19 th Alzheimer Europe C onference 28-30 May 2009, Brussels

1. 19th Alzheimer EuropeConference28-30 May 2009, Brussels The violent behaviour of patients as an Ethical Problem Hannele Laaksonen D. Sc., RN Principal Lecturer University of Applied SciencesHealth Care and Social Services Finland

2. Background of the study • Violent behaviour has increased in psychiatric health care (Needham, ym. 2005; Farrell, ym. 2007; Bonner, ym. 2007; Duffin 2007; Josefsson, ym. 2007) • Patients’ violent behaviour towards each other has been examined little, if at all • Finland was the first in Europe to pass an Act (17.8.1992/785) where it is stated that patients have the right to receive good and quality treatment • In the case of dementia patients, it is very important to safeguard their physical integrity

3. Purposes of the study • to increase knowledge of the incidence of violence in dementia care, especially mentally and physically violent behaviour between patients • to start a dialogue about how to prevent violent behaviour

4. Research problem • Whatkind of violentbehaviourhasbeenreportedamongpatients and nurses at onepsychiatric dementia careunit in Finland between 2005 and 2007? • Researchmethod and data collection: • Quantitativelongitudinalstudy • Documentevaluation • Violentbehaviourdocumentsfrom 2005-2007 (N=145) • Materialanalysed in autumn 2008

5. Lehtiharju Hospital • a publichospitalwhichservesseveralmunicipalities in Ostrobothnia on the westcoast of Finland • threeunits: psychogeriatricunit, social rehabilitationunit, and daycareunit • Thisstudywascarried out in the psychogeriatricunit, whichhas 18 beds • Patients’ diagnoses: • About 60% have dementia • About 40% haveschizophrenia • Otherdiagnoses (withabovementioned) aremental and distressdisturbances • Unit’sdegree of use is 99-120% • Unitdivided into twomodules: a smallerone for dementia patients and a largerone for the rest

6. Number of cases of violent behaviour and the targets of behaviour %

7. The classification of cases of violentbehaviour Classification of violent behaviour in 2005

8. Cases of Violent behaviour 2005-2007 (in months) f

9. Number of cases according to time of day

10. Whatkind of situationslead to violentbehaviour? (patient-patient)

11. Placeswhereviolentbehaviouroccurs (n=145) • Dining room/lounge 25% • Own rooms 24% • Corridors 16% • Toilet 9% • Office 2% • Unnamed places 24%

12. Cases of violentbehaviour(n= 94, patient-patient) 2005 – 2006 • Shouting, threatening, abusivelanguage 75% • Beating (fistfight) 78% • fists to the face, arms, back, orchest • Gripping , squeezing • Pushing • Twistinghands • Threatening for examplewithchair • 2007 • Gripping, squeezing (33%) • Hitting (33%) • Pushing (14%) • Strangulation (5%) • Tearing (5%) • Distortion (5%)

13. Consequences of violent behaviour

14. Management of violent situations • Nurses intervene 53% • The situation calms down on its own 39% • Patient moved by nurses 5% • On one occasion, a patient bound with belt • Victim left

15. Discussion • The main aims are to decrease violent behaviour and to prevent incidents from happening in the future Patient perspective: • Single rooms are recommended • Unit divided into smaller modules • No one in extra beds • Timing of meals: for example, small groups eat together and/or some patients eat in their own rooms • Nurses should be present as much as possible

16. …continued… Environmentalperspective : • Development of rooms, diningrooms, corridors, livingrooms and otherplaces inside the unit (alsofurniture) • Enoughspace to walkaround the unit: in rooms, corridors and livingrooms Careperspective: • Enoughnurses to care for patients • Moreeducation of staffabouthow to manageviolentsituations • Makeproceduresabouthow to act in differentviolentsituations • It is alwaysnecessary to organizediscussionmeetingsafter a violentsituation: howweacted and howweshould act in the future • Workcoaching • Morenurses on evening and nightshifts

17. Thank you!