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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 | 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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