Application of the duty to protect HIV-positive patients.
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Confidentiality↗
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Results for “Dangerous Behavior”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
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Do Tarasoff principles apply in AIDS-related psychotherapy? Ethical decision making and the role of therapist homophobia and perceived client dangerousness.
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Attitude↗
Outpatient civil commitment: a dangerous charade or a component of a comprehensive institution of civil commitment?
This article examines three criticisms frequently directed toward preventive commitment as one form of outpatient commitment. These criticisms contend that preventive commitment (a) abandons the dangerousness criteria for civil commitmnet, (b) promotes unwarranted inpatient commitment of those who do not meet civil commitment criteria, and (c) undermines important individual liberties by diluting the right to refuse treatment. Understanding and evaluating these criticisms requires analysis of the intersection among empirical, conceptual, and justificatory claims. According to the analysis presented here, advocates of preventive commitment can defend a legitimate role for preventive commitment. This analysis applies to preventive commitment as a dispositional alternative within a comprehensive institution of civil commitment involving distinct parens patriae and police power components.
Civil Rights↗
Involuntary outpatient commitment.
This article offers a novel approach to outpatient commitment (OPC). After distinguishing 4 varieties of OPC, the article shows how 3 are easy to justify, whereas "preventive outpatient commitment" (POC) requires more careful scrutiny. The article argues that, as a general matter, POC is not justified, except for on a "one free shot" basis. The hope is that patients will come to appreciate the benefits of treatment in the community and will become voluntarily compliant; after one free shot, they are in a much better position to decide. The consequences of noncompliance are also explored.
Advance Directives↗
Rehabilitation of child molesters: a cost-benefit analysis.
This study examined the cost effectiveness of the rehabilitation of child molesters by designing and testing a cost-benefit model. The model uses program and reoffense data from a treatment center for offenders and costs derived from averaged figures obtained from state agencies. Results of the analysis, as well as related policy issues, are discussed.
Child↗
A typology of men who batter: three types derived from cluster analysis.
Important theoretical and treatment implications may be revealed when men who batter their intimate partners are categorized according to type. Data on 165 batterers were cluster analyzed, and three types identified: family-only aggressors, generalized aggressors, and emotionally volatile aggressors. The clustering variables explained 90% of the variance in category assignment. Implications for treatment are discussed.
Adult↗
Confidential communications of psychotherapists.
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Child Abuse↗
Neuroscience and legal determination of criminal responsibility.
Neuroscience is increasingly identifying associations between biology and violence that appear to offer courts evidence relevant to criminal responsibility. In addition, in a policy era of 'zero tolerance of risk', evidence of biological abnormality in some of those who are violent, or biological markers of violence, may be seized on as a possible basis for preventive detention in the interest of public safety. However, there is a mismatch between questions that the courts and society wish answered and those that neuroscience is capable of answering. This poses a risk to the proper exercise of justice and to civil liberties.
Antisocial Personality Disorder↗
'Intravenous sedation: the risk to the dentist'.
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Anxiety↗
An ethnomethodological analysis of the use of seclusion.
The use of seclusion in psychiatric practice is a contentious issue. This paper reports on an ethnomethodological approach to understanding the decision-making process in the use of seclusion. Through first-level and second-level reasoning analysis, three themes emerged which underscored the subjects' rationalization process. These were: (a) mechanistic searching, (b) frame conflict, and (c) asylum status. This research suggests that the decision to use seclusion is based on a complex interplay of cultural and organizational factors rather than due to the presentation of symptoms by the patient.
Attitude of Health Personnel↗
'We have to put up with it--don't we?' The experience of being the registered nurse on duty, managing a violent incident involving an elderly patient: a phenomenological study.
The incidence of violence directed towards nurses is well known. However, despite guidelines and training aimed at preventing or minimizing these incidents, recent reports indicate an increase in their occurrence. This phenomenological study investigated the experiences of five registered nurses who had to manage a violent incident involving an elderly patient. The purpose of this was to discover what these nurses 'know' about the structure of such an experience and, through the use of Colaizzi's method of data analysis, present this knowledge in the form of an exhaustive description of the experience. Taped interviews were used to collect the data. The analytical process revealed that the experience is structured around five themes: professional competence, nursing identity, powerlessness and oppression, loss (neglected and deserted) and strategies for survival. The discussion analyses these themes and the relationships between them, highlighting the issues of nurse autonomy and exercising accountability. The implications for nursing practice, education and research include recognition of nurses as a professional group to enable autonomous practice, the ways in which nurses' perceptions of nursing knowledge may affect their educative role and the need to extend this study further to provide answers to the questions raised therein.
Dangerous Behavior↗
New perspectives on vulnerability using emic and etic approaches.
New perspectives on vulnerability using emic and etic approaches The concept of vulnerability has not been developed theoretically from a nursing perspective. It has been viewed epidemiologically as population-based relative risk with little consideration of its experiential qualities. The purpose of this paper is to analyse critically the use of the term vulnerability using elements of concept clarification and a critical literature review. A new perspective of vulnerability is offered based on differentiating between the concepts of risk and experience. Risk consists of assumptions from etic or external evaluation of relative danger while lived experience informs an emic or personal interpretation. Assumptions related to the etic view include normative social values, objective harm and endangerment, and social sanction for intervention. An emic view of vulnerability is based on experiential perception of challenge to personal integrity and the universal and mutual nature of the phenomenon. Questions about the evaluation of harm, potential for growth, subjectivity and objectivity, social sanction and capacity for action, can help clarify the range between these two dimensions.
Anthropology, Cultural↗
A dirty business: caring for people who are a nuisance or a danger.
This paper argues that developments in chemical, administrative and legal methods of control, once confined to the asylum, now operate over mental patients in the community. Differences between the hospital and the community have thus been eroded. This paper therefore seeks to understand how mid-twentieth century sociology, that informed an understanding of the asylum prior to its demise, can be usefully revisited to inform an understanding of the contemporary practice of community mental health nursing. It is argued that in their development, community mental health nurses (CMHNs) have endeavoured to associate themselves with the clean work of caring, rather than with the dirty work of coercive control. However, CMHNs now find themselves representing societal and psychiatric demands for the greater control of mental patients in the community to their clients. Issues of control and care (coercion and persuasion) in community mental health care nursing practice are thus considered in relation to theory regarding the imposition of power.
Coercion↗
Horizontal violence: experiences of Registered Nurses in their first year of practice.
BACKGROUND: Interpersonal conflict among nurses (traditionally called 'horizontal violence' or 'bullying') is a significant issue confronting the nursing profession. However, there is a dearth of research focusing on horizontal violence experienced by new graduate nurses. AIMS: In order to assess the priority for preventive intervention programmes, the aims of this study were to determine the prevalence of horizontal violence experienced by nurses in their first year of practice; to describe the characteristics of the most distressing incidents experienced; to determine the consequences, and measure the psychological impact, of such events; and to determine the adequacy of training received to manage horizontal violence. METHOD: An anonymous survey was mailed to nurses in New Zealand who had registered in the year prior to November 2000 (n = 1169) and 551 completed questionnaires were returned (response rate 47%). Information was requested on the type and frequency of interpersonal conflict; a description of the most distressing event experienced; the consequences of the behaviour; and training to manage such events. The Impact of Event Scale was used to measure the level of distress experienced. RESULTS: Many new graduates experienced horizontal violence across all clinical settings. Absenteeism from work, the high number of respondents who considered leaving nursing, and scores on the Impact of Event Scale all indicated the serious impact of interpersonal conflict. Nearly half of the events described were not reported, only 12% of those who described a distressing incident received formal debriefing, and the majority of respondents had no training to manage the behaviour. CONCLUSIONS: First year of practice is an important confidence-building phase for nurses and yet many new graduates are exposed to horizontal violence, which may negatively impact on this process. The findings underscore a priority for the development of effective prevention programmes. Adequate reporting mechanisms and supportive services should also be readily available for those exposed to the behaviour.
Adult↗
Unwillingness to be violated: carers' experiences of caring for a person acting in a disturbing manner. An interview study.
Carers working in psychiatric care are sometimes exposed to insane, unpredictable and violent actions. In rare cases a patient appears to be resistant to all forms of pharmacological treatment. Fifteen carers (four registered nurses, 11 enrolled nurses) on a psychiatric ward in Sweden were interviewed about their experiences when caring for a person who acted in a disturbing manner. Narrative interviews were conducted and interpreted using a method inspired by Ricoeur. Four themes were formulated which describe the carers' uncertainty about the future, their inability to interpret the patient's disturbing behaviour and their own overall feeling of meaninglessness. The carers were of the opinion that the patient had the power and ruled the ward, which led to them feeling they were subjugated victims. The interviews also revealed the carers' recognition of forbidden feelings and actions and unknown negative sides. These results were interpreted and reflected on in the light of an ethical framework in order to achieve a deeper understanding of the text. This paper shows that an ethical perspective is important when searching for the meaning of caring for patients acting in a disturbing manner. The study raises the question: 'Is it possible to establish good when evil has dominion?'.
Attitude of Health Personnel↗
Nursing staff perceptions of the behaviour of older nursing home residents and decision making on restraint use: a qualitative and interpretative study.
This study examined staff perceptions of the behaviour of older nursing home residents and how these perceptions govern their decision making on restraint use. Data were collected in unstructured interviews with 20 trained and untrained nursing staff from two Swiss nursing homes. Data analysis was based on Colaizzi's phenomenological method. Two main themes were extracted from the data: (i) situations in which behaviour is perceived in terms of a problem that needs to be controlled and consequently leads to restraint use; and (ii) situations in which behaviour is perceived in terms of something one has to learn to live with and consequently leads to avoidance of restraint. Staff members' choices to perceive resident's behaviour from the angle they did were clearly associated with the rights and responsibilities of both nursing staff and older people. It is concluded that the primary source of change towards the avoidance of restraint use does not necessarily lie in external factors, but in staff members themselves.
Adult↗
Prevalence of criminal offending by men and women with intellectual disability and the characteristics of offenders: implications for research and service development.
The investigation of the relationship between criminal offending and the presence of an intellectual disability (ID) is problematic for two main reasons. First, because of problems associated with the definition of 'ID' and secondly, because much criminal offending goes undetected or unreported, and studies can only investigate those already involved with the criminal justice process. Studies using IQ as a continuous variable indicate that significantly below-average intellectual ability is an independent predictor of future offending. Whilst people with ID may be over-represented in parts of the criminal justice system, given the intellectual and other psychosocial disadvantages which they experience, the level of offending behaviour in this particularly vulnerable group is strikingly low. The present authors propose that two broad groups of people can be identified. The first, broader, group is one of people for whom social disadvantage and mental ill health (particularly substance abuse), coupled with a significant intellectual impairment, are the main characteristics. Secondly, there is a smaller group of people, usually already known to ID services as service users, but for whom the process whereby what might have been conceptualized as 'challenging behaviour' becomes 'offending' is far from clear. The distinction the present authors make between challenging behaviour and offending is important for understanding how 'difficult' behaviour becomes identified as 'antisocial/criminal behaviour'. They argue that research needs to move from prevalence and descriptive studies to investigating the processes which determine movement in and out the criminal justice system. The present political emphasis on public protection and proposals for significantly broader mental health legislation raise the danger of a re-expansion of institutional models of care, rather than the development of multi-agency support networks. The present paper underscores a note of caution, particularly where choices have to be made between expanding institutional models on the one hand and providing more integrated services on the other. Over and above policy decisions, these are social and political choices.
Comorbidity↗
Research and literature on sex offenders with intellectual and developmental disabilities.
The present paper sets out to review the literature on several aspects of sex offenders with intellectual and developmental disabilities, including the relationship between sex offending and developmental disabilities, the prevalence and characteristics of sex offenders in this client group, assessment, treatment, and outcome of intervention. Several important variables were identified as influencing the disparate results found in different prevalence studies. These include variations in inclusion criteria, differences in the source of the sample, differences in determination of IQ, the impact of deinstitutionalization, and the effect of changing social and penal policies in the area where studies have been conducted. Although some studies have suggested an increasing incidence, there is no clear evidence for the over- or under-representation of people with developmental disabilities amongst sex offenders. One of the main methodological flaws in several reports listing the characteristics of sex offenders is that considerations are based on clinical samples. Therefore, there is no control group to show that these characteristics do not exist in other samples of individuals with intellectual disability (ID). It does appear that sex offenders with ID are more likely to commit offences across categories and to be less discriminating in their victims. There may also be an association with sexual abuse in childhood. The primary issue considered has been assessment of competency, in that people with ID are considered to be disadvantaged by the criminal justice process. While several authors have delineated the important areas for assessment, there are few assessment measures with robust psychometric properties. Pharmacological, behavioural, educational and cognitive treatments are reviewed. Several comprehensive treatments which include all of the aforementioned methods are also considered. Although most studies do not report particularly positive outcomes, several authors have found better outcomes with treatment lasting at least 2 years.
Cross-Sectional Studies↗