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EDITOR’S COMMENT

'Take a stand against violent behaviour in A&E'

  • 41 Comments

Posters telling people not to be aggressive towards staff are commonplace in many organisations - the post office, train stations and yes, even hospitals.

It seems shocking that the one place where staff are under enormous stress - life and death type stress - and struggling to look after people that they should be subjected to spitting, swearing and physical assault. That was a view echoed by Simon Burns, the health minister who came to support the launch of the proposed redesign of A&Edepartments to reduce violence towards patients and staff at the Design Council last week.

The project involved frontline NHS staff in three pilot trusts, design experts, psychologists and behaviourists to understand the problem and try to fix it.

It did what many staff can’t do - look at the environment from the perspective of an anxious relative, or patients who are confused or intoxicated, or just frustrated by waiting.

The project has been applauded for its simplicity in redefining signage and making the wait more tolerable for patients by providing more information about when they’ll be seen, but it has also built in a greater degree of support for staff witnessing such events.

The nurses from the University Hospital Southampton Foundation Trust pilot said they had become accustomed to “low-level aggression”, and didn’t really see it as a problem. But by recognising it, challenging it and changing it, they had made A&E a safer place.

Nurses are typically resilient and stoical, dismissing bad behaviour as part of their job. But this project shows shrugging off the problem is not the best solution. Nurses have the knowledge to make a difference, now they need the confidence to say enough is enough.

  • 41 Comments

Readers' comments (41)

  • One of my relatives went to A and E recently. He was assessed by a triage nurse and waited a while for treatment. He said at no point was he told what would happen next. Being a reasonably bright person he coped with this lack of information but wondered why the nurses who spoke to him couldn't have given just a little more information. Signage etc does not replace interaction with and reassurance from staff.

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  • michael stone

    Anonymous | 22-Nov-2011 2:13 pm

    'He said at no point was he told what would happen next.'

    That is an extremely common complaint, from the public. This 'not talking properly to people' happens all over the place, and is the root cause of many of the problems, confusions and confrontations which happen everwhere in both life and healthcare'. By coincidence, I just sent an e-mail to my local PALS office which included the following:

    Nick Clark's widow was talking about his death 5 years ago, on R4's PM yesterday just before 6 pm. Now, amongst her points were these 2:

    1) I'm not really sure if we both wanted to be told if Nick was going to get better, or to die - but we didn't actually ask, and nobody told us - until 2 days before his death, I was told, and I don't think Nick ever was told.

    2) Because we were not told earlier, we did not have a chance to 'say goodbye to each other properly'.

    His widow, who said 1) was a common experience amongst the bereaved spouses she had subseqently talked to, also pointed out that 'other people who saw Nick a few weeks before his death, could see he was dying - but I'm not sure that I could see that'. She now suspects, but can't be sure, that Nick also knew he was dying by then, but never actually said that to her.

    The problem here, is that I think clinicians don't like to admit that people are dying, until very near to death, because it sometimes upsets people, leads to arguments, lack of hope, etc. Which is one reason why 1) happens.

    But AFTER A DEATH, WHEN YOU ARE BEREAVED, what 'plays on your mind, FOREVER' is 2) - nobody told us, SO WE COULDN'T PREPARE FOR THE DEATH PROPERLY'.

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  • I do absolutely agree with this new plan to redesign a lot of A&E departments and creating an environment that is helpful to patients and relatives, but I think it is only part of the solution. It must also be coupled with an absolute adherence to the zero tolerance policy, I have worked in places where the policy was for all intent and purpose ignored by staff and it was horrendous. There is NEVER an excuse for violence or abuse toward staff, it really is as simple as that. WE are trying our best to help, but THEY have to play their part too.

    Yes improvements can be made to the departments etc, and perhaps we can communicate more, but the public need to realise what a highly stressful and hectic envioronment the department is for staff too. Dealing with unrealistic expectations, violence and abuse, stressful life and death decisions, and all with far too few staff and too many patients, is it any wonder that some things do not work perfectly? The public need to realise that too.

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  • michael stone | 23-Nov-2011 11:03 am

    If only it were that simple. The 'public' do not consist of 'like-minded' people who all want the same things from clinicians. Probably difficult for you to understand, but there are often reasons why people don't ask questions. People often know instinctively and don't need someone spelling it out to them. Some people genuinely don't want to know. I saw a doctor receive a punch in the face after imparting the reality of a patient's condition. His crime? According to the patient, it was because the doctor had taken away his hope. It isn't about clinicians not admitting that people are dying. It is nowhere near as simple as that. As for the radio interview quoted, that is only one side of the story. Without knowing the full circumstances of all the interactions, it is just too easy and unfair to blame the clinicians, who have no right of reply.

    Meanwhile back to the actual article, I agree that a re-design of A&E to protect staff and patients can't be a bad thing. However, it must be coupled with nurses ceasing to tolerate incidents and, most importantly, severe consequences for those who perpetrate these crimes.

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  • michael stone

    Anonymous | 23-Nov-2011 5:41 pm

    I have also sent, having heard this chap yesterday, the following to my 'e-mail discussion partners' today:

    'Apparently PM has had ‘hundreds’ of e-mails, and it will be mentioning them on Friday – I think it said about 5-45pm.

    Yesterday, they had a retired consultant on ‘for the other side’s view’. He said that the conversations ‘need approaching gradually’, because people cannot ‘take in’ a really bad diagnosis ‘in one go’. But it did seem, that ‘trying to delay the discussion’ was the reality, of the behaviour he was describing.

    This chap apparently had a pain in his leg as a teenager, which the NHS sorted out – it was a spinal tumour. But he kept asking ‘what’s wrong with me’ and nobody would ever tell him – they all told him to stop asking. It was years later, when he was a medical student, that he came across someone who had treated him, and finally got the answer !

    I also think the fact that NHS care tends to be ‘conveyor belt’ and ‘episodic’ if you are a clinician, but must necessarily be seen in ‘holistic’ terms if you are a patient or relative, is a factor.

    I think paramedics, if they resuscitated father, would NOT then see the rest of father’s life, be it short in hospital, or longer (and perhaps ‘distressed’).

    If doctors and nurses annoy you, I think PALS tends to get in the way of what you actually want to do: you probably don’t want to tell PALS your problem, so they can get answers to what they think the problem was – you want the clinicians who you think did something wrong to be placed face-to-face with you, so that you can then say ‘Why did you do …. ?’

    And if you have a bad experience, and end up with ‘bereavement services’, again, I’d guess you are not talking to the people who you think caused the distress you think was unnecessary, but instead to someone else.

    How is the EoLC Strategy, dealing with this ‘you lot see only ‘your individual bits of my experience, but I saw IT ALL’ aspect ?'


    As for my original piece, about what Nick Clark's widow said, the reply from 'someone who should know' was:

    'This is an absolutely central element of the End of Life Care Strategy.
    Evidence suggests that no-one wants to start the conversation for fear of
    the other's emotions, but whoever does start it the other is glad and it
    tends to be productive and positive. This applies to both public and professionals. Dying Matters is doing GP training which finds the same thing. GPs are reluctant at first but when they have the confidence to
    discuss end of life issues with patients both benefit.'

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  • michael stone

    mike | 23-Nov-2011 11:25 am

    Andy Hamilton recently said 'when someone says 'we have a zero tolerance policy', I translate that to 'we are ludicrously over-sensitive'.

    He then went on to describe airport staff taking away a tube of his toothpaste, returning 5 minutes later with a very mangled tube of toothpaste, and placing it back in front of him. So he said 'If you like it that much, you can keep it'. Some other member of staff came over, and said 'We have a zero tolerance polciy to abuse'.

    Andy said 'That wasn't abuse - that was a complaint. If you would like me to, I can demonstrate abuse for you'.

    The problem, is that violent drunks are definitely a problem - yes, obviously. But 'getting wound up, because we have been waiting forever, and nobody is telling us what is going on' is not resolvable by a 'zero tolerance policy' (that approach leads to escalation, there), but calls for better communication with the people who are 'getting annoyed'.

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  • michael stone

    Anonymous | 23-Nov-2011 5:41 pm

    This is difficult for me to 'understand' - the points you made, seem obvious to me.

    I have experience, when my 'peacefully comatose and terminal' mother died at home, of a paramedic claiming that 'her death was sudden, because I was called' DESPITE my pointing out that the GP had told me to tell any cover GP, that the death was expected.

    I also have problems with the Police, and that paramedic, who apparently think that after you have agreed to phone a GP when someone dies at home, you should automatically phone someone immediately - logically, absurd (almost everyone will phone someone immediately, for most home deaths - but perhaps not when it is 40 minutes before surgery hours, and you ahve spent 4 days watching a comatose relative 'finishing dying': you might check the person has died, as I did, under those circumstances).

    I also don't understand this. When at home, EoLC patients can talk to their relatives, before talking to anyone else - why do so many 'professionals' think things which are not recorded, apaprently cannot ahve happened ? madness !

    But I digress - yes, I DO understand the potential problems of honestly telling patients their prognoses. But I'm not sure that all clinicians, understand the problems caused by NOT doing that !

    You need to analyses these things from ALL perspectives, to make progress.

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  • michael stone | 24-Nov-2011 2:58 pm

    Isn't this about the redesign of A&E? Once again, yet another debate about Eolc!!!!
    For every single story (lifted from the media!) you recount in the demonstration of a point, we could tell a hundred demonstrating many other views and realities. No. You don't understand the realities of a clinician's work. Simple as that. After all, aren't you the one who constantly makes the bizarre claim that nurses can't properly understand what it is to be a patient, because of their job?!

    You need to analyses these things from ALL perspectives, to make progress.

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  • My hospital claims zero tolerance , but no notices are displayed. We do have a lot to answer for as nurses- we need to inform patients regarding care and delays, we need to restict the number of people accompanying the patient into the area (A & E), where there are spectators it insites people to be abusive and aggressive. Yes we have a red card policy,which uesd to work , but it was changed without consultation with staff, persons who now are responsible for initiating the card have not be trained or are not available and who has time to make a call when a colleague is being atttacked. Guess what I was acosted when leaving one night and chased to my car- security, not interested, and nothing could be done because i failed in my fright to say to the man- excuse whats your name and address. Incident form was completed.

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  • I read some statistics in the BMJ the other day. It was something like over 50,000 attacks on NHS staff last year ad not much over 100 prosecutions. So there we have it, no deterrent to the yobs who want to give us a punch.

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  • michael stone

    Anonymous | 25-Nov-2011 10:28 pm

    I did say 'but I digress'.

    And I do indeed claim that nurses cannot understand the experience of being a patient, without their understanding being influenced by the fact they are also a nurse - it must be true, logically. HOW INFLUENCED is a legitimate question - but I do not believe the answer is 'not at all'.

    I also agree that there are too many attacks on hospital staff, and that some patients are unreasonably confrontational, and that it is not I who am being attacked in A&E, so I have no experience of that.

    But I have a problem when complaint becomes confused with confrontation - just not helpful !

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  • It's all very well and good having a zero tolerance policy but we do need to be careful not to overlook the fact that many medical conditions as well as symptoms such as chronic pain, can lead people to act in aggressive or violent ways.

    Michael is quite correct when he says that one of the problems is that complaint becomes confused with confrontation. I would actually go further than that and say very often a simple question, such as how long a wait will be is often confused with confrontation.

    There is absolutely nothing wrong with Michael talking about end of life care in this context either, as he was talking about poor communication which as we know is a large pre disposing factor to aggression and vilolence.

    I suspect he would've been able to make the point if he was a nurse and the lowest the low: a member of the public

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  • michael stone

    Geeze | 29-Nov-2011 1:09 pm

    Thank you Geeze, I was digressing a bit into EoLC but as you pointed out, it si connected to bad communication and my persoanl experience of the problems that can cause were during EoLC.

    I am heartened that some nurses, do understand that treating a complaint as de facto 'aggressive' can cause confrontations - but, I fully accept that a violent drunk, is de facto a problem !

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  • Another debate down the toilet.

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  • As an A&E nurse, I feel obliged to point out that the highly qualified and experienced staff in many A&Es are very well aware of the reasons, medical and otherwise, for challenging behaviour AND how to deal with it. Interesting that this discussion has been hijacked by a couple who obviously know little of the reality of this behaviour, or how to deal with it appropriately. The so-called Zero Tolerance policy is (as ANYONE who actually works in A&E knows) a joke. Suggesting that the levels of violence and aggression faced by A&E staff on a DAILY basis are in large part due to poor communication, is stupid, downright insulting and displays stunning ignorance! Obviously, neither of you are nurses.

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  • Zero tolerance to eolc interrupting every debate about every topic on this website intended primarily for clinical professionals.

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  • Anonymous | 2-Dec-2011 8:09 pm

    Hear Hear!


    Anonymous | 2-Dec-2011 7:01 pm

    At last, someone who agrees that violence against nurses isn't actually our fault or should be tolerated!!

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  • Anonymous | 2-Dec-2011 9:47 pm

    problem is that it falls on deaf ears despite the comments of quite a few readers following other articles. Such behaviour disappointingly just kills all discussions between professionals.

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  • Half of those who pitch up in A&E are NOT emergencies and could be better managed by dealing with problems sooner (themselves) and/or by attending their GP. They are often the ones who clog up the system in the first place. Then they get aggressive with the staff because they have to wait, whilst staff are dealing with genuine emergencies. So lets stop kidding ourselves that this is down to the staff. I have absolutely no problem with a zero tolerance policy. The trouble is management never implement it or support their staff.

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  • Anonymous | 3-Dec-2011 4:36 pm

    are there clear guidelines for the general public to help them make the decision whether they need to attend A&E or there GP? I get the impression that this is not the case so the blame should not lie with them. I would imagine that GPs work office hours only and on an appointment system. If an individual is worried, anxious or feels it would be harmful to wait for appointments offered or they are unable to be attended to for other reasons then they will go to A&E. If they need attention out of hours then presumably A&E is the only alternative.

    Zero tolerance is not a means of helping a patient find a solution to their problems and helps nobody. It is merely a concept which has originated in 'clever' America and from general management theory which normally everybody in the NHS and patients associated with it hate so much. It can exacerbate the situation which may have otherwise been alleviated by good problem solving skills, by showing tolerance and understanding and by offering adequate care and attention. Causes or anger and aggression among sick or injured individuals and those in their entourage are well documented and do not need to repeated here where space is limited.

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  • Anonymous | 3-Dec-2011 4:51 pm

    Utter rubbish!!
    There is plenty of research which proves very clearly that many patients refer themselves inappropriately to A&E DURING GP surgery hours as well as at other times! The reasons vary from "It's nearer to where I live" to the fact that they simply don't like their GP. Nothing to do with your portrayal of "sick or injured individuals" Most GP surgeries and Health Centres issue very clear advice about how to manage minor ailments, and guess what? There are NHS out of hours services:
    •GPs working in NHS walk-in centres or minor injuries units (MIUs).
    •Teams of healthcare professionals working in primary care centres, MIUs or NHS walk-in centres.
    •Healthcare professionals (other than doctors) making home visits, following a detailed clinical assessment.
    •Ambulance services moving patients to places where they can be seen by a doctor or nurse, to reduce the need for home visits.
    Alternatively, you can call NHS Direct on 0845 4647 (24 hours a day, seven days a week) for medical advice. Telephone consultations and triage (an assessment of how urgent your medical problem is) are an important part of all out-of-hours care.
    Didn't you know that?! Or is it just easier to turn up at A&E, because you can't be bothered applying a little common sense and taking some personal responsibilty for your health?

    As said by Anonymous | 2-Dec-2011 7:01 pm:
    'Suggesting that the levels of violence and aggression faced by A&E staff on a DAILY basis are in large part due to poor communication, is stupid, downright insulting and displays stunning ignorance!'


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  • Anonymous | 3-Dec-2011 10:46 pm

    From Anonymous | 3-Dec-2011 4:51 pm

    No I am sorry I did not know which is why I asked the question. The organisation of access to medical services is different in the country I live in.

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  • michael stone

    Anonymous | 3-Dec-2011 4:51 pm

    No, there is not clear guidance about when to go to A&E, and when to go elsewhere/delay seeking a clinical opinion. In any event, which position are clinicians adopting - are patients supposed to be capable of diagnosing their own illnesses, or does such diagnosis require expert emdical training !?

    My own PCT has currently got a leaflet out, a 'Don't go to A&E if ...' plea. But while it tells people to not go to A&E if they have a stomach ache, I must point out that the chap being illustrated is almost doubled-over: I think that if a stomach pain is bad enough to leave you doubled-up, you probably should seek a rapid medical opinion as to its cause !

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  • a colleague of mine who had recently had a baby presented with acute abdo. pain and 40 fever and A&E but was sent home. She was hospitalised the next day and was dead within 48 hours.

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  • Anonymous | 4-Dec-2011 12:49 pm

    Poor baby and poor family. However, without the complete story from BOTH sides, my assumption is that the A&E staff are being held responsible for this.

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  • This seems to have moved from the unacceptable face of violence and aggressive behaviour towards A&E staff, to somehow excusing it because, somehow, the public are not to be challenged on taking responsibility for their own health and behaviour! Nonsense!

    The fact remains that it IS unacceptable and should NOT be tolerated. As stated previously, A&E staff are well used to aggression due to medical conditions, distress, etc., and how to deal with it appropriately, so let's cut out the patronising PC attitude of those without a clue. Those patients are not the issue.

    My trust is one of the few who have actually taken the Zero Tolerance approach seriously. We have successfully prosecuted 98% of those who have perpetrated criminal acts (yes folks, that's what they are) against staff. We have the stats on the walls of our A&E. With the rapid decline in this type of behaviour and dramatic improvement in the environment for both patients and staff, it blows right out of the water, those moronic theories that nurses are at fault. Robust measures which are enforced properly, protect all who use A&E (even the idiots who use it inappropriately). Plain and simple!

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  • Anonymous | 4-Dec-2011 3:25 pm

    it was attributed to inexperience of a junior medical officer in A&E and a heavy workload. Our colleague was seriously ill and it may have been too late to offer much hope to her and her family but there seems little excuse for sending someone home late in the evening with acute abdominal pain and such a high fever and who had only very recently given birth without properly examining them, which was the case.

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  • Anonymous | 4-Dec-2011 3:48 pm

    the programme you describe seems to be successful and laudable but it might be far more effective if there was a national scheme with rules, regs, laws, etc. so that everybody knows exactly where they stand and for the protection of those trying to do their their job which isn't at first had coping with violent individuals.

    It should also be made far clearer the uses of A&E and under what circumstances people should attend and what alternative arrangements are available 24/24 7/7 so in an emergency or in moments of panic the public know how best to get the attention they need.

    Unfortunately the UK always seem to rely on patching up what is no longer working and piecemeal solutions instead of concrete national plans which everybody understands and can more easily adhere to. It seems this would also lead to more cost effective, efficient, targeted and higher quality services which are also easier for the staff to manage and be remunerated for accordingly.


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  • Anonymous | 4-Dec-2011 4:36 pm

    "it was attributed to inexperience of a junior medical officer in A&E and a heavy workload."

    If that is the case, then surely that is all the more reason for the public to use A&E appropriately? Don't over-burden services and the staff who work within them. Then the risk of such tragic incidents would be drastically reduced.

    Anonymous | 4-Dec-2011 5:57 pm

    The NHS zero tolerance policy IS national. However, many trusts do not value their staff enough to enforce it. The laws governing assault, etc. are also national. It is a crime to assault another person, and it is in these terms that we should be discussing violence against staff. Instead of this insufferable attitude that the punch in the face you received, from the nasty individual who thought that he/she would get away with it, because they are a patient, and it's part of your job to take that. Without the commitment from NHS trusts to deal with these problems, nursing staff are left exposed to very real threats and actual danger. It isn't that they can't; it's that they won't do anything about it. As far as I'm concerned, that in itself, is criminal.

    With regard to
    "It should also be made far clearer the uses of A&E and under what circumstances people should attend and what alternative arrangements are available 24/24 7/7 so in an emergency or in moments of panic the public know how best to get the attention they need."

    No one, least of all A&E staff want people not to attend if they genuinely think that their problem constitutes an emergency. Even if it isn't. The problem lies in those who attend when they KNOW it isn't an emergency, but have some other reason for by-passing a more appropriate service. How else should the other services be advertised? If you phone your GP out of hours, you are either given the out of hours service number or transferrred straight through. THe NHS Direct number is on walls all over hospitals, health facilities, street billboards, newspapers, online and TV. Most people have the number of their GP, Dentist, garage, hairdresser, etc. somewhere obvious. Surely, it is not too much to expect that they can also record out of hours arrangements and numbers in their area. I don't accept that there is not enough information available. There is and the public should take responsibilty for finding it out.


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  • Anonymous | 4-Dec-2011 7:29 pm

    Anonymous | 4-Dec-2011 4:36 pm

    "it was attributed to inexperience of a junior medical officer in A&E and a heavy workload."

    "If that is the case, then surely that is all the more reason for the public to use A&E appropriately? Don't over-burden services and the staff who work within them. Then the risk of such tragic incidents would be drastically reduced."

    quite correct but what is being done about it to change the attitudes of the public if, as you point out, all the information is readily available to them.

    It must be an attitude problem must it not, and particularly in the UK, where the service is free and easily accessible leading the public to think that there is no need to bother considering or registering the information provided on alternatives? However, I think there must also be plenty of responsible individuals who do not willfully abuse the system.

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  • Anonymous | 4-Dec-2011 7:54 pm

    "quite correct but what is being done about it to change the attitudes of the public if, as you point out, all the information is readily available to them."

    What would you suggest? Perhaps the lack of consequences has something to do with it.

    "However, I think there must also be plenty of responsible individuals who do not willfully abuse the system."

    I would agree with you there, but there are enough who do abuse the system for it to be a problem.

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  • michael stone

    Anonymous | 4-Dec-2011 7:29 pm

    While SOME patients knowingly abuse the NHS, it seems to me that you are somewhat 'anti-patient'.

    You commented:

    '"it was attributed to inexperience of a junior medical officer in A&E and a heavy workload."

    If that is the case, then surely that is all the more reason for the public to use A&E appropriately? Don't over-burden services and the staff who work within them. Then the risk of such tragic incidents would be drastically reduced.'

    No, because 'a colleague of mine who had recently had a baby presented with acute abdo. pain and 40 fever and A&E but was sent home. She was hospitalised the next day and was dead within 48 hours.' isn't acceptable, however busy A&E is - after all, you seem to imply 'that it is easy to spot the time-wasters'.

    Don't junior medics these days get told of the dangers of acute post-birth infections during their training? And didn't 'colleague' probably imply that the woman who died, had some clinical knowledge - if so, she would presumably have had a 'reasonable basis for having decided to attend A%E'.

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  • It's interesting that a debate is only ever "hijacked" or going down the toilet when someone says something other people don't like.

    Calm down, act like the professionals you alll claim to be and stop being so threatend by an opposing point of view

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  • Mr Stone you have the comments of two commentators mixed up and have totally missed the point yet again which is the danger of non-professionals interferring in these debates.

    My colleague was not a nurse but was highly valued member of our ward team. What I did not add was that her fever and abdo. pain was not related to the birth of the child but then the young and inexperienced doctor would not have know this without examining her. He was at professional fault for his negligence but it is also a systems error having people left in charge on A&E out of normal working hours without adequate experience to cope with such diverse and serious pathologies and with such a heavy workload. Added to the fact of the long working hours at that time and lack of sleep.

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  • there is so much bad press about hospitals and care that perhaps the fear of putting themselves in such hands is one of the contributing factor of aggression. Attitude of the staff can do much to alleviate this. If a patient feels secure, safe and welcome and knows what will happen to them at every step and who all the people involved in their care are, this must have a positive effect. If they have needs which aren't being met and see staff slouching around and chatting this can raise anger. Fear of diagnosis is also a major factor which can trigger aggression.

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  • michael stone

    Anonymous | 5-Dec-2011 11:36 am

    Mr Stone you have the comments of two commentators mixed up and have totally missed the point yet again which is the danger of non-professionals interferring in these debates.


    I would mix things up less often, if people would either not post as anonymous or, at least, use a nickname below 'anonymous'.

    And as Geeze has pointed out, 'missing the point' seems to be something many posters accuse anyone who puts forward a different perspective of doing.

    Anyway, thank you for for clarification of the earlier post - clarification, in my opinion, is almost always useful.

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  • michael stone

    Although Jenni's headline was divergent, what seems to have prompted her to post this was:

    'The project involved frontline NHS staff in three pilot trusts, design experts, psychologists and behaviourists to understand the problem and try to fix it.

    It did what many staff can’t do - look at the environment from the perspective of an anxious relative, or patients who are confused or intoxicated, or just frustrated by waiting.'

    This is actually, pretty clearly, part of the goverment's 'NUDGE THEORY' approach to persuading people to alter their behaviour, and that initiative is about altering the enviroment of A&Es by fairly simple changes to layout and behaviour of staff, in order to PREVENT confrontations.

    Shouting 'enforce zero tolerance' misses the point completely, as that is a RESONSE TO 'aggression' which has ALREADY OCCURRED (and also involves the possibility of over-reactions to valid complaints).

    GEEZE: it is remarkable how many supposedly expert professionals, are 'threatened by an opposing point of view' - this is true not only of nurses, but also of the consultant-level medics who actually write a lot of high-level guidance. Some react very badly, to proof that the guidance they have published, is flawed (usually legally flawed): although some do respond in a more appropriate, consider-the-arguments, fashion.

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  • michael stone | 5-Dec-2011 2:07 pm

    I think you are guilty of accusing others of that which you are guilty of yourself. Flawed arguments.
    Answer me this. Just how many years have you put in as an A&E nurse? None. So what do you know about working in that environment? Then stop being so short-sighted and cheap as to accuse someone who is obviously sick to the back teeth with the havoc wreaked in A&E by VIOLENCE, as 'anti-patient'. Your comment is uncalled for and ignorant, sir. Did you ever stop to think how frightening it is for other patients and their relatives to have these aggressive individuals sitting next to them in the waiting room; or see a nurse (or other member staff) assaulted in front of their eyes?

    Geeze | 5-Dec-2011 11:36 am

    The same tired, old statements about 'calming down' and 'acting like professionals'. Go buy yourself some new material. Try to have an original thought instead of adopting the position of Michael Stone's nodding flunky. Act like a professional.

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  • michael stone

    Anonymous | 5-Dec-2011 7:32 pm

    I have never claimed to have any experience as a nurse. But from Jenni's post itself:

    'It did what many staff can’t do - look at the environment from the perspective of an anxious relative, or patients who are confused or intoxicated, or just frustrated by waiting.'

    I have no problem with a 'zero tolerance approach' to violent 'patients' in A&E - but I do have a problem with wholly one-sided analyses, and with the extension of 'zero tolerance/we are the experts' to the subtler areas of this type of probelm analysis, which require a genuine multi-perspective methodology.

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  • michael stone | 6-Dec-2011 11:56 am

    "I do have a problem with wholly one-sided analyses"

    Which is exactly what you are peddling!

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  • Not long ago I was hit and punched by a well-built male patient who became aggressive at waiting whilst I was attending to another much-sicker patient. Despite having a zero-tolerance policy my trust took no action against this patient because he then wrote a letter to the manager saying he had had fantastic care (no apology for assaulting me!) and they wanted to use said letter for brownie points on some audit report!

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