderate sensitivity and high specificity with an adequate inter-rater reliability. CONCLUSION: The BVC is a useful instrument for predicting inpatient violence within the next 24-h period. The psychometric properties of the instrument are satisfactory. Results from ongoing studies will give important information on cultural differences, the validity of the BVC in less well staffed wards, the clinical use of the checklist and its ability to predict violence throughout all the hospital stay.

Attention deficit hyperactivity disorder, reading disability, and personality disorders in a prison population.

Attention Deficit Hyperactivity Disorder (ADHD) has long been recognized in children, and for many the disorder persists into adulthood. There is a growing concern that the adults with ADHD who have the least favorable outcome, are among those who end up in prison. The aim of this study was to assess childhood ADHD and its persistence into adulthood among a representative sample of Norwegian prison inmates, as well as personality disorders and reading difficulties, which in previous studies have been linked to ADHD. The results indicate that persistent ADHD is very common among prison inmates. Personality disorders and reading difficulties are also common. Psychiatric comorbidity complicates the diagnosis of ADHD in adults. A greater awareness about ADHD in adults certainly is warranted, especially within the prison system because of the risk of misdiagnosing psychiatric disorders and also the risk of missing a condition possibly amenable to treatment.

Predicting inpatient violence using the Broset Violence Checklist (BVC).

This paper reports early analysis of the Broset Violence Checklist. An instrument aiming to assist in the process of the prediction of violence from mentally ill in-patients. Early results appear promising and directions for future research using the instrument are suggested.

A European perspective on psychiatric nursing and violent incidents: management, education and service organisation.

The topic of violent incidents and its importance to inpatient psychiatric nursing practice is well recognised in the academic literature. However the awareness and profile of the issue in different European countries is highly variable. In this paper five European countries are compared: Italy, Norway, the Netherlands, Sweden and the UK. Contextual factors are likely to determine the perception, recognition and acknowledgement of the problem. Those described in detail here are the organisation of psychiatric inpatient services, the training of psychiatric nurses, and the methods used by those nurses to control and contain disturbed patients. For each of these factors large variations exist between the countries considered. The conclusion is drawn that there is much scope for useful comparative research.