Objective To identify, synthesize and structure the defining characteristics of overstimulation.Methods The literature search was conducted in relevant international databases (Pubmed, Medline, CINAHL, Psyndex, PsycArticles, PsychINFO). The literature analysis was conducted according to Mayring's method of qualitative content analysis.Results Despite the scanty data available on symptoms or effects of sensory overload, twelve literature-sources were identified, describing signs and symptoms of sensory overload. A cluster of psychopathological and behavioral characteristics of sensory overload was developed.Conclusions Further research is needed to obtain an evidence-based description of the defining characteristics of sensory overload.

In the context of mental disorders sensory overload is a widely described phenomenon used in conjunction with psychiatric interventions such as removal from stimuli. However, the theoretical foundation of sensory overload as addressed in the literature can be described as insufficient and fragmentary. To date, the concept of sensory overload has not yet been sufficiently specified or analyzed. The aim of the study was to analyze the concept of sensory overload in mental health care. A literature search was undertaken using specific electronic databases, specific journals and websites, hand searches, specific library catalogues, and electronic publishing databases. Walker and Avant's method of concept analysis was used to analyze the sources included in the analysis. All aspects of the method of Walker and Avant were covered in this concept analysis. The conceptual understanding has become more focused, the defining attributes, influencing factors and consequences are described and empirical referents identified. The concept analysis is a first step in the development of a middle-range descriptive theory of sensory overload based on social scientific and stress-theoretical approaches. This specification may serve as a fundament for further research, for the development of a nursing diagnosis or for guidelines.

Discharge from psychiatric inpatient care is frequently described as chaotic, stressful, and emotionally charged. Following discharge, service users are vulnerable to becoming overwhelmed by the challenges involved in readapting to their home environments, which could result in serious problems and lead to readmission. The short transitional intervention in psychiatry (STeP) is a bridging intervention that includes pre- and post-discharge sections. It aims to prepare patients for specific situations in the period immediately following discharge from a psychiatric hospital. We conducted a quasi-experimental pilot study to determine the feasibility of the intervention, and gain insight into the effects of the STeP. Two inpatient wards at a Swiss psychiatric hospital participated in the study, and represented the intervention and control arms. Patient recruitment and baseline assessment were performed 2 weeks prior to discharge. Follow-up data were collected 1 week subsequent to discharge. Questionnaires measured coping, admission and health-care usage, self-efficacy, working alliance, experience of transition, and the number of difficulties experienced following discharge. Fourteen and 15 patients completed the follow-up assessment in the control and intervention groups, respectively. The STeP did not affect primary or secondary outcomes; however, it was shown to be feasible, and patients' feedback highlighted the importance of post-discharge contact sessions. Further research is required to improve understanding of the discharge experience, identify relevant patient outcomes, and assess the effectiveness of the intervention in an adequately-powered randomized, controlled trial.

Ziel der Studie Identifizierung, Synthese und Strukturierung der definierenden Merkmale von Reizüberflutung. Methode Die Literatursuche wurde in den relevanten internationalen Datenbanken (Pubmed, Medline, CINAHL, Psyndex, PsycArticles, PsychINFO) durchgeführt. Die Literaturanalyse wurde in Anlehnung an die qualitative Inhaltsanalyse nach Mayring durchgeführt. Ergebnisse Trotz dürftiger Datenlage konnten 12 Quellen identifiziert werden, welche Zeichen und Symptome von Reizüberflutung beschreiben. Ein Cluster an psychopathologischen und verhaltensbezogenen Merkmalen von Reizüberflutung konnte entwickelt werden. Schlussfolgerungen Weitere Forschung zum Thema ist für eine auf Evidenz basierte Darstellung der definierenden Merkmale von Reizüberflutung notwendig.

Background: Within the scope of the research project on the subjects of sensory overload and stimulus regulation, a theoretical framework model of the nursing care of patients with sensory overload in psychiatry was developed. In a second step, this theoretical model should now be theoretically compressed and, if necessary, modified. Aim: Empirical verification as well as modification, enhancement and theoretical densification of the framework model of nursing care of patients with sensory overload in psychiatry. Method: Analysis of 8 expert interviews by summarizing and structuring content analysis methods based on Meuser and Nagel (2009) as well as Mayring (2010). Results: The developed framework model (Scheydt et al., 2016b) could be empirically verified, theoretically densificated and extended by one category (perception modulation). Thus, four categories of nursing care of patients with sensory overload can be described in inpatient psychiatry: removal from stimuli, modulation of environmental factors, perceptual modulation as well as help somebody to help him- or herself / coping support. Conclusions: Based on the methodological approach, a relatively well-saturated, credible conceptualization of a theoretical model for the description of the nursing care of patients with sensory overload in stationary psychiatry could be worked out. In further steps, these measures have to be further developed, implemented and evaluated regarding to their efficacy.

Background: The concept of “removal from stimuli” has already been examined by a Delphi-Study. However, some knowledge gaps remained open, which have now been further investigated. Aim: Examination of the concept “management of sensory overload in inpatient psychiatry” including its sub-concepts and specific measures. Method: Analysis of qualitative data about “removal from stimuli” by content analysis according to Mayring. Results: A theoretical description and definition of the concept could be achieved. In addition, sub-concepts (removal from stimuli, modulation of environmental factors, help somebody to help him-/herself) could be identified, theoretical defined and complemented by possible specific measures. Conclusions: The conceptual descriptions provide a further step to raise awareness of professionals in the subject area. Furthermore, we created a theoretical basis for further empirical studies.

Objective: The aim of the study was to narrow down the topic area and to generate a heuristic understanding of "Reizabschirmung" (removal from stimuli) in the German-speaking countries based on clinical expertise. Methods: The Delphi-Method of consensus building within an expert panel was selected. Results: The consensus found on some aspects lead to a reduction of the scope of the topic and a first approximation towards a conceptual definition of "Reizabschirmung" was generated. Conclusions: The perception of "Reizabschirmung" in the German-speaking countries is presented. However, further research is needed for precise concept clarification and elaboration.

Les personnes incarcérées présentent plus de problèmes de santé mentale que la population générale. L’environnement carcéral en soi peut provoquer des troubles mentaux et un haut niveau de stress mais, pour beaucoup de détenus, les troubles mentaux étaient préexistants à l’incarcération. Actuellement, les soins dispensés dans les prisons sont au centre d’enjeux sociopolitiques importants, ils représentent une opportunité d’améliorer la santé mentale des personnes incarcérées. Le but de cette étude est de constater la santé mentale des personnes incarcérées ainsi que leur perception du stress et d’explorer les relations entre leur santé mentale, leur perception du stress et leurs caractéristiques sociodémographiques. Cette étude descriptive exploratoire a inclus 40 personnes incarcérées en détention avant jugement dans une prison préventive de Suisse selon une méthode d’échantillonnage non probabiliste par convenance. Les trois instruments utilisés afin de collecter les données sont l’échelle HoNOS-Secure-F, l’échelle du stress perçu et un questionnaire sociodémographique. Les résultats montrent que les domaines obtenant les scores les plus élevés au niveau de la santé mentale concernent les problèmes sociaux et les troubles du comportement. Les détenus présentant la plus mauvaise santé mentale sont incarcérés pour des délits relatifs aux mœurs. Les détenus souffrant d’antécédents psychiatriques présentent plus de problèmes sociaux durant leur détention. Les détenus souffrant de troubles liés à la consommation de substances ainsi que de troubles cognitifs ont la fréquence la plus élevée d’incarcérations. Dans cette étude, la santé mentale est associée de manière statistiquement significative avec le stress perçu. Les résultats de cette étude, discutés d’après le modèle conceptuel pour la promotion de la santé mentale et la prévention des troubles mentaux permettent de constater que les personnes incarcérées présentent un cumul de facteurs de risque pour la santé mentale, alors que les facteurs protecteurs de la santé mentale sont peu présents en milieu carcéral.

The aim of the study was to narrow down the topic area and to generate a heuristic understanding of "Reizabschirmung" (removal from stimuli) in the German-speaking countries based on clinical expertise.The Delphi-Method of consensus building within an expert panel was selected.The consensus found on some aspects lead to a reduction of the scope of the topic and a first approximation towards a conceptual definition of "Reizabschirmung" was generated.The perception of "Reizabschirmung" in the German-speaking countries is presented. However, further research is needed for precise concept clarification and elaboration.

Der Begriff „Reizabschirmung“ wird in der deutschsprachigen psychiatrischen Fachliteratur nicht einheitlich verwendet. Um das Begriffsverständnis zu homogenisieren, untersuchten die Autoren im Rahmen einer Literaturübersicht, was unter Reizabschirmung verstanden wird. Zudem stellen sie dar, welche Interventionen zur Reizabschirmung von Pflegenden und Betroffenen angewendet werden können.

AIMS AND OBJECTIVESTo identify groups of caregivers in terms of their use of measures for dealing with resident aggression and the differences between these groups related to their characteristics.BACKGROUNDCaregivers in nursing home are confronted with a major challenge when faced with the aggressive behaviour of residents. Therefore, the application of recommended measures is important in supporting caregivers and promoting safety for residents.DESIGNCross-sectional survey.METHODSA total of 804 caregivers working in 21 Swiss nursing homes provided data. The questionnaire used was based on published recommendations regarding management of aggressive behaviour and amendments by experts.RESULTSThe most widely used measure aimed to calm down the resident and to understand the meaning of aggressive behaviour. Physical activities were applied by around 50% of the respondents, and interdisciplinary case reviews as well as standardised instruments for assessment and documentation were used by <50%. Caregiver characteristics such as employment level, support from superiors, institutionalised support for affected caregivers and training in aggression management are associated with their use of recommended measures. Furthermore, caregivers' competence in empathising with the residents' perspective in connection with their professional experience has a positive influence on applying recommended measures.CONCLUSIONCaregivers use multifaceted measures in understanding the meaning of underlying aggression, but there is a certain failure to use standardised instruments. Caregivers differ significantly in the frequency of their application of recommended measures. Support from superiors and assistance for affected caregivers positively influence their use of measures, whereas training in aggression management leads to less use.RELEVANCE TO CLINICAL PRACTICEFindings show the importance of support from superiors and institutionalised assistance for affected caregivers. Caregiver competence in empathising with the residents' perspective is important in using person-centred approaches in the care of residents with aggressive behaviour.

The successful application of the Nursing Interventions Classification (NIC) in inpatient psychiatry depends on whether the classification adequately describes nursing care in this setting. The present study aimed to identify nursing interventions mentioned in journal articles on psychiatric inpatient nursing care and to compare these with the labels, definitions and activities described in the NIC to elucidate how well the classification covers these interventions. The MedLine, PsychInfo, Cochrane and CINAHL databases were searched for journal articles about nursing care in the adult inpatient setting. A qualitative content analysis approach was used to indentify nursing interventions in the articles. About 84% of the statements (terms and definitions) are encompassed by the interventions listed by the NIC. Very few interventions need to be added to the NIC classification or necessitate a reorganization of the taxonomy. Nevertheless, the further development of the NIC will promote its use in the daily work of psychiatric nurses and enhance the quality of nursing care in the inpatient setting.

Die vorliegende deskriptiv-explorative Querschnittstudie, an der 814 Pflegende (51.8 %) aus 21 Schweizer Alters- und Pflegeheimen teilnahmen, gibt einen Einblick in die Erfahrungen und den Umgang mit aggressivem Verhalten der Bewohner(innen). Zudem wurde die Belastung aggressiven Verhaltens auf die Pflegenden und die Auswirkungen auf die Beziehung zwischen Pflegenden und Bewohner(inne)n erfasst. Die Befragung wurde mithilfe eines validierten Fragebogens durchgeführt. Rund 38 % der Pflegenden haben in den letzten sieben Arbeitstagen vor der Datenerhebung Aggressionsereignisse erlebt. In den meisten Fällen ging die Aggression von Bewohner(inne)n aus, die an Demenz und/oder Depression litten und trat während einer pflegerischen Tätigkeit mit Körperkontakt auf. Als Auslöser vermuteten die Teilnehmenden in erster Linie das «Nichtverstehen» und die «Überforderung» der Bewohner(innen). Ein «beruhigendes Gespräch» und «Distanz einnehmen» wurde am häufigsten eingesetzt, um die Situation zu beruhigen. Rund 40 % der Teilnehmenden empfinden körperliche Angriffe als belastend und etwa 23 % haben Angst, vor allem, wenn aggressives Verhalten ohne Vorwarnung auftritt. Rund 4 % der Pflegenden vermeiden anschließend häufig oder immer den Kontakt zu den betreffenden Bewohner(inne)n und 12.3 % erleben eine Störung in der Beziehung. Es ist zu vermuten, dass die Pflegenden die Emotionen der Bewohner(innen), die dem aggressiven Verhalten zugrunde liegen, in der akuten Phase der Eskalation unzureichend erfassen sowie mögliche Frühwarnzeichen beginnender Aggression spät oder nicht erkennen.

The present exploratory descriptive cross-sectional study with the participation of 814 (51.8%) caregivers in 21 Swiss nursing homes provides insight into caregivers' experiences and handling of residents' aggressive behaviour. Moreover, caregiver burden with regard to resident aggression and the consequences on the caregiver-resident-relationship were investigated. The survey was carried out by means of validated questionnaire. Approximately 38% of participants experienced aggressive incidents during the last seven days prior to data collection. In most cases aggressive behaviour was caused by residents suffering from dementia and/or depression and occurred during nursing interventions involving physical contact. As a trigger for aggressive behaviour participants predominately assumed "non-understanding and excessive demand" of residents. Reassuring conversation and keeping oneself at a distance were most often used to calm the situation. Approximately 40% of participants experienced physical attacks as especially distressing and circa 23% were frightened, particularly when aggressive behaviour occurred without warning. Approximately 4 % of caregivers avoided contact with residents after an aggressive incident and 12.3 % perceived a disturbed relationship. It can be assumed that caregivers do not adequately perceive emotions possibly underlying aggressive behaviour in the escalation phase and therefore may not identify early signs of beginning aggression.

Aim. This study focuses on the experience of healthcare staff with regard to patient and visitor violence in a general hospital. The occurrence of patient and visitor violence, staffs interventions and the consequences of violence for different professions are investigated.Background. There is a lack of studies describing the factors influencing the occurrence of patient and visitor violence, intervention strategies and consequences. Existing studies often focus on nurses experiences and single interactive factors between staff and patients/visitors involved.Design. A cross-sectional survey.Method. The survey was conducted in 2007 including 2495 staff working on different wards in a Swiss university general hospital. The questionnaire used was the Survey of Violence Experienced by Staff German Version-Revised.Findings. Half of the staff experienced patient and visitor violence in the past 12 months and 11% in the past week. The age of the staff and the length of experience in their present workplace influenced the exposure to patient and visitor violence. Violence occurred mainly when staff carried out tasks involving close personal contact. Only 16% of the staff was trained in aggression management. The feeling of confidence in managing patient and visitor violence depended significantly on the organizational attitude towards violence. The principal interventions used were calming and informative discussion.Conclusion. To prevent patient and visitor violence and improve management strategies, training which focuses on communication skills, which is specific to the professional context and which emphasizes patient centeredness, need to be designed and implemented. A strong organizational commitment is imperative to reduce violence.

The aim of this study is to explore the association between the patient-nurse working alliance and the degree of how much substance use control is perceived as burdensome in an addiction therapy setting. Imogene King's theory and the working alliance concept were used as the theoretical framework. The investigation was undertaken using a self-administered questionnaire with the short-form of the working alliance inventory (WAI) translated and validated in French and targeting a convenience sample (n=28). In this sample the working alliance was evaluated by 12 questions on a Likert-Scale and perceived as generally good (x = 61.68, max = 84). A significant negative linear relation was found between the perception of the drug-controls as burdensome, evaluated by an additional question on a visual analogue scale (VAS), and the establishment of a working alliance (r = -0.67, p-value > 0.001). Furthermore, the form of admission is important as involuntarily hospitalized patients (n = 7) (t, p-value = 0.018) form poorer working alliances, and perceive the controls as more burdensome (Z, p-value = 0.004) as opposed to voluntarily hospitalized patients (n = 21). Even though these results cannot be generalized because of the small sample (n = 28), they raise important questions for nursing practice, especially for involuntarily hospitalized patients. These patients seem to be more susceptible to any disturbance of the relationship and possible consequences need to be taken into account. In addition, drug-control might have to be reassessed. The findings also raise questions about the use of camera supervision as an alternative to nursing supervision and about the need for the primary nurses to refrain from control interventions.

Purpose: Caregivers in nursing homes often experience aggressive behavior of residents. The aim of this study was to explore the caregivers experiences with aggressive behavior from residents and to identify environmental factors as well as caregiver and resident characteristics related to aggressive behavior in Swiss nursing homes. Design: A retrospective cross-sectional survey was conducted between November 2010 and April 2011 with a sample of caregivers working in various nursing homes in the German-speaking part of Switzerland. In total, 814 caregivers (response rate 51.8%) of 21 nursing homes participated in the study. Methods: Data were collected using the German version of the Survey of Violence Experienced by Staff (SOVES-G-R). Standard descriptive statistics were used to describe and summarize the date. To identify risk factors related to the experience of aggression by residents, multilevel logistic regression analysis was applied. Findings: The prevalence of participants reporting an aggressive incident during the 12-month period prior to data collection was 81.6%. Of these, 76.5% had experienced verbal aggression, 27.6% threats, and 54.0% physical aggression. The predictive variables in the multiple regression model for physical aggression were: staff education level (odds ratio [OR]= 1.82), gender (OR = 1.82), age (< 30 years vs. 3045 years: OR = 1.46; < 30 years vs. > 45 years: OR = 2.13), and confidence in managing physical aggression (OR = 1.49). The predictive variables for threatening behavior were staff education level (registered nurses vs. non-registered nurses: OR = 1.70; nonstudent vs. student: OR = 1.89) and age (< 30 years vs. 3045 years: OR = 2.00; < 30 years vs. > 45 years: OR = 2.04). Conclusions: Caregivers in nursing homes are at high risk for experiencing aggressive behavior. The identified risk factors are in line with earlier investigations, but some contradictory results also were observed. Clinical Relevance: The high risk for registered nurses exposed to aggressive behavior and the increased risk for caregivers who feel confident in managing aggressive behavior cast a critical light on the content and aim on present programs for management of aggressive behavior. Caregivers in nursing homes should be qualified in understanding resident aggression in a comprehensive way. A critical point in this topic seems to be the interaction between caregiver and resident during basic care activities. This topic should be investigated in further research projects.