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Managing violence and aggression - a student perspective


Nursing Times student blogger Jonathan Lyons on coping with violent confrontations and aggression at work.

Violence and aggression have become an occupational hazard for not only nursing staff, but medical staff, health care assistants, porters, allied health professionals and students.

Being confronted by violence from patients and their family members is completely unacceptable, but often tolerated, particularly in acute environments such as A&E units where there is a high likelihood of caring for someone under the influence of either drugs, alcohol or both.

There are local and national initiatives involving nursing staff and police forces aim to reduce violence and aggression towards health care professionals, but how do we cope as individuals when faced with violence and or aggression?

During my continuing care placement in second year I was eager to attend a case conference scheduled to determine guardianship of a patient. The nursing staff knew there was a division within the family and that it could become quite heated. My perseverance was rewarded and, with the consent of both sides of the family and the social work department, I was invited to sit in during the conference.

When all parties had arrived it became clear we were short of seats in the room, I offered to get more and brought some from the dining area within the unit. There were two men and a woman on one side of the family and two men and two women on the other. With everyone seated the case conference began.

As the meeting progressed I realised it would not be the heated discussion I had been warned of. There were a few disagreements, but both sides appeared calm and in control. I hadn’t really known what to expect as this had been a new learning experience for me, however, I was pleased it was not living up to the hype it had received.

The case conference lasted an hour and the social work department sought to obtain guardianship. It appeared both sides of the patient’s family agreed with the decision.

I was returning the chairs I had borrowed back to the dining area as the meeting broke up. A man from one side of the family offered assistance, which I was grateful for. En route to the dining room I caught up with the other side of the family who were entering the dining area, they appeared slightly nervous, which I didn’t think much of at the time. They asked me to fetch their relative from her room, so I placed the chairs back where I had taken them from and left to bring the patient to the dining room to see her family.

As I was explaining to the patient that her family wanted to say hello, I heard screaming coming from the direction of the dining area. I apologised to the patient, explaining that I had to investigate and I would come back for her as soon as I could.

In the dining area, I could not believe what was happening. The man who had offered to help me return the chairs was on the ground being attacked by the two nervous looking men from the other side of the family, then out of nowhere the other man arrived to help the apparent victim. It was absolute chaos. All I could think was: “This is a hospital.”

I knew this could not continue and I was concerned for the older gentleman being assaulted. I made my way to the shouting. I was concerned for my own safety but more so for the safety of the victim. As more staff had arrived, I felt confident enough in my ability that I could defuse the conflict. In the end, raising my voice and separating everyone involved was enough to end the fight.

An ambulance and a number of police officers arrived at the scene shortly afterwards. The main victim was treated by the ambulance crew while the police officers took statements from everyone involved in the situation, which resulted in two arrests. But I was left shocked.

During my placement in A&E I expected to be exposed to violence and aggression, but not in a Primary Care hospital looking after patients requiring either community care assessment or long term care. On reflection I am aware that my previous experiences as a special constable with my local police force had helped me defuse that situation in a quick and effective manner. I can’t help be concerned that had I not had those experiences or had that been another student how would I or they have coped?

There is no real advice on how to deal with these situations when they arise. Perhaps our training should include a module focused on managing violence and aggression. As student nurses we are taught and do our upmost to ensure patient safety, perhaps we should also be taught how to ensure our own.


Readers' comments (3)

  • In my career i have witnessed numerous aggressive incidents.I have also witnessed hundreds more potential incidents defused by the use of skilled communication (skills equally valid in compassionate care).I feel that two issues make the difference to effective violence prevention
    1 The ridiculous "hyping" by staff which lead to anxiety in themselves which leaks out in interaction,promoting mistrust and raising the potential for violence
    2 The failure by Trusts to act consistently by pursuing charges against individuals who act aggressively. Although "zero tolerance" signage is widely displayed,Trusts universally fail to act in congruence with this policy by pressing charges.
    I attended the latest version of my own Trust's conflict resolution training last year,and found it depressingly pointless , as it failed to address the behaviour and attitudes of staff and organisations which actively promote mistrust and division.
    I have also witnessed frequently witnessed the use of two phrases which are gauranteed to inflame any person who is already frustrated ."Calm Down""You are being aggressive" are both commonly used and provoke people.Whereas "could we discuss this problem in a less public place" and similar attitudes at least acknowledge that people have a legitimate right to strong emotion,to express it ,and have their dignity respected.

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  • Sadly this is so true. I have for thirty years worked in Mental health.In that time I have actively researched violence and aggression. and have for the past 15 years taught prevention and management of aggression courses. However the higher managers have always resisted the time taken to train people (my course was a week with a refresher every year) so when the SMS brought in their 2 day course they jumped at it. When talking to the course participants they have all said that the the initial course made them think about their own attitudes and behavior and that their confidence in dealing appropriately with violence and aggression was greatly enhanced.
    15 tears ago many staff talked about being unprepared and unsupported when dealing with violence and aggression there were murmurings from government that they would address it. Alas I see no change.

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  • As someone who has a lifetime of training in Martial Arts and an ex soldier, I perhaps have a slightly different perspective when it comes to dealing with violence and aggression.

    I think that the current 'deescalation' and 'breakaway technique' (please!!!) courses are nothing more than a joke, designed to relieve trusts of legal responsibility in the event of an actual incident. The level of training and upkeep simply isn't anywhere near enough for these skills to be effective and in the majority of course the crap that is spouted is unbelievable anyway. (I have literally sat amazed at some of the things these courses teach! And not in a good way!)

    And yes, as a Nurse we can recognise the difference between those who have no control over their behaviour or who are simply expressing strong emotion, and those who attack or abuse staff.

    No, I think the biggest problem is the complete lack of action and support from trusts. 'Zero tolerance' should mean exactly that. If a Nurse is attacked, abused or whatever, then that person should be ejected straight away, dealt with severely by the police, and refused any treatment again in the trust. Many people act violently toward staff safe in the knowledge that they can get away with their behaviour.

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