Sandhya gupta
Senior Faculty
Title: A Question of preventative care in Psychiatric ward: Initial Therapeutic Alliance between nurse and incidence of violent behaviour among psychiatric inpatients
Biography
Biography: Sandhya gupta
Abstract
A study to find out the possibility of prevention of aggressive acting out behavior of patients admitted in Acute Psychiatric unit and correlate it with the initial therapeutic alliance with health care team members was conducted in a tertiary care teaching hospital at New Delhi. Hundred patients consecutively admitted to the psychiatric ward during six months, were assessed by two tools; Helping alliance questionnaire (HAQ-II) for quality of initial therapeutic alliance and Overt Aggression Scale (OAS) to record the violent incidents. Twenty six patients exhibited violence during their first week of hospital stay. In all 38 violent incidents were reported during 700 patient days and the rate of violent incidents was 5.3%. The mean therapeutic alliance score of patients who were violent (65.42 ± 24.10; n=26) was significantly lower than that of patients who were non-violent (82.88 ± 16.71; n=74) during hospital stay. The low quality of initial therapeutic alliance, and high risk of acting out violent behaviour of patients during the first week of hospitalization was found. The model resulting from the binary logistic regression revealed that the therapeutic alliance (OR=0.961, p=0.006) and preadmission violence (OR=10.8, p=0.001) were predictors of violent behaviour even when other variables were controlled. The findings stress the importance of a good therapeutic alliance which is a modifiable factor to prevent violent behaviour of the patient admitted in a psychiatric inpatient unit. Conclusion: If health care team members take utmost care to develop therapeutic alliance in the initial period itself the acting out behavior of patients can be prevented.