Factores organizacionales y ambientales que influyen en la presencia de conductas violentas en unidades de hospitalización psiquiátrica

• Autores: Jorge Quílez Jover, María Teresa Icart Isern
• Localización: Metas de enfermería, ISSN 1138-7262, Vol. 19, Nº. 1, 2016
• Idioma: español
• Títulos paralelos:
  • Organization and environmental factors with impact on the presence of violent behaviours in Psychiatric Hospitalization Units
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• Resumen
  • español

    Objetivo: evaluar la evidencia disponible en materia de factores laborales en unidades de hospitalización psiquiátrica, que influyen en la presencia de conductas violentas hacia el personal de Enfermería.

    Método: se realizó una revisión narrativa de la literatura. La búsqueda de artículos se ha llevado a cabo en las bases de datos electrónicas PubMed, CINAHL, PsicInfo y la plataforma Scopus desde enero de 2000 hasta agosto de 2015. Se han incluido estudios en lengua inglesa, francesa y española, estudios prospectivos que recogieran factores de riesgo laboral de conductas violentas en el lugar de trabajo, más concretamente en unidades de salud mental. La publicación debía presentar datos clínicos primarios, en los que la muestra o submuestra incluyera pacientes hospitalizados.

    Resultados: los factores de riesgo se clasificaron de acuerdo al modelo conceptual de Chappell y Di Martino, centrándose en los factores laborales (entorno). Los factores que presentaron mayor relación con el aumento de incidentes violentos son las barreras estructurales de las unidades (distribución física), la falta de seguimiento y control de las ratios en función de las cargas de trabajo y la tipología de patologías e ingresos y la infracomunicación de incidencias.

    Conclusiones: evaluar y reconocer los factores de riesgo generadores de conductas violentas puede ser útil a la hora de establecer estrategias de prevención e intervención, no solo en relación a los profesionales (acciones formativas, competencia profesional, experiencia laboral, etc.) y usuarios (abordajes específicos en función de la patología), sino también en cuestiones estructurales (espacios menos restrictivos), organizativas (seguimiento y control de las ratios en función de las cargas de trabajo) y culturales (mejorar la comunicación de incidencias y la práctica reflexiva).

  • English

    Objective: to assess the evidence available regarding occupational factors in Psychiatric Hospitalization Units, with impact on the presence of violent behaviour towards the Nursing Staff.

    Method: a narrative review of literature was conducted. Articles were searched for in the electronic databases PubMed, CINAHL, PsicInfo, and the Scopus platform, from January, 2000 to August, 2015. The search included studies in English, French or Spanish: prospective studies including occupational risk factors for violent behaviour in the working place, more specifically in Mental Health Units. The publication should present primary clinical data, where the sample or sub-sample included hospitalized patients.

    Results: risk factors were classified according to the concept model by Chappell and Di Martino, focusing on occupational factors (setting). The factors presenting the highest relationship with the increase in violent incidents were: structural barriers in the units (physical distribution), lack of follow-up and ratio control based on workloads and the typology of conditions and admissions, and the insufficient communication of incidences.

    Conclusions: assessing and acknowledging the risk factors that generate violent behaviours can be useful in order to implement strategies for prevention and intervention, not only regarding professionals (training actions, professional competence, work experience, etc.) and users (specific approach based on each condition), but also in structural matters (less restrictive spaces), organization matters (follow-up and control of ratios based on workloads), and cultural aspects (to improve the communication of incidences and the reflexive practice).

• Referencias bibliográficas
  • Bresler S, Gaskell MB. Risk assessment for patient perpetrated violence: Analysis of three assaults against healthcare workers. Work [Internet]....
  • Lawoko S, Soares * JJF, Nolan P. Violence towards psychiatric staff: a comparison of gender, job and environmental characteristics in England...
  • Krug EG, Mercy JA, Dahlberg LL, Zwi AB. The world report on violence and health. Lancet. Elsevier 2002; 360(9339):1083-8.
  • Staggs VS. Nurse staffing, RN mix, and assault rates on psychiatric units. Res Nurs Health [Internet] 2013 Feb [citado 3 ene 16]; 36(1):26-37....
  • Galián Muñoz I, Llor Esteban B, Ruiz Hernández JA. Violencia de los usuarios hacia el personal de Enfermería en los hospitales públicos de...
  • Ridenour M, Lanza M, Hendricks S, Hartley D, Rierdan J, Zeiss R, et al. Incidence and risk factors of workplace violence on psychiatric staff....
  • Chappel D, Di Martino V. Violence at work. Geneva Int Labor Off. 2006.
  • Hershcovis MS, Barling J. Towards a relational model of workplace aggression. Research companion to the dysfunctional workplace [Internet]...
  • Kirkbride JB, Fearon P, Morgan C, Dazzan P, Morgan K, Tarrant J, et al. Heterogeneity in incidence rates of schizophrenia and other psychotic...
  • Hamrin V, Iennaco J, Olsen D. A review of ecological factors affecting inpatient psychiatric unit violence: implications for relational and...
  • Decaire MW, Bedard M, Riendeau J, Forrest R. Incidents in a psychiatric forensic setting: association with patient and staff characteristics....
  • Koekkoek B, van Meijel B, Hutschemaekers G. “Difficult patients” in mental health care: a review. Psychiatr Serv. Am Psychiatric Assoc [Internet];...
  • Johnson ME. Keeping the unit safe: a grounded theory study. J Am Psychiatr Nurses Assoc [Internet] 2006 Feb 1 [citado 5 ene 2016];12(1):13-21....
  • Bowers L, Allan T, Simpson A, Jones J, Van Der Merwe M, Jeffery D. Identifying Key Factors Associated with Aggression on Acute Inpatient Psychiatric...
  • Soliman AE, Reza H. Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatr Serv. Institute of Psychiatry,...
  • Chou K-R, Lu R-B, Mao W-C. Factors relevant to patient assaultive behavior and assault in acute inpatient psychiatric units in Taiwan. Arch...
  • Johnson K, Delaney M. Keeping the unit safe: the anatomy of escalation. J Am Psychiatr Nurses Assoc. 13:42-52.
  • Duxbury J. An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health...
  • Bowers L, Alexander J, Simpson A, Ryan C, Carr-Walker P. Student psychiatric nurses’ approval of containment measures: Relationship to perception...
  • Owen C, Tarantello C, Jones M, Tennant C. Violence and Aggression in Psychiatric Units. Psychiatr Serv [Internet] 1998 Nov [citado 5 ene 2016];49(11):1452-7....
  • Cintas C. “Quand la violence au travail ne se trouve pas là où on l’attend...”: Le cas d’un hôpital psychiatrique. / “When violence is not...
  • Morrison EF. The culture of caregiving and aggression in psychiatric settings. Arch Psychiatr Nurs [Internet] 1998 Feb [citado 5 ene 2016];12(1):21-31....
  • Martin T, Daffern M. Clinician perceptions of personal safety and confidence to manage inpatient aggression in a forensic psychiatric setting....
  • De Benedictis L, Dumais A, Sieu N, Mailhot M-P, Létourneau G, Tran M-AM, et al. Staff perceptions and organizational factors as predictors...
  • Abderhalden C, Needham I, Dassen T, Halfens R, Fischer JE, Haug H-J. Frequency and severity of aggressive incidents in acute psychiatric wards...
  • Parnell S. Inpatient psychiatric healthcare worker and administrator perceptions of workplace interventions for patient-on-staff assault....
  • Edward K-L, Ousey K, Warelow P, Lui S. Nursing and aggression in the workplace: a systematic review. British Journal of Nursing. Mark Allen...
  • Beaskoa AMU. Los otros derechos en la práctica diaria. Estud jurídicos. Centro de Estudios Jurídicos; 2012.
  • Gillespie GL, Gates DM, Fisher BS. Individual, relationship, workplace, and societal recommendations for addressing healthcare workplace violence....
  • Andrés-Pueyo A, Echeburúa E. Vatoración del riesgo de violencia: instrumentos disponibles e indicaciones de aplicación. Psicothema 2010; 22(3).
  • Arbach K, Andrés-Pueyo A. Valoración del riesgo de violencia en enfermos mentales con el HCR-20. Papeles del Psicólogo. Consejo General de...
  • Pueyo AA. La predicción de la violencia. Papeles del psicólogo. Madrid: Consejo General de Colegios Oficiales de Psicólogos 2007; (003):145.
  • Chang J-C, Lee C-S. Risk Factors for Aggressive Behavior Among Psychiatric Inpatients. Psychiatr Serv [Internet] 2004 Nov [citado 5 ene 2016];55(11):1305-7....