Transcript Folienmaster_FBG_e

Expertise in Clinical Aggression:
Knowledge Transfer, from Research to Best Practice
Prof. Sabine Hahn, PhD, MNSc, CNS
BERN
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Content
- Definition
- What we know
- Prevalence,
- Influencing factors.
- Best practice transfer: SAVEinH
- Professional organisations,
- Health professionals,
- Education,
- Research,
- Politics.
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Definition
Patient and visitor violence/aggression is any verbal, nonverbal, or physical behaviour that is threatening to others
or to property, or physical behaviour that actually does
harm to others or to property (Morrison, 1990).
- Violent/aggressive behaviour is exhibited in different
forms (McKenna, 2004)
• Verbal violence
• Threats
• Physical assault
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BACKGROUND: WATH WE KNOW
Violence & Aggression (V&A) in the Health Sector
 25% of all workplace violence
 Mental health care and emergency settings
 Nursing profession
 Patient and visitor
 Underestimated
General Hospitals, elderly care, community setting
 No comprehensive description
 Existing results are conflicting
 No specific prevention and intervention strategies
 No best practice
(Chapell & Di Martino 2006, Fernandes et al. 1999, Hahn et al. 2008, Hahn et al. 2012, Hegeny et al. 2010, Wells &
Bowers, 2002, Winstaley & Whittington 2004)
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PREVALENCE AND CONSEQUENCES IN THE
GENERAL HOSPITAL SETTING
Prevalence of violence &
aggression
%
Consequences of violence &
aggression
In the past 12 months1
51
In the past 12 months1
Verbal
Physical
Threats
46
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Emotionally upsetting
90
Physical
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In the week prior to data
collection1
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Verbal
Physical
Threats
67
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multiple responses possible
(Hahn et al. 2012a, 2012b)
%
Participants: 2495 health care staff, nursing staff, medical
doctors, physical therapists, occupational therapists, nutritionists,
medical assistants, radiology assistants
ward secretaries etc. (response = 52%)
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INTERACTION
Staff
• Profession
• Gender
• Age
• Experience
• Attitude and perception
• Closeness of patient and
visitor contact
• Consequences
• Training in aggression
management
• ...
Workplace/Organisational Context
• Architectural work environment
• Organisational work environment
• Regulations
• Information strategies
• ....
Interaction
Violence - Aggression
Interaction
• Intervention or treatment
• Information management
• ....
Patient/Visitor
• Gender
• Age
• Health condition:
Physical illness,
Mental state
• Emotional condition
• Knowledge
(situational)
• …
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INFLUENCE OR RISK FACTORS
IN GENERAL HOSPITALS
Workplace/ Organisational context
 Geriatric wards, intensive care units, recovery rooms, anesthesia,
intermediate care, step-down units, emergency rooms, outpatient units
 Processes of long waiting times, multiple examinations and tests,
institutional bans or coercion
 Low personnel level
 No official position or formal process in the sense of a verbal or written
report after PVV (no standards)
 Confusing and disturbing environment
Interaction




Close patient contact
Painful examinations or tests
Not at the same eye level
Counselling
(Hahn et al. 2009; Hahn &
Metzenthin, 2010; Afzali et al.
2010; Hahn et al. 2012a, 2012b,
2013)
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INFLUENCE OR RISK FACTORS
RESULTS: EXAMPLE 1 - INTENSIVE
CARE
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INFLUENCE OR RISK FACTORS IN
GENERAL HOSPITALS
Higher risk
Lower risk
Profession
Medical doctors
Professional level
Students
Attitude
Aggression is emotionally letting off
steam
Preventive measures against
violence is important
Age
Younger staff up to age 30
Patients’ age
Over 65 years
Visitor contact
Husbands, wives,
partners, siblings
Training in aggression
management
Yes (only 16% have a
training in aggression
management)
(Participants: 2495 health care staff,
in Hahn et al. 2012b)
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INFLUENCE OR RISK FACTORS IN
GENERAL HOSPITALS
Patient
Characteristics
Health
cognitive impairment, pain, substance intoxication, withdrawal, mental or
behavioural disorders, disorders of the blood and immune system
Emotions
frustration, dissatisfaction, anxiety and stress
Orientation
deficits in comprehending the situation, low level of information provided
Age
over 65 years (geriatric wards for patients between 71 and 80 years,
surgery for patients between 18 and 24 years)
Gender
results inconsistent
Visitor
Characteristics
Emotions
anxious, having excessive demands, insecure in the situation,
dissatisfied with therapy
Orientation
low level of information
(Hahn et al. 2012a, 2012b)
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INTERACTIONS AND INTERVENTION
 Strategies are numerous, imaginative and individually effective.
 Suggestions for solutions are, however, not always realised
(problem of interdisciplinary communication).
 In very critical situations, many people are involved; this fact often
increases the aggression potential of the patients, thus preventing
a purposeful de-escalation strategy.
 Coercive measures
"Well, I did not feel good, somehow, it made me, somehow, if I may say so,
”pissed off“. In such a situation, one has much to do, and then been so long
at the emergency, with the patient so out of control that one has to resort to a
syringe injection. So, I was not in any way satisfied"(I2.1.2.).
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(Hahn et al. 2009)
THERE IS NO WORLD WITHOUT AGGRESSION
OR VIOLENCE….
- It is important how health care staff
control their own aggression and how
they react to the aggression of
patients/visitors/relatives.
- It is a challenge to find constructive
solutions for a better interaction in
aggressive situations.
To improve best practice in the prevention and management of
patient and visitor violence, we need attention to this problem in
general hospitals, nursing homes and community care.
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BEST PRACTICE SAVEinH
A global Strategies Addressing ViolencE in
Hospitals
Advance notice
Prevention
Early warning signs
Safe environment
Information strategy
Escalation
Intervention
De-escalation
Medication
Crisis
Recovery
Intervention
Protection of self and others
Security service
Self-defense techniques
Maybe
Depression
Reflexion
Aftercare for workers, patients,
relatives of patients
Documentation
Group reflexion
Interdisciplinary support and
collaboration
Concept of advanced
interdisciplinary training
Security Service
Aftercare and support
Controlling
Normal
behaviour
Clear Attitude & Definition
Quality measures and Quality
development programmes
SAVEinH
Guideline & Standards
Clear and suitable
public information
Technical and structural means
and conditions
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BEST PRACTICE EDUCATION AND TRAINING




Theoretical input
Verbalisation of experiences of clinical aggression
Repetition and reflection of communication skills
Training with professional actors with special
education in principals of communication, especially
in feedback techniques.
 2-6 students per training session: 1 is the nurse and
others are observers.
 Video observation and structured reflection
 Students alternate their roles; nurse or observer.
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BEST PRACTICE EDUCATION AND TRAINING
WITH SP’s
 BETTER AGGRESSION MANAGEMENT WITH “PATIENTS”
 SP’s offer the best way to simulate realistic realistic interactions.
 Experiences can be directly transferred to the work setting.
 A more realistic method in contrast to role playing.
 Provides possibilities to reflect on the communication and deescalation competences in a safe setting.
 Increased level of learning due to experiencing own emotions
combined with the training situation.
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BEST PRACTICE SAVEinH
Strategies Addressing ViolencE in Hospitals
Professional organisations, Education, Research and
Politics:
 Advice and support for Hospitals, nursing homes and community
care how to address patient/visitor/relative aggression & violence.
 Providing adequate education and further education for all health
care staff and improving staff resilience.
 Providing information and information strategies for politics,
security law, community and professionals.
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THERE IS NO WORLD WITHOUT AGGRESSION
OR VIOLENCE….
Staff experience less patient and
visitor violence
- If hospitals have a clear organisational
attitude and take patient and visitor
violence seriously
- If staff feels safe
In a climate of reduced financial resources and efforts for patient
safety, it is significant for clinical aggression now to be carefully
explored and addressed (Gallant-Roman 2008, Hahn 2012).
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THANK YOU FOR YOUR ATTENTION
For more information, please contact
Sabine Hahn, [email protected]
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