Patience lost with violence
NHS staff are trained to deal with aggression, says Christine Jardine
PEOPLE who decide to pursue a career in the health service are most often motivated by the desire to help o t h e r s . Howe ve r, these admirable sentiments can be quickly undermined by the rising levels of violence in the sector.
Aggression from patients and their families is an issue that everyone who works in the modern health service must face. NHS Greater Glasgow and Clyde has decided to tackle the problem head-on by providing all staff with training.
Figures last year show that between April and June there were 380 reported incidents involving violence and aggression towards staff. About 40% of all incidents involving staff are violent or aggressive.
“Those incidents can vary from someone shouting or screaming violently to actually grabbing hold of you,” said Sheena Gordon, regional coordinator for training in NHS Greater Glasgow and Clyde.
Training to counter that trend does not mean teaching staff about physical self-defence.
“Broadly, the training looks at how to prevent aggression, and where it can’t be prevented it is about managing it,” said Sheena.
“So we are looking at being defensive, calming a situation, and having an exit strategy, if the incident gets to the point where it cannot be controlled.”
The most difficult area for staff to work is often Accident and Emergency at the major hospitals, particularly at the weekend.
“Sometimes when patients or those with them come into accident and emergency they are drunk, or patients with head injuries might not know that they are being violent. We’ve got to care for these patients, but have to be aware of the possibility of violence.
“A lot of the time it is about trying to divert their attention, and dealing with these situations is down to approach. If you try to get somebody to talk about something, it can help.
“With patients with dementia, for example, if you know what they used to do when they were employed you can get them talking about something else and calm them.”
It is about two years since Sheena took over responsibility for training staff in countering violence and aggression, first in Argyle and Clyde and then, after reorganisation, in Greater Glasgow and Clyde.
She had originally worked in health and safety and became interested in dealing with violence and aggression when she realised how many hospitals were having to cope with the problem. When I first started with the authority, training wasn’t provided,” she said. “Nowwe provide training on a variety of levels.”
That view is backed by Ken Fleming, head of health and safety for NHS Greater Glasgow and Clyde, who has overall responsibility for training.
“Ten or 15 years ago it wasn’t something which was regarded as being widely needed.
“Then about five years ago it started to move into the headlines, and we started hearing about people being injured.”
In-house trainers implement the training, but the structure and format is provided by a private company. Many of the authority’s trainers are nursing staff or health and safety advisers, who do the work in addition to their main jobs.
Sheena said: “Although most of the training is about avoid- ing situations, we have five trainers who specialise in teaching disengagement physical skills. By that I mean how to approach patients and how to get away if somebody grabs hold of you.”
Although it is a problem that must often alarm or frighten staff, the attitude which comes across is one of understanding that everyone is working in a situation where emotions are running high and that patients and their families are bound to be tense.
Ken Fleming said that it is only in the psychiatric wards that restraint of patients is necessary, and that the medical staff in those areas do have deescalation training.
Many incidents are, said Sheena, easier to deal with. “We often get families who are worried and stressed, or patients who are trying to leave the ward, perhaps elderly patients who want to go home.”
It is also, of course, not a situation in which one type of training fits all staff. The differ- ences between working in accident and emergency or with elderly patients mean that everyone needs skills particular to their area.
To meet demand, the first stage of all training is to assess exactly which skills the individual member of staff requires. Then they will be provided with the necessary classes.
Increasingly these classes will, according to Sheena, include the use of technology and interactive DVDs. “We are just about to introduce a new form of introduction training. At the moment nursing staff in certain parts of Glasgow get an afternoon, as do some junior doctors.
“But I hope this new e-learning will be more widely available in the summer. Depending on a number of things, staff will then do another one or two days training. We have also recently introduced a half–day course for staff who do not have contact with the public on an ongoing basis.”
In all areas of the health service it is vital that the safety of patients and staff is taken into account, and that applies as much to the violence and aggression training as anything else. Patient safety is always, say trainers, the main focus of everyone’s attention.