Tero Laiho - Academia.edu (original) (raw)

Papers by Tero Laiho

BMC Health Services Research, 2017

Background: Patient aggression and violence against staff members and other patients are common c... more Background: Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. Methods: The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. Results: There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. Conclusion: In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

International Journal of Mental Health Systems, 2014

Background: The concept of ward culture has been proposed as a reason for the often reported diff... more Background: The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods: The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent's gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results: Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions: Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.

International Journal of Mental Health Nursing, Dec 5, 2019

The Safewards model was created to reduce conflict and containment in psychiatric inpatient units... more The Safewards model was created to reduce conflict and containment in psychiatric inpatient units. The model suggests alternative methods for containment and aims to create a safer hospital experience for both patients and staff. The evaluation of this model has provided evidence that it might be implemented on adolescent psychiatric wards. This study evaluated the impact of the implementation process of the Safewards model on the social climate of adolescent psychiatric inpatient wards by using the Essen Climate Evaluation Schema questionnaire. The study was carried out on six closed wards of one Finnish hospital district. Data were collected at baseline (42 adolescent inpatients and 134 staff members) and after the implementation of the model (39 inpatients and 115 staff members). The data were analysed using the Mann-Whitney U-test. The findings of this preliminary study indicate that inpatients' experience of patient cohesion and therapeutic hold and staff members' experience of safety on adolescent psychiatric wards might be improved by the implementation of the Safewards model on adolescent psychiatric wards.

The Use of Coercive Measures in Forensic Psychiatric Care, 2016

Journal of Psychiatric and Mental Health Nursing, 2013

The purpose of this integrative literature review was to describe different factors involved in t... more The purpose of this integrative literature review was to describe different factors involved in the decision-making process of using seclusion or restraint, and to discuss the process in practice. The data used in this review were systematically retrieved from the following databases: CINAHL, Medline and PsycINFO. Manual data retrieval was conducted from the reference lists of the papers that came up in the original database search. A total of 32 studies were selected. Results suggest that the situations that lead to the use of seclusion or restraint are always dynamic and circumstantial. During the decision-making process staff observe a patient's behaviour, assesses risk and chooses and uses interventions that aim to de-escalate the situation. This process is affected by the previous experiences and history of staff as well as the behaviour and previous experience of the patient.

International Journal of Mental Health Systems, 2014

CITATIONS 3 READS 67 7 authors, including: Some of the authors of this publication are also worki... more CITATIONS 3 READS 67 7 authors, including: Some of the authors of this publication are also working on these related projects: Research on financing systems' effect on quality on mental health care (REFINEMENT) View project Implementing ja researhing Cognitive Adapatation Training (Vellingan) model View project Abstract

BMC Health Services Research, 2017

Background: Patient aggression and violence against staff members and other patients are common c... more Background: Patient aggression and violence against staff members and other patients are common concerns in psychiatric units. Many structured clinical risk assessment tools have recently been developed. Despite their superiority to unaided clinical judgments, staff has shown ambivalent views towards them. A constant worry of staff is that the results of risk assessments would not be used. The aims of the present study were to investigate what were the interventions applied by the staff of a psychiatric admission ward after a high risk patient had been identified, how frequently these interventions were used and how effective they were. Methods: The data were collected in a naturalistic setting during a 6-month period in a Finnish psychiatric admission ward with a total of 331 patients with a mean age of 42.9 years (SD 17.39) suffering mostly from mood, schizophrenia-related and substance use disorders. The total number of treatment days was 2399. The staff assessed the patients daily with the Dynamic Appraisal of Situational Aggression (DASA), which is a structured violence risk assessment considering the upcoming 24 h. The interventions in order to reduce the risk of violence following a high DASA total score (≥4) were collected from the patients' medical files. Inductive content analysis was used. Results: There were a total of 64 patients with 217 observations of high DASA total score. In 91.2% of cases, at least one intervention aiming to reduce the violence risk was used. Pro re nata (PRN)-medication, seclusion and focused discussions with a nurse were the most frequently used interventions. Non-coercive and non-pharmacological interventions like daily activities associated significantly with the decrease of perceived risk of violence. Conclusion: In most cases, a high score in violence risk assessment led to interventions aiming to reduce the risk. Unfortunately, the most frequently used methods were psychopharmacological or coercive. It is hoped that the findings will encourage the staff to use their imagination when choosing violence risk reducing intervention techniques.

International Journal of Mental Health Systems, 2014

Background: The concept of ward culture has been proposed as a reason for the often reported diff... more Background: The concept of ward culture has been proposed as a reason for the often reported differences in treatment decisions when managing inpatient aggression. We therefore studied whether staff on wards actually shares similar perceptions and attitudes about aggression and whether the specialty of the ward on which the staff members work influences these opinions. Methods: The Attitudes Towards Aggression Scale was used to assess attitudes towards aggression in 31 closed psychiatric wards. Altogether 487 staff members working on the study wards were asked to fill in the scale. Respondent's gender, age, educational level, working experience on the current ward, and specialty of this ward (acute, forensic, rehabilitation) served as background variables. Results: Most of the variance found was due to differences between individuals. Belonging to the personnel of a particular ward did not explain much of the variance. Conclusions: Psychiatric staff on the wards does not share attitudes on aggression. As each staff member has his/her own opinion about aggression, training for dealing with aggression or violent incidents should be done, at least partly, on an individual level. We also suggest caution in using the concept of ward culture as an explanation for the use of restrictive measures on psychiatric wards.

International Journal of Mental Health Nursing, Dec 5, 2019

The Safewards model was created to reduce conflict and containment in psychiatric inpatient units... more The Safewards model was created to reduce conflict and containment in psychiatric inpatient units. The model suggests alternative methods for containment and aims to create a safer hospital experience for both patients and staff. The evaluation of this model has provided evidence that it might be implemented on adolescent psychiatric wards. This study evaluated the impact of the implementation process of the Safewards model on the social climate of adolescent psychiatric inpatient wards by using the Essen Climate Evaluation Schema questionnaire. The study was carried out on six closed wards of one Finnish hospital district. Data were collected at baseline (42 adolescent inpatients and 134 staff members) and after the implementation of the model (39 inpatients and 115 staff members). The data were analysed using the Mann-Whitney U-test. The findings of this preliminary study indicate that inpatients' experience of patient cohesion and therapeutic hold and staff members' experience of safety on adolescent psychiatric wards might be improved by the implementation of the Safewards model on adolescent psychiatric wards.

The Use of Coercive Measures in Forensic Psychiatric Care, 2016

Journal of Psychiatric and Mental Health Nursing, 2013

The purpose of this integrative literature review was to describe different factors involved in t... more The purpose of this integrative literature review was to describe different factors involved in the decision-making process of using seclusion or restraint, and to discuss the process in practice. The data used in this review were systematically retrieved from the following databases: CINAHL, Medline and PsycINFO. Manual data retrieval was conducted from the reference lists of the papers that came up in the original database search. A total of 32 studies were selected. Results suggest that the situations that lead to the use of seclusion or restraint are always dynamic and circumstantial. During the decision-making process staff observe a patient's behaviour, assesses risk and chooses and uses interventions that aim to de-escalate the situation. This process is affected by the previous experiences and history of staff as well as the behaviour and previous experience of the patient.

International Journal of Mental Health Systems, 2014

CITATIONS 3 READS 67 7 authors, including: Some of the authors of this publication are also worki... more CITATIONS 3 READS 67 7 authors, including: Some of the authors of this publication are also working on these related projects: Research on financing systems' effect on quality on mental health care (REFINEMENT) View project Implementing ja researhing Cognitive Adapatation Training (Vellingan) model View project Abstract