PDF(Pubmed)
Abstract：
Transgressive incidents directed at staff by forensic patients occur frequently, leading to detrimental psychological and physical harm, underscoring urgency of preventive measures. These incidents, emerging within therapeutic relationships, involve complex interactions between patient and staff behavior. This study aims to identify clusters of transgressive incidents based on incident characteristics such as impact, severity, (presumed) cause, type of aggression, and consequences, using latent class analysis (LCA). Additionally, variations in incident clusters based on staff, patient, and context characteristics were investigated. A total of 1,184 transgressive incidents, reported by staff and targeted at staff by patients between 2018-2022, were extracted from a digital incident reporting system at Fivoor, a Dutch forensic psychiatric healthcare organisation. Latent Class Analysis revealed six incident classes: 1) verbal aggression with low impact; 2) verbal aggression with medium impact; 3) physical aggression with medium impact; 4) verbal menacing/aggression with medium impact; 5) physical aggression with high impact; and 6) verbal and physical menacing/aggression with high impact. Significant differences in age and gender of both staff and patients, staff function, and patient diagnoses were observed among these classes. Incidents with higher impact were more prevalent in high security clinics, while lower-impact incidents were more common in clinics for patients with intellectual disabilities. Despite limitations like missing information, tailored prevention approaches are needed due to varying types of transgressive incidents across patients, staff, and units.
摘要：
法医患者针对工作人员的越轨行为经常发生，导致有害的心理和身体伤害，强调预防措施的紧迫性。这些事件,在治疗关系中出现，涉及患者和员工行为之间的复杂互动。本研究旨在根据事件特征，如影响，严重程度,（推定）原因，类型的侵略，和后果，使用潜在类分析(LCA)。此外,基于员工的事件集群的变化，病人,并对背景特征进行了调查。共发生1184起侵犯事件,由工作人员报告，并在2018-2022年间由患者针对工作人员，是从Fivoor的数字事件报告系统中提取的，荷兰法医精神病保健组织.潜在类别分析揭示了六个事件类别：1）低冲击力的言语攻击；2）中等冲击力的言语攻击；3）中等冲击力的身体攻击；4）中等冲击力的言语威胁/攻击；5）具有高冲击力的身体攻击；6）具有高冲击力的言语和身体威胁/攻击。工作人员和患者的年龄和性别存在显着差异，工作人员职能，在这些类别中观察到患者诊断。影响较大的事件在高安全诊所更为普遍，而影响较低的事件在智障患者的诊所中更为常见。尽管有诸如信息缺失之类的限制，由于患者之间不同类型的侵犯事件，需要量身定制的预防方法，工作人员,和单位。
