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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)

  • 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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