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How should we challenge violence and aggression?

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Hospital accident and emergency staff have become resigned to patient violence and aggression. 

This is one of the findings of a recent review, which looked at staff experiences of violence and aggression in emergency departments.

The authors of the review also identified that staff sometimes missed signs of increasing aggression and found it hard to understand why they were being attacked.

The authors noted that “staff made judgements about the reasons for violent incidents which impacted on how they coped and subsequently tolerated the aggressor”.

The knee-jerk reaction when we hear stories about violence is to call for a zero tolerance policy.

This reminded me of the first article in our archive issue, which argues that zero tolerance may not be appropriate in clinical situations, as it can create a barrier to understanding patients’ emotional needs.

The authors argue that “challenging behaviour is an area in which nursing needs to rediscover its professionalism” and they include scenarios to demonstrate how health professionals can respond when challenged with aggressive behaviour.

The scenarios offer an opportunity to reflect on everyday situations and are a great resource for team discussions around this very difficult topic.

Patients can often become frustrated and angry when they feel they are not receiving the care they need. This is a particular issue for those with long-term conditions and disabilities – such as a spinal cord injury (SCI) – who have become experts in their care.

The author of the second article in this archive issues notes that patients with SCI usually have a long period of specialist rehabilitation, during which they develop their own routines to self-manage, for example bowel and bladder care to avoid incontinence.

Admission to hospital to non-specialist wards can be challenging for these patients and the nurses who may lack knowledge of their condition. This article provides an overview of the principles of looking after patients who have had a SCI, and the authors emphasise the importance of listening to and learning from patients’ expertise.

Back in the 1980s, when I started my training, we usually administered oxygen without a prescription or indeed even a plan. Thankfully, we have moved on and we have the knowledge and technology to deliver oxygen in a safer and more systematic way.

”This is a concern for healthcare organisations, who also need to consider the training needs of nursing associates”

However, in 2017 the British Thoracic Society found that still more than four in 10 patients receiving oxygen did not have a prescription, and over half of hospitals did not provide nurses and doctors with adequate training in oxygen administration.

This is a concern for healthcare organisations, who also need to consider the training needs of nursing associates (NAs) following the publication of advisory guidance from Health Education England on NAs’ role in medicines administration and draft Nursing and Midwifery Council proficiency standards – both of which cover medicines via the inhaled route.

With this in mind, the third article in this issue looks at the principle of oxygen administration and emphasises the importance of ongoing assessment and evaluation to ensure therapy is safe and effective. You may also find our update on the process of breathing useful.






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