174,961 research outputs found

    Predictors of violent incidents amongst patients in psychiatric intensive care units: A review of global evidence

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    Aim: The objective is to identify key predictors of violent behaviour amongst patients admitted to PICUs. Methods: A literature search was carried out in five online databases using a predefined strategy with terms relevant to the setting and population. Articles were screened based on the inclusion criteria and quality assessed using the Hawker critical appraisal tool. A thematic matrix was prepared from the final articles to highlight the pivotal predictors for violent behaviour in PICUs. Results: Initial search without duplicates retrieved 152 articles, of which 120 were excluded after screening their title and abstract. The full-text of 32 articles was read of which a total of 10 studies with 4733 participants were included in the literature review. These studies had good designs and methodological quality. The key predictors of violent incidents were a longer duration of in-patient stay, higher readmission rate, non-voluntary admission to PICUs, previous history of violence and substance misuse, permanent staff absences, being a single young male, having low level of education and having schizophrenia. Conclusion: The findings suggest that a variety of different factors contribute to violent incidents in PICUs. Our results may assist in the development of community and hospital-based interventions including situation management regular staff training, promoting a friendly environment and post-incident debriefs that can prevent future violent incidents in PICU

    A safer place for patients: learning to improve patient safety

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    1 Every day over one million people are treated successfully by National Health Service (NHS) acute, ambulance and mental health trusts. However, healthcare relies on a range of complex interactions of people, skills, technologies and drugs, and sometimes things do go wrong. For most countries, patient safety is now the key issue in healthcare quality and risk management. The Department of Health (the Department) estimates that one in ten patients admitted to NHS hospitals will be unintentionally harmed, a rate similar to other developed countries. Around 50 per cent of these patient safety incidentsa could have been avoided, if only lessons from previous incidents had been learned. 2 There are numerous stakeholders with a role in keeping patients safe in the NHS, many of whom require trusts to report details of patient safety incidents and near misses to them (Figure 2). However, a number of previous National Audit Office reports have highlighted concerns that the NHS has limited information on the extent and impact of clinical and non-clinical incidents and trusts need to learn from these incidents and share good practice across the NHS more effectively (Appendix 1). 3 In 2000, the Chief Medical Officer’s report An organisation with a memory 1 , identified that the key barriers to reducing the number of patient safety incidents were an organisational culture that inhibited reporting and the lack of a cohesive national system for identifying and sharing lessons learnt. 4 In response, the Department published Building a safer NHS for patients3 detailing plans and a timetable for promoting patient safety. The goal was to encourage improvements in reporting and learning through the development of a new mandatory national reporting scheme for patient safety incidents and near misses. Central to the plan was establishing the National Patient Safety Agency to improve patient safety by reducing the risk of harm through error. The National Patient Safety Agency was expected to: collect and analyse information; assimilate other safety-related information from a variety of existing reporting systems; learn lessons and produce solutions. 5 We therefore examined whether the NHS has been successful in improving the patient safety culture, encouraging reporting and learning from patient safety incidents. Key parts of our approach were a census of 267 NHS acute, ambulance and mental health trusts in Autumn 2004, followed by a re-survey in August 2005 and an omnibus survey of patients (Appendix 2). We also reviewed practices in other industries (Appendix 3) and international healthcare systems (Appendix 4), and the National Patient Safety Agency’s progress in developing its National Reporting and Learning System (Appendix 5) and other related activities (Appendix 6). 6 An organisation with a memory1 was an important milestone in the NHS’s patient safety agenda and marked the drive to improve reporting and learning. At the local level the vast majority of trusts have developed a predominantly open and fair reporting culture but with pockets of blame and scope to improve their strategies for sharing good practice. Indeed in our re-survey we found that local performance had continued to improve with more trusts reporting having an open and fair reporting culture, more trusts with open reporting systems and improvements in perceptions of the levels of under-reporting. At the national level, progress on developing the national reporting system for learning has been slower than set out in the Department’s strategy of 2001 3 and there is a need to improve evaluation and sharing of lessons and solutions by all organisations with a stake in patient safety. There is also no clear system for monitoring that lessons are learned at the local level. Specifically: a The safety culture within trusts is improving, driven largely by the Department’s clinical governance initiative 4 and the development of more effective risk management systems in response to incentives under initiatives such as the NHS Litigation Authority’s Clinical Negligence Scheme for Trusts (Appendix 7). However, trusts are still predominantly reactive in their response to patient safety issues and parts of some organisations still operate a blame culture. b All trusts have established effective reporting systems at the local level, although under-reporting remains a problem within some groups of staff, types of incidents and near misses. The National Patient Safety Agency did not develop and roll out the National Reporting and Learning System by December 2002 as originally envisaged. All trusts were linked to the system by 31 December 2004. By August 2005, at least 35 trusts still had not submitted any data to the National Reporting and Learning System. c Most trusts pointed to specific improvements derived from lessons learnt from their local incident reporting systems, but these are still not widely promulgated, either within or between trusts. The National Patient Safety Agency has provided only limited feedback to trusts of evidence-based solutions or actions derived from the national reporting system. It published its first feedback report from the Patient Safety Observatory in July 2005

    Service provider difficulties in operationalising coercive control

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    We examined perspectives of social workers, police officers, and specialist domestic abuse practitioners about their perceived ability and organizational readiness to respond effectively to incidents of coercive and controlling behavior. Interviews revealed intervention and risk assessment strategies structured around an outdated, maladaptive concept of domestic abuse as an unambiguous and violent event and frontline services that lacked appreciation of the power dynamics inherent in controlling relationships. The analysis demonstrates how lack of definitional clarity around nonphysical domestic abuse can increase the use of discretion by frontline services and, by extension, increase the discounting of coercive control by pressured frontline officers

    Patients Emotions during Meal Experience: Understanding through Critical Incident Technique

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    Background and Objectives: It was established that eating experience may affect patients emotionally. Acknowledging the role and understanding the basis of patients’ emotions in their food consumption may assist in identifying their nutritional status as well as their satisfaction with foodservice. To date, there are limited studies focusing on patients’ food-related emotional experiences. Hence the present study sought to explore the issue using a qualitative approach. Methods: The study was conducted in three Malaysian public hospitals, two of which from rural and one from urban areas. Information about aspects of the hospital food experience was gathered using semi-structured interview method. A total of 29 patients who felt well enough to provide information about the hospital food were identified with the help of the head nurses. Patients were recruited based on the concept of data saturation. The interview was implemented based on Critical Incident Technique (CIT), which enables systematic extraction of information from the wealth of data in the stories told by the interviewees about things which have happened to them. Data were analysed using content analysis method. Findings: Patients were found toexperience emotions including frustration, interest, enjoyment, hostility, shame, boredom, sadness, anger, surprise and satisfaction in relation to food provision. The frequency of incidents eliciting negative emotions (56.7%) was higher than that of positive incidents (43.3%). Frustration, interest, and enjoyment were the most frequently reported emotions. Conclusions: Our study highlights emotion as an important aspect of patients’ food consumption, and lays a ground for incorporation of food-related emotion into hospital services and patient management research. Our study also indicated the CIT to be effective and credible in elucidating hidden patients’ emotions, which encourages its application in future relevant studies

    Using the Critical Incident Technique to Assess Gaming Customer Satisfaction

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    Before gaming organizations can initiate efforts to service their customers, they must be able to effectively manage the service encounter. Although every service encounter is not necessarily critical to satisfaction, it is not always obvious which are crucial to the customer and which are not. Using critical incidents reported by gaming customers and employees, this study identifies service encounters that both parties perceive as being very satisfactory or very dissatisfactory from the customer\u27s point of view. Identifying particularly positive and negative customer service experiences can provide direction for management in allocating resources specifically to those areas that maximize customer satisfaction and correct those that cause customer dissatisfaction

    Model-Based Mitigation of Availability Risks

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    The assessment and mitigation of risks related to the availability of the IT infrastructure is becoming increasingly important in modern organizations. Unfortunately, present standards for Risk Assessment and Mitigation show limitations when evaluating and mitigating availability risks. This is due to the fact that they do not fully consider the dependencies between the constituents of an IT infrastructure that are paramount in large enterprises. These dependencies make the technical problem of assessing availability issues very challenging. In this paper we define a method and a tool for carrying out a Risk Mitigation activity which allows to assess the global impact of a set of risks and to choose the best set of countermeasures to cope with them. To this end, the presence of a tool is necessary due to the high complexity of the assessment problem. Our approach can be integrated in present Risk Management methodologies (e.g. COBIT) to provide a more precise Risk Mitigation activity. We substantiate the viability of this approach by showing that most of the input required by the tool is available as part of a standard business continuity plan, and/or by performing a common tool-assisted Risk Management

    BlackWatch:increasing attack awareness within web applications

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    Web applications are relied upon by many for the services they provide. It is essential that applications implement appropriate security measures to prevent security incidents. Currently, web applications focus resources towards the preventative side of security. Whilst prevention is an essential part of the security process, developers must also implement a level of attack awareness into their web applications. Being able to detect when an attack is occurring provides applications with the ability to execute responses against malicious users in an attempt to slow down or deter their attacks. This research seeks to improve web application security by identifying malicious behaviour from within the context of web applications using our tool BlackWatch. The tool is a Python-based application which analyses suspicious events occurring within client web applications, with the objective of identifying malicious patterns of behaviour. This approach avoids issues typically encountered with traditional web application firewalls. Based on the results from a preliminary study, BlackWatch was effective at detecting attacks from both authenticated, and unauthenticated users. Furthermore, user tests with developers indicated BlackWatch was user friendly, and was easy to integrate into existing applications. Future work seeks to develop the BlackWatch solution further for public release
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