Aggression & Violence in Nursing
- : West Lakes
A Practical Guide to Staying Safe at WorkOverview
Have you ever felt that your physical safety at work was compromised? Are you worried that your next shift may expose you to unnecessary abuse and intimidation? Perhaps you’re still dealing with the emotional trauma of a previous hostile incident. You are not alone! Nurses across Australia are currently exposed to unacceptably high levels of occupational aggression and violence. This is not only affecting our physical and emotional health but it is impacting our ability to provide patient care. This program complements a range of system-wide changes that are being implemented around the country. You will learn about:
- How to build your own knowledge and skills to keep yourself safe at work
- The subtle, early signs of pending violent behaviour
- Easy ways to de-escalate aggressive behaviour safely
- Break and escape moves
- What to say if you are threatened or abused
- Tips on debriefing after a critical incident
- How to stay safe when workplace violence exists
Need for Program
Recent examples reported in the media indicate that aggression and violence in emergency departments, general hospital wards, mental health units or aged care settings across Australia means that they are not always safe places to work. An occupational violence task force has been established to tackle this ‘high risk’ trend. Nurses need to be able to recognise subtle signs of aggression and violence and be given appropriate communication strategies to de-escalate these potentially dangerous situations. As well, knowledge of how to practically respond to aggression and violence should such incidents occur is essential. This will improve the likelihood of a nurse staying safe at work.Purpose of Program
The purpose of this program is to assist nurses to feel and be more safe at work by discussing and demonstrating practical techniques to prevent, defuse and act when aggression and violent incidents are present.Learning Outcomes
At the conclusion of this program it is expected that the participants will be able to:
8:30am - Registration and Refreshments
9:00amSetting the Scene for Workplace Safety
This introductory session will open the seminar by exploring, from a nursing perspective, the current issue of occupational violence. It will use a realistic case scenario where a nurse's’ safety was compromised. This will generate discussion on the following:
- Abuse, threats, initiation and assault - why do nurses cop it all?
- What are the statistics surrounding occupational violence in healthcare in Australia and has this recently changed?
- Why are nurses concerned about safety at work?
- Is this impacting patient outcomes?
- A look at what may have contributed to and triggered this problem?
- The 'big picture' system issues that impact the current situation
- Personal versus organisational responsibility
- Should a certain degree of workplace violence be reasonably expected?
9:45amRecognising Red Flags - Triggers of Violence
Violent people are highly unpredictable. It can be very difficult to know when they may change from calm and collected to full blown aggressive. However, there are physical changes and subtle behavioral cues that may serve as warning signs. Your ability to closely recognise and interpret these signals are vital if violence is to be prevented. Stopping smaller incidents from ‘blowing up’ is much more favourable than dealing with a critical incident. This session will look at the anatomy of human behaviour to help understand the following:
- Subtle changes in behaviour could be warning signs
- Physical indications that a person may be becoming violent
- Screening for a history of violence and common risk factors
- Other warning signs to be aware of:
- Threatening behaviour
- Intimidating behaviour
- Affect or mood changes
- Environmental changes
- Recognising these behaviours as indicators of ‘stress’ and not necessarily violence
- The importance of interpreting and acting on these behaviours ‘in context’
11:00am - Morning Tea and Coffee
11:30amStages of the Aggression Cycle
Whilst anger is seen as a normal human emotion, as nurses we must be able to use emotional and social intelligence to read the behaviour of others - with ease. Understanding this will position us to respond in the manner that is likely to best keep us safe. Building on from the previous session, we will now look at the stages of the aggression cycle. It will demonstrate practical responses to typical behaviours that occur at each stage, which are the:
- Triggering phase
- Escalation phase
- Crisis phase
- Recovery phase
- Post crisis phase
12:30pmKeep Calm and … Assess and Manage the Crisis!
Despite best attempts to prevent such occurrences, given the current landscape, nurses will inevitably be required to respond to violent crises. You may be the personally involved in an episode or be the first to arrive to help out a co-worker. These events will vary depending on the setting you practice in and your patient/client population. What remains the same though are the crisis management principles. This session will look at what you can do to assess and manage a crisis. Includes:
- Overview of crisis assessment and management principles
- Step-by step techniques for managing physical aggression during a crisis
- Examples of how to respond when staff are assaulted and property is damaged
- Body language, poisoning and stance during a crisis
1:00pmPractical De-escalation Techniques
It is known that during a crisis, asides from body language, what we say, but importantly how we say things is what makes a difference between a violent situation escalating or being defused. This may ultimately be the difference between a nurse being injured or staying safe. This helpful session before lunch will provide you with an opportunity to role play the following verbal communication strategies to defuse violence during a crisis:
1:30pm - Lunch Break and Networking
2:15pmWhat Now? The Post-Crisis Phase
The post-crisis phase is the period following a crisis situation which proceeds a violent or aggressive episode. Although it is likely to be perceived that the initial danger is over, it is still important to understand that during this phase a person may still be at risk of harming you, themselves or others. It is therefore incredibly valuable that nurses are given the knowledge and skills to appropriately act, communicate and respond to further triggers of aggression during this phase. This session will inform you of the following:
- Risk factors for further violence
- What nursing interventions are most important during this phase?
- Behaviours that can indicate a person may be triggering again
- Essential de-escalation communication if a person re-triggers
- The role of post-crisis care plans
3:00pm - Afternoon Tea and Coffee
3:15pmMental Illness and Violence - Stop the Stigma
It is not uncommon for mental illness to be sensationally linked to violence. The perception that the two are always connected has damaging consequences for people living with a mental illness in the community who may already be stigmatised. As such, this final session of day one will open up discussion of the following:
- How do you rationalise that it wasn’t the person that acted violently, but it was ‘the mental illness’?
- The key to providing non-judgmental care
- If a person with a mental illness becomes violent, are there other factors to be aware of?
- Mental Health Act and other legal considerations
- The nursing response to self-harm in the context of mental illness and violence
4:15pm - Close of Day One of ProgramDay Two
9:00am - Commencement of Day Two
9:00amThe Art of Assertive Communication
When working with highly unpredictable and potentially violent people the way we communicate is undoubtable extremely important. The fine balance in not just what we say, but how we say it, may be the difference between you being exposed to aggression or violence or staying safe. This very practical session will give you information about how to communicate assertively and not cross the line and become aggressive. It will be highly interactive and explains:
- How can poor communication contribute to aggression and violence?
- Tips for being to be assertive but not aggressive
- Safe language at work
- Realistic scenarios to practice being assertive but not aggressive
10:00am‘Listen Up’ - How to Deal with Complaints
Acts of aggression from unhappy family members or violent behaviour from an angry patient, may lead to informal or formal complaints. How you respond at this early stage has important ramifications. Yet, in the new era of healthcare where the patient is at the centre of care, how can we respond calmly if we’ve just been abused or threatened? This session arms you with insights into the appropriate management of complaints. Includes:
- First line response - what to say and do initially
- When to offer support and when to offer an apology?
- Reading the signs - when to listen, when to speak
- How to remain calm even under pressure
- What to say if you are threatened or abused
- The role of personal and professional boundaries
- Follow up documentation and other actions required
11:00am - Morning Tea and Coffee
11:30amIllicit Drugs, Alcohol and Violence
The correlation between acts of violence and substance abuse including illicit drugs and alcohol is strong. The nature of drugs such as stimulants like methamphetamines, amphetamines and cocaine can cause high levels of aggression and agitation. Many nurses working in Emergency Department settings will be often required to respond to this concern. If we are not well-informed on how to act the unpredictable nature of these people are likely to leave nurses feeling vulnerable. As such, nurses must confidently be able to recognise and manage the damaging consequence of alcohol and illicit substance abuse. This valuable session will look at:
- Which substances may cause the highest levels of agitation and why?
- An overview of current approaches to managing drug and alcohol induced violence
- How does the management of aggression vary between classes of substances e.g stimulants, hallucinogens
- Treatment options that work - pharmacological and non-pharmacological options
- What if a person is experiencing drug-induced psychosis and becomes violent?
- Managing violence associated with withdrawal from illicit substances
- The use of restraint - what is considered to be a reasonable amount of force and how do we choose the least restrictive practice?
1:00pm - Lunch Break and Networking
1:45pmBreak and Escape Techniques for Nurses
While you would likely feel comfortable in saving someone else’s life, how confident would you be in protecting your own life? Despite being taught the skills to manage the physical emergencies of others, we are not taught basic self-defence skills necessary to keep ourselves safe in an emergency. This session is therefore essential. It will use a range of teaching techniques to demonstrate how any nurse, short or tall, can use their body mechanics to physically protect themselves when under physical duress.
3:30pm - Afternoon Tea and Coffee
3:45pmThe Power of Debrief
Debriefing after critical incidents is vital if you are personally involved or witness a stressful or traumatic event whilst at work. The key to moving on and not letting an event continue to affect you is being able to openly talk about the event without fear of judgement. This final session will discuss what such a debrief entails and when it is effective. As well, it will provide a valuable opportunity to safely come together as a group to debrief. Includes:
- What does a constructive debrief look like?
- How debriefing can prevent critical incidents causing undue stress at work and at home
- When to know that you may need some additional support other than debriefing
- An opportunity to constructively debrief as a group
4:30pm - Close of Seminar and Evaluations
Craig Maloney has an impressive background which includes a Master of Mental Health Nursing and graduate qualifications in Child Adolescent Mental health, Alcohol and other Drugs. Craig has experience working in research, and occupational health and safety and is a well sought after risk Governance and quality systems architect. He has substantial teaching experience in the area of managing workplace aggression and adverse incidents, mental health, nursing root cause analysis and risk management. Craig is a Credentialed Mental Health Nurse; a Fellow of the Australian College of Mental Health Nurses; and, a Member of the Australian Institute of Company Directors. He is the recipient of two national awards for his work in primary health care and mental health and currently works in risk and quality management and is a pioneer in the concept of males working in family violence.